Bosutinib (Bosulif®) is a targeted therapy drug. It is used to treat chronic myeloid leukaemia (CML).
Bosutinib (Bosulif®) is used to treat chronic myeloid leukaemia (CML). It may sometimes 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 belongs to a group of targeted therapy drugs known as cancer growth inhibitors.
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. This means you may have to take different strengths of tablets to make one dose. Your doctor, nurse or pharmacist will tell you how many of each to take. Ask them if you are not sure. 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 sometimes called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given 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
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
You will have regular blood tests during treatment. If needed, your doctor may reduce or delay your treatment for a short time, until your cell count increases.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
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
- heavy periods
- bleeding from the back passage (rectum) or when you empty your bowels (poo)
- black, tarry stools (poo)
- blood in your urine (pee)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you 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. Diarrhoea means passing more stools than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
Your hospital team 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 at least 2 litres (3½ 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 will give you anti-sickness drugs to help prevent or control sickness during and after chemotherapy. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may 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.
Your skin may become more sensitive to the sun. If you are out in the sun, use a sun cream with a high sun protection factor (at least SPF 30) to protect your skin.
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. 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 you have headaches, tell your doctor. They may give you painkillers to help.
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.
Changes to your taste
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. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
Effects on the kidneys
This treatment can affect how your kidneys work. You will have blood tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual.
It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.
Tumour lysis syndrome
This treatment may cause the cancer cells to break down quickly. This releases chemicals from the cells into the blood. Your body can usually get rid of these, but may not be able to cope with large amounts. This can affect the kidneys and the heart. It is called tumour lysis syndrome (TLS).
You will have regular blood tests to check for TLS. Your doctor may also give you drugs and extra fluid through a drip to prevent TLS. Drinking at least 2 litres (3½ pints) of fluid a day will also help.
High blood pressure
This treatment may cause high blood pressure. Tell your doctor or nurse if you have ever had any problems with your blood pressure. Your nurse will check your blood pressure regularly during treatment. Let them know if you have any headaches.
Hepatitis B reactivation
If you have had Hepatitis B (a liver infection) in the past, temozolomide can make it active again. Your doctor or nurse will talk to you about this and may test you for Hepatitis B before, during, and after treatment.
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.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated 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.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses 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.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
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