A 47-year-old man with CML intolerant of imatinib was switched to a second-generation tyrosine kinase inhibitor. Six months later he develops progressive dyspnoea and bilateral pleural effusions requiring repeated thoracentesis. Which agent is responsible?
- A Imatinib
- B Nilotinib
- C Dasatinib ✓
- D Hydroxyurea
Correct answer: C. Dasatinib
Explanation
Dasatinib inhibits SRC-family kinases in addition to BCR-ABL, and this off-target effect produces immune-mediated pleural effusions, sometimes with pulmonary arterial hypertension, particularly in older patients or those with cardiac risk factors. Management includes dose reduction, diuretics, steroids, or switching agents. Nilotinib is associated instead with peripheral arterial occlusive disease, QT prolongation and hyperglycaemia, while imatinib causes fluid retention and oedema rather than true serosal effusions.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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