Posterior reversible encephalopathy syndrome induced by enzalutamide in a patient with castration-resistant prostate cancer

Abstract

Summary Posterior reversible encephalopathy syndrome (PRES) is a clinical/radiological syndrome characterized by symptoms that can include seizure, headache, impaired vision and hypertension, and can be confirmed by magnetic resonance imaging. Numerous reports have emerged that describe PRES in cancer patients. The list of medications linked to PRES can include traditional cytotoxic chemotherapeutics (e.g., cisplatin, cyclophosphamide, and high-dose corticosteroids), newer agents that target the vascular endothelial growth factor pathway (e.g., bevacizumab, sunitinib, and pazopanib), and supportive care mediations (e.g., granulocyte colony stimulating factors and erythropoietin). We report, for the first time, a case of PRES that is secondary to treatment with enzalutamide, a potent androgen receptor antagonist used in the treatment of metastatic castration-resistant prostate cancer. Enzalutamide is approved for the treatment of both docetaxel-pretreated and chemotherapy-naïve metastatic castration-resistant prostate cancer. Enzalutamide has been previously linked to the increased risk of seizures. Clinicians should be aware that, in rare cases, patients treated with enzalutamide could potentially be at risk for PRES. If symptoms suggestive of PRES arise in patients receiving enzalutamide, the drug should be discontinued immediately and the diagnostic process should be initiated.

Duration of Treatment in Prostate Cancer Patients Treated with Abiraterone Acetate or Enzalutamide

“…37 Moreover, potential reasons for treatment discontinuation could include the development of central nervous system (CNS) conditions such as fatigue and posterior reversible encephalopathy syndrome events, though the latter is infrequent. 15,38 In the literature, advanced prostate cancer has often been associated with CNS conditions such as fatigue. 39,40 Results from various trials evaluating the effectiveness of ENZ reported an association between ENZ and several CNS complications, particularly fatigue.…”

Ocular complications with the use of radium-223: a case series

“…The third case includes a patient on several medications during the time of Ra-223 administration including enzalutamide. Single case reports of posterior reversible encephalopathy syndrome (PRES) have been observed in individuals receiving enzalutamide [ 26 ]. PRES is characterized by seizure, headache, impaired vision, and hypertension.…”

Potential Ophthalmological Side Effects Induced by Anti-Neoplastic Regimens for the Treatment of Genitourinary Cancers: A Review

“…Enzalutamide (and other second-generation antiandrogens) frequently causes blurred vision, which is usually self-limiting. In rare cases, enzalutamide can cause PRES (posterior reversible encephalopathy) syndrome with headache, seizures, impaired vision, and hypertension [ 26 , 27 ]. Although definite evidence is lacking, enzalutamide-mediated GABA receptor inhibition in the central nervous system (CNS) has been suggested as a potential mechanism [ 27 ].…”