Bosutinib (Bosulif®)

Bosutinib (Bosulif®) is a targeted therapy drug used to treat some people with chronic myeloid leukaemia (CML). It may also be used to treat other cancers.

It is best to read this information with our general information about the type of cancer you have.

Bosutinib is given as tablets. You usually have it as an outpatient. Your cancer doctor or nurse will tell you how often you will have it.

Like all targeted therapy drugs, bosutinib can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

How bosutinib works

Bosutinib is a type of targeted therapy called a tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins in the body that control how cells grow and divide. Bosutinib blocks (inhibits) signals in the leukaemia cells that make them grow and divide. Blocking the signals causes the cells to die.

It’s best to read this information with our general information about the type of cancer you have. During treatment, you will see a cancer doctor and a cancer nurse. This is who we mean when we mention doctor or nurse in this information.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


When bosutinib is used

Bosutinib is a treatment for people with Philadelphia chromosome positive chronic myeloid leukaemia (Ph+ CML). You must have had at least one previous TKI drug before bosutinib can be given to you. It is used if other TKI drugs (such as imatinib, nilotinib and dasatinib) are unlikely to help you, or the side effects are too severe.

Bosutinib may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a clinical trial.

If a drug is not available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice. We have further information on what to do if a treatment is not available.


Taking bosutinib tablets

Bosutinib comes in tablets, so you can take it at home. Always take the tablets exactly as explained. This is important to make sure they work as well as possible for you. You may be given tablets of different strengths.

You should take the tablets in the morning with food. They must be swallowed whole with a glass of water. They should not be chewed, opened or crushed. Take them at the same time every day.

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, you should take your next dose as normal the following day. Tell your doctor or nurse. Do not take a double dose unless your doctor tells you to.

Here are some other things to remember about the tablets:

  • 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 you are sick just after taking the tablets, contact the hospital. Do not take another dose.
  • If your treatment is stopped, return any unused tablets to the pharmacist.


About side effects

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 haven’t 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.

More information

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.


Common side effects

Risk of infection

Bosutinib 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, such as:
    • feeling shivery
    • a sore throat
    • a cough
    • diarrhoea
    • needing to pass urine often.

You will have blood tests while you are taking bosutinib. If your white blood cell count is low, your doctor may ask you to stop taking bosutinib or reduce the dose for a 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:

  • nosebleeds
  • bleeding gums
  • 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.

Diarrhoea

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.

Feeling sick

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.

Tummy (abdominal pain)

Some people find that bosutinib causes pain or discomfort in their tummy. Let your doctor or nurse know if this happens to you. They can give you painkillers to relieve it.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop: 

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Skin changes

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

Feeling tired is a common side effect. 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.

Headaches

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.

Effects on the liver

Bosutinib may cause changes in the way your liver works. There is more risk of this in the first three months of taking bosutinib. Your doctor will take regular blood samples to check how well your liver is working during that time.

Fluid build-up

Fluid build-up (retention) can affect 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).


Less common side effects

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 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.

Effects on the kidneys

You will have regular blood tests to check how well your liver and kidneys are working.

Hepatitis B reactivation

If you have had a liver infection called hepatitis B in the past, bosutinib can make it active again. Your doctor or nurse will talk to you about this and test you for hepatitis B.

Raised levels of uric acid (tumour lysis syndrome)

This drug 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 they may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints. This is called gout.

Your doctor may give you tablets called allopurinol (Zyloric®) to help prevent this. Drinking at least 2 litres (3.5 pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.


Other information about bosutinib

Other medicines

Some medicines can affect this treatment or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any medicines you are taking, including vitamins, herbal drugs and complementary therapies. St John’s Wort can make bosutinib less effective.

Fertility

It is not known if bosutinib will affect whether you can get pregnant or father a child.

If you are worried about fertility, it is important to talk with your doctor before you start chemotherapy treatment. There may be ways to preserve fertility for men and women.

Contraception

It is not advisable to become pregnant or father a child while taking bosutinib. This is because little is known about the effects of bosutinib on a developing baby.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. 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.