Response to Provenzano et al. and De Carlo et al.

We appreciate the comments from Provenzano et al. and De Carlo et al. regarding our recently published Brief Report. 1 Kalchiem-Dekel O. Falcon C.J. Bestvina C.M. et al. Brief report: chylothorax and chylous ascites during RET tyrosine kinase inhibitor therapy. J Thorac Oncol. 2022; 17: 1130-1136 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar The experiences they shared in the management of patients with chylous ascites on selpercatinib are an important contribution to the literature. As Provenzano et al. mentioned, nontraumatic chylous effusions are rare 2 Doerr C.H. Allen M.S. Nichols 3rd, F.C. Ryu J.H. Etiology of chylothorax in 203 patients. Mayo Clin Proc. 2005; 80: 867-870 Abstract Full Text Full Text PDF PubMed Scopus (263) Google Scholar and current management strategies are primarily on the basis of data pertaining to traumatic and iatrogenic chylous effusions, which are more prevalent. 3 Maldonado F. Cartin-Ceba R. Hawkins F.J. Ryu J.H. Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci. 2010; 339: 314-318 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar In our cohort, chylous effusions were most prevalent among patients treated with the selective RET inhibitor, selpercatinib; however, they were also observed among patients treated with multikinase inhibitors with anti-RET activity, specifically cabozantinib, lenvatinib, and agerafenib. Moreover, no cases of chylous effusion were identified among patients treated with another selective RET inhibitor, pralsetinib. These findings highlight a potential lack of a strong relationship between RET inhibition and the development of chylous effusions. Chylous Ascites as a Possible Rare Side Effect of Selpercatinib in RET-Positive NSCLCJournal of Thoracic OncologyVol. 18Issue 2PreviewWe attentively read the study by Kalchiem-Dekel et al.1 retrospectively reporting that chylous effusion could emerge as a potential side effect of selected RET inhibitors, especially selpercatinib. Full-Text PDF Ascites During Selpercatinib Treatment: Need for a Multidisciplinary ApproachJournal of Thoracic OncologyVol. 18Issue 2PreviewThe brief report by Kalchiem-Dekel et al.1 interestingly described the occurrence of spontaneous chylous effusions in patients who underwent treatment with multiple tyrosine kinase inhibitors and specific RET inhibitors. In particular, the incidence of this complication raised to 7% (15 of 217) in patients treated with selpercatinib. The authors also accurately reported the diagnostic workup, which confirmed the fatty nature of the effusions. Nevertheless, no therapeutic approaches other than symptomatic drainage were reported; neither dose reduction obtained an improvement of the condition. Full-Text PDF