TY - JOUR
T1 - Brief Report
T2 - Chylothorax and Chylous Ascites During RET Tyrosine Kinase Inhibitor Therapy
AU - Kalchiem-Dekel, Or
AU - Falcon, Christina J.
AU - Bestvina, Christine M.
AU - Liu, Dazhi
AU - Kaplanis, Lauren A.
AU - Wilhelm, Clare
AU - Eichholz, Jordan
AU - Harada, Guilherme
AU - Wirth, Lori J.
AU - Digumarthy, Subba R.
AU - Lee, Robert P.
AU - Kadosh, David
AU - Mendelsohn, Robin B.
AU - Donington, Jessica
AU - Gainor, Justin F.
AU - Drilon, Alexander
AU - Lin, Jessica J.
N1 - Publisher Copyright:
© 2022 International Association for the Study of Lung Cancer
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Introduction: Spontaneous chylous effusions are rare; however, they have been observed by independent investigators in patients treated with RET tyrosine kinase inhibitors (TKIs). Methods: This multicenter, retrospective study evaluated the frequency of chylous effusions in patients treated with RET TKIs. Clinicopathologic features and management of patients with chylous effusions were evaluated. Results: A pan-cancer cohort of 7517 patients treated with one or more multikinase inhibitor or selective RET TKI and a selective TKI cohort of 96 patients treated with selpercatinib or pralsetinib were analyzed. Chylous effusions were most common with selpercatinib (7%), followed by agerafenib (4%), cabozantinib (0.3%), and lenvatinib (0.02%); none were observed with pralsetinib. Overall, 12 patients had chylothorax, five had chylous ascites, and five had both. Time from TKI initiation to diagnosis ranged from 0.5 to 50 months. Median fluid triglyceride level was lower in chylothoraces than in chylous ascites (397 mg/dL [interquartile range: 304–4000] versus 3786 mg/dL [interquartile range: 842–6596], p = 0.035). Malignant cells were present in 13% (3 of 22) of effusions. Chyle leak was not identified by lymphangiography. After initial drainage, 76% of patients with chylothorax and 80% with chylous ascites required additional interventions. Selpercatinib dose reduction and discontinuation rates in those with chylous effusions were 47% and 0%, respectively. Median time from diagnosis to disease progression was not reached (95% confidence interval: 14.5–undefined); median time from diagnosis to TKI discontinuation was 11.4 months (95% confidence interval: 8.2–14.9). Conclusions: Chylous effusions can emerge during treatment with selected RET TKIs. Recognition of this side effect is key to prevent potential misattribution of worsening effusions to progressive malignancy.
AB - Introduction: Spontaneous chylous effusions are rare; however, they have been observed by independent investigators in patients treated with RET tyrosine kinase inhibitors (TKIs). Methods: This multicenter, retrospective study evaluated the frequency of chylous effusions in patients treated with RET TKIs. Clinicopathologic features and management of patients with chylous effusions were evaluated. Results: A pan-cancer cohort of 7517 patients treated with one or more multikinase inhibitor or selective RET TKI and a selective TKI cohort of 96 patients treated with selpercatinib or pralsetinib were analyzed. Chylous effusions were most common with selpercatinib (7%), followed by agerafenib (4%), cabozantinib (0.3%), and lenvatinib (0.02%); none were observed with pralsetinib. Overall, 12 patients had chylothorax, five had chylous ascites, and five had both. Time from TKI initiation to diagnosis ranged from 0.5 to 50 months. Median fluid triglyceride level was lower in chylothoraces than in chylous ascites (397 mg/dL [interquartile range: 304–4000] versus 3786 mg/dL [interquartile range: 842–6596], p = 0.035). Malignant cells were present in 13% (3 of 22) of effusions. Chyle leak was not identified by lymphangiography. After initial drainage, 76% of patients with chylothorax and 80% with chylous ascites required additional interventions. Selpercatinib dose reduction and discontinuation rates in those with chylous effusions were 47% and 0%, respectively. Median time from diagnosis to disease progression was not reached (95% confidence interval: 14.5–undefined); median time from diagnosis to TKI discontinuation was 11.4 months (95% confidence interval: 8.2–14.9). Conclusions: Chylous effusions can emerge during treatment with selected RET TKIs. Recognition of this side effect is key to prevent potential misattribution of worsening effusions to progressive malignancy.
KW - Chylothorax
KW - Chylous ascites
KW - Non–small cell lung cancer
KW - RET tyrosine kinase inhibitor
KW - Selpercatinib
KW - Thyroid cancer
UR - http://www.scopus.com/inward/record.url?scp=85134781923&partnerID=8YFLogxK
U2 - 10.1016/j.jtho.2022.06.008
DO - 10.1016/j.jtho.2022.06.008
M3 - Article
C2 - 35788405
AN - SCOPUS:85134781923
SN - 1556-0864
VL - 17
SP - 1130
EP - 1136
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 9
ER -