Table 5.

Management of dasatinib-related pleural effusion

Pleural effusion	Definition National Cancer Institute Common Toxicity Criteria (NCICTC)	Recommendation
Grade 1	Absence of symptoms	Monitoring by chest X-ray
Grade 2	Symptomatic requiring diuretics or ≤ 2 therapeutic thoracentesis	First episode: withdraw treatment until effusion has decreased to grade 1 or lower, supportive treatment (use steroids, diuretics, thoracentesis if large volume or significant symptoms).
		Second episode: withdraw treatment and resume at a lower dose (level 1*) and supportive treatment
		Third episode: withdraw treatment and reduce the dose one additional level or consider treatment discontinuation
Grade 3	O2 supplement required, > 2 thoracentesis required, thoracic draining or pleurodesis	First episode: withdraw treatment until effusion has decreased to grade 1 or lower, supportive treatment (steroids, diuretics, thoracentesis, thoracic draining, pleurodesis)
		Second episode: withdraw treatment and reduce the dose one additional level or consider treatment discontinuation
Grade 4	Life-threatening, hemodynamic instability, requiring mechanical ventilation	Discontinue treatment

*Dose reduction: chronic stage, 100 mg/day → 80 mg (level 1); advanced phase, 140 mg/day → 100 mg/day (level 1) → 80 mg/day (level 2)