Hi there!
I am now under dasatinib for around 3 months, and yesterday I have started to develop issues of chest pressure and chest pain. The pain is sharp but not strong as I take deep breath, it is felt somewhere close to my heart. However, I am not experiencing shortness of breath.
What should I do? I am definitely finding my doctor, but is there any educated guess? Is it one of those side effects? I just did an ECG and it turned out fine.
Many thanks!
Worried
Josiah
Your symptoms describe pleural effusion (PE).
PE is the top side effect of dasatinib.
https://www.ncbi.nlm.nih.gov/pubmed/28082112
https://www.sciencedirect.com/science/article/pii/S2152265016305687
https://www.webmd.com/lung/pleural-effusion-symptoms-causes-treatments#1
See your doctor to verify you have P.E. developing. Treatment usually consists of stopping dasatinib until the PE clears. Once PE is corrected, you would re-start dasatinib on a reduced dose (20 mg in your case). If PE re-occurs, you may have to change drugs.
However - there is emerging data that CML patients who do experience pleural effusions due to dasatinib also show a dramatic response to the drug treating their CML. If you can stay on dasatinib, you are likely to have a very good CML response especially on the lower dose.
http://www.bloodjournal.org/content/124/21/3142?sso-checked=true
From the paper linked above:
"Conclusion: The incidence of PE on dasatinib treatment is associated with advanced patient age, lymphocyte value at 1 month (especially in the CD56-positive fraction), and achievement of an early molecular response."
So - maybe having PE develop is a good thing ???
The key is PE is manageable and should be watched closely. Don't dismiss your symptoms - see your doctor. An x-ray will confirm. If you can stay on dasatinib - stay on dasatinib, but don't let your doctor keep the same dose you are on now. Insist on a lower dose and see if you continue to respond. You can always change drugs if you don't. I have a suspicion your CML is getting destroyed.
Hi Josiah,
What you describe is something I also experienced when I started taking Sprycel. I had several tests done including a CT scan and an ultrasound, but there was nothing discovered to indicate PE. The chest pressure seemed to go away after around 5 months. I've been told by two doctors that if the pressure is directly below the sternum it is possibly a gastrointestinal issue. This information obviously does not mean you don't have a PE and you should definitely have the doctor look into it, but hopefully the discomfort you feel goes away soon similar to mine.
Hope that helps,
Ian
Hi Josiah,
If you haven't seen this post from earlier this year, check it out.
https://www.cmlsupport.org.uk/thread/12264/pressure-chest-when-standing
Thanks scuba, Ian and Kirk for all the information!
I am also suspecting PE, but just worried because the symptoms was a bit off from an usual PE (mainly about feeling strong heart beats). Its weekend here, but I am definitely scheduling an X-ray chest scan ASAP. It's not all good news for this early onset of PE-like symptoms, for now I am worried if I could exercise heavily as I usually do.
Just hope this resolves quickly. Many thanks
Josiah
Just for an update!
The X-ray chest scan turned out very clean, so clean that my doctor gave me weird look for it. I have no idea what was going on, but I am sure 1. the pain sensation was real and 2. I am feeling so much better now, even after some intense soccer sessions. I will keep myself cautious, but gladly I could continue the 50mg treatment.
3-month-milestone is coming this weekend! Hoping for some good results!
