Bosutinib (Bosulif®) is a targeted therapy drug. It is used to treat chronic myeloid leukaemia (CML).
Bosutinib is a type of targeted therapy drug called a cancer growth inhibitor. Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Most people who have CML have a gene change in the leukaemia cells called the Philadelphia (Ph) chromosome. When you are diagnosed with CML, your blood and bone marrow samples are tested for this change.
The gene change means that the leukaemia cells make high levels of a chemical that tells cells to develop and divide. This makes the leukaemia cells grow and divide in an uncontrolled way. Bosutinib blocks the chemical. This makes the leukaemia cells die.
Bosutinib comes in tablets, so you can take it at home.
During treatment you usually see a leukaemia doctor (haematologist), a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Bosutinib is a long-term treatment and you should carry on taking it for as long as your doctor tells you. Bosutinib can reduce the number of blood cells in your blood or may affect your liver. You will have regular blood tests during treatment to check your blood cell levels and how well your liver is working. If needed your doctor may tell you to stop taking bosutinib until the test results get better.
Bosutinib tablets come in different strengths. Your doctor, nurse or pharmacist will tell you how many of each to take. Always take them exactly as you are told to. This is important to make sure they work as well as possible for you.
Take the tablets in the morning with food. Try to take them at the same time every day. Swallow them whole with a glass of water. They should not be chewed, broken or crushed.
There are some important things to remember when taking your tablets:
- Do not eat grapefruit or drink grapefruit juice while you are having bosutinib. This can change how effective the drug is.
- If you forget to take the tablets, take them as soon as you realise. But if it is less than 12 hours until the next dose, do not take the missed tablets. You should never take a double dose.
- If you are sick just after taking the tablets, tell your doctor. You may need to take another dose. But do not take another dose without telling your doctor first.
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of the sight and reach of children.
- If your treatment is stopped, return any unused tablets to the pharmacist.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may reduce or delay your treatment for a short time.
Anaemia (low number of red blood cells)
Bosutinib can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion. Your dose of bosutinib may also be reduced.
Bruising and bleeding
Bosutinib can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor or nurse if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- bleeding from the back passage (rectum) or when you poo
- black, tarry poos (stools)
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion. Your doctor may also reduce your dose of bosutinib.
This is common after taking the first dose of bosutinib. Your nurse or doctor may give you anti-diarrhoea drugs to take at home. The diarrhoea can usually be controlled with these medicines. But it is very important to tell your doctor if it is severe or continues. It is important to drink around 2 litres (3.5 pints) of fluid every day if you have diarrhoea.
Your doctor may ask you to stop taking bosutinib. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes the dose is reduced.
Your doctor can give you anti-sickness drugs to help prevent sickness. Take the drugs exactly as your nurse or pharmacist tells you.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital. They can give you advice and change the anti-sickness drug to one that works better for you.
Some people find that bosutinib causes pain or discomfort in their tummy (abdomen). Let your doctor or nurse know if this happens to you. They can give you painkillers to relieve it.
Your skin may become dry and itchy or you may develop a mild skin rash. Some people develop a rash that looks like acne. Your doctor can prescribe medicine or creams to help with skin changes and give you advice on how to manage it.
Rarely, bosutinib can cause severe skin reactions. If your skin becomes painful, or you develop a severe rash or blisters, contact your hospital straight away.
Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
Effects on the liver
Bosutinib may affect how your liver works. There is more risk of this in the first 3 months of taking bosutinib. Your doctor will take regular blood samples to check how well your liver is working during that time.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Bosutinib can cause fluid build-up (retention) in different parts of the body. Most commonly, it causes swelling of the ankles or swelling around the eyes. Drugs that make you pass more urine (diuretics) can help to get rid of some of the fluid. A short course of steroids may also be helpful. Usually, fluid build-up settles without treatment.
Sometimes fluid may collect in the lining of the lungs. This is called pleural effusion. Rarely, fluid collects in the tummy area (called ascites) or in the sac around the heart (called pericardial effusion).
Muscle and joint pains
You may have joint or muscle pains, especially in your back. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
- a fever (high temperature)
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
Effects on the heart
This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
- notice any changes to your heart rhythm.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor straight away.
Effects on the kidneys
Bosutinib can affect how your kidneys work. You will have regular blood tests to check how well your kidneys are working.
Raised levels of uric acid (tumour lysis syndrome)
This treatment may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid but may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you tablets called allopurinol (Zyloric®) to help prevent this. Drinking at least 2 litres (3½ pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
High blood pressure
Hepatitis B reactivation
If you have had Hepatitis B (a liver infection) in the past, this treatment can make it active again. Your doctor or nurse will talk to you about this and test you for Hepatitis B.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.
Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.
If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.