Dasatinib, a multikinase inhibitor: therapy, safety, and appropriate management of adverse events.

Tyrosine kinase inhibitors are the standard of care for the treatment of chronic myeloid leukemia or Philadelphia chromosome-positive acute lymphoblastic leukemia. Dasatinib is a second-generation tyrosine kinase inhibitor that has been shown to be efficacious in treatment of patients with chronic myeloid leukemia or Philadelphia chromosome-positive acute lymphoblastic leukemia who are resistant or intolerant to frontline imatinib. In clinical trials of dasatinib, the adverse events that arise during therapy are mostly mild to moderate in severity and are usually reversible and manageable with appropriate intervention. Cytopenias can be treated with dose modification or interruption. Pleural effusions can be effectively managed with prompt delivery of supportive care and dose modification. Patients at risk of cardiac abnormalities or bleeding-related events require careful monitoring. Pharmacokinetic analysis of dasatinib indicates interactions with a number of other agents and a complete treatment history should be taken before initiating therapy because mitigating drug-drug interactions are critical for patient safety.