Dear colleague,
Pancreatitis is unusual under dasatinib. However, if there are not other contributing causes, I would think that the drug is clearly the trigger of this complication. Since there has been acute pancreatitis, and not just lipase or amylase increase, I would not rechallenge the patient with dasatinib. I would not try Nilotinib either, given the strong association of this drug with pancreatic abnormalities. Ponatinib is not available but if available it would be other TKI to avoid in case of pancreatitis. Therefore, after the resolution of the pancreatitis I would try imatinib. Bosutinib would be my second choice.
Francisco Cervantes
(case repeated here for reader reference)
I have a 52 y.o. male with newly dxed CML. A little over 1 wk. after starting Sprycel 100 mg qday his WBC is dropping nicely, but he has developed abdominal pain with a lipase of approx 7500 and an amylase of nearly 1000. A CT scan of abd/pelvis is c/w acute pancreatitis. There are no prior known risk factors for this complication, though a GI physician is being consulted. I am holding Sprycel pending rcovery from the pancreatitis, but any thoughts regarding rechallenging the pt. with the same dose vs. lowering the dose vs. substituting a different TKI?
Many thanks!