Bosutinib (Bosulif®)

Bosutinib comes as tablets, so you can take it at home.

During treatment you usually see a: 

• blood cancer doctor (haematologist)
• cancer nurse or specialist nurse
• 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 your blood cell levels 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 1 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 once a day 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 taking bosutinib. This can change how effective the drug is.
• If you forget to take the tablets, take them as soon as you remember. 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 moisture, heat and direct sunlight.
• Keep them safe, somewhere children cannot see or reach them.
• If your treatment is stopped, return any unused tablets to the pharmacist. 

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is 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. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C 
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, 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 your white blood cell count is low, your doctor may stop your treatment for a short time, until your cell count increases. Sometimes they will reduce the dose of your treatment.

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 feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Bosutinib can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• 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 treatment dose.

This treatment may cause diarrhoea. This is common after taking the first dose. 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, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid 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) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

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 between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

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).

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.

This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop: 

• a cough that does not go away
• wheezing
• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

If you have had a liver infection called hepatitis B in the past, this treatment can make it active again. Your doctor or nurse will talk to you about this. They will test you for hepatitis B.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.