Brief Report: Chylothorax and Chylous Ascites During RET Tyrosine Kinase Inhibitor Therapy

Or Kalchiem-Dekel, Christina J. Falcon, Christine M. Bestvina, Dazhi Liu, Lauren A. Kaplanis, Clare Wilhelm, Jordan Eichholz, Guilherme Harada, Lori J. Wirth, Subba R. Digumarthy, Robert P. Lee, David Kadosh, Robin B. Mendelsohn, Jessica Donington, Justin F. Gainor, Alexander Drilon, Jessica J. Lin

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish
Pages (from-to)1130-1136
Number of pages7
JournalJournal of Thoracic Oncology
Issue number9
StatePublished - 1 Sep 2022
Externally publishedYes


  • Chylothorax
  • Chylous ascites
  • Non–small cell lung cancer
  • RET tyrosine kinase inhibitor
  • Selpercatinib
  • Thyroid cancer

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine


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