Efficacy and safety of bosutinib in the second and third line of treatment in chronic myeloid leukemia

Tyrosine kinases inhibitors (TKIs) are the mainstay of chronic myeloid leukemia (CML) treatment. The choice of a specific TKI depends on its side effects, disease phase, ABL mutations, concomitant diseases, and reimbursement possibility. Bosutinib is a second generation TKI (2GTKI) approved for the treatment of patients with CML in all phases, previously treated with ≥1 TKI, who cannot be treated with imatinib, nilotinib or dasatinib. It is active against the majority of mutant BCR-ABL1, except T315I and V299L. Response rates in patients resistant or intolerant to imatinib treated with bosutinib are similar to those observed for other 2GTKI. Bosutinib may be also effective in patients with advanced phases of CML after other TKI failure. The most common side effects include gastrointestinal symptoms, rash, and increased transaminase activity. Bosutinib causes less cases of pleural effusion, hypercholesterolemia, hyperglycemia, and cardiovascular complications than other TKIs, therefore it is a very important therapeutic option for patients with these disorders.