Does anyone have any thoughts/experience with Bosutinib and elevated ALT numbers. After stalling out at .7 on Imatinib I was switched to Bosutinib 1.5 months ago. Now I have liver values about 1.5 to 2 times normal high for last 3 weeks. My doctor is suggesting a possible 5 day holiday from the medicine, but I fear taking a break and what that could do to my BCR/ABL. I am hoping to see if we can monitor closely with a weekly blood check before pausing the Bosutinib. Otherwise, after getting through the early GI issues I seem to be tolerating Bosutinib well.
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Bosutinib and elevated Liver values
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When I first started Bosulif, my alt and ast were elevated. The point where my Dr would require a pause was when they were 4 times the normal range. That only happened once and we just reduced dosage until they were normal again. That happened in the first 6 months and haven’t had an issue since. Been on Bosulif since the end of 2012. Currently on 400 mg. It’s been the best TKI for me. Hope your liver values level out as mine did. Best to you!
Thank you. I appreciate you sharing your experience. Hoping it clears up for me without having to stop taking the TKI.
I was started on Bosutinib going on 3 years ago. At just over 6 weeks from starting on 500mg I was feeling so ill I called and was brought in for a blood test. That showed my ALT at over 9 times normal so I was stopped for 3 and a half weeks. They then tried me on 400mg. Up went the ALT so they dropped me to 300mg but ALT still went up. Stopped again for 3 weeks then restarted at 200mg. ALT was still a bit high but over 6 months it finally got to the normal range and has stayed there ever since.
My understanding is that 200mg is below the recommended minimum dose but I'm grateful that the consultant was willing to try it as otherwise I'd have had to go to the last possible TKI for me - Pontinib and 200mg has got my BCR-ABL down from 0.27% to 0.0145%. These days I'm only in for blood tests every 3 months which is great too.
I suspect that my initial nausea, long gone, was linked to the higher dosages. I do take a daily Granisetron 1mg against nausea but I suspect I could do without it. So it seems to me that there is quite a bit of dose adjustment available to get the liver levels sorted out. Best of luck.
You could try supporting your liver with Milk Thistle and if you can cut out anything that places extra strain on your liver - painkillers, alcohol etc.
I suspect it may be dose-related - a hot topic at the moment on this forum with some interesting discussion on dose reductions and how that might be the way to go for good responders.
Sandy