Hypertensive Retinopathy Secondary to Anlotinib Treatment

Abstract

Purpose: We report a case of a middle-aged woman who developed hypertensive retinopathy following oral administration of Anlotinib. Observations: A 48-year-old woman presented to our hospital with sudden painless loss of vision in both eyes combined with headache, nausea, and vomiting following oral administration of Anlotinib. This drug is often used to control cancer progression. Due to the deterioration of her blood pressure, which reached 167/113 mm Hg, Anlotinib was discontinued and the blood pressure was controlled by hypertension medications. This normalized her blood pressure, alleviated headache, and restored her vision. She visited our eye department 37 days later for eye checkup. The best-corrected visual acuities was 0.3 in the right eye and 0.4 in the left eye. The fundus examinations revealed a clear boundary of the optic papilla with significant stellate exudation in the macular area. The posterior pole of the retina displayed high hemorrhage, with a cotton-wool spot appearance. Optical coherence tomography (OCT) revealed atrophy in the outer segment of macular area, and hard exudations in retinal layers. Based on these findings, hypertensive retinopathy was diagnosed, as a secondary complication of Anlotinib. Conclusions and Significance: Anlotinib can induce hypertensive retinopathy. Patients receiving this drug should be closely monitored for potential complications.

Posterior Reversible Encephalopathy Syndrome Associated With Anlotinib: A Case Report and Literature Review

“…Hence, anlotinib induced endothelial dysfunction and hypertension in our patient, who had no history of hypertension, may both contributed to PRES. Accordingly, in reviewed cases, we found that anlotinib occasionally increase blood pressure in those who had no history of hypertension, which simultaneously happened with vascular involved adverse effects ( 6 , 8 , 10 ). Discontinuation of anlotinib and anti-hypertensive drug could control increased blood pressure.…”

“…A study reporting the phase I clinical trial outcomes for this drug found that the safety dosage is 12 mg/day (4) and that the most common adverse effects related to nervous system disorder was reported to be dizziness and headache in the ALTER0303 trial (5). In addition, there are a few rare adverse effects reported (6)(7)(8)(9)(10). Though there have been cases of PRES induced by other VEGF inhibitors, anlotinib has not been previously reported to be associated with PRES (11)(12)(13).…”

Posterior reversible encephalopathy syndrome associated with use of anlotinib to treat squamous cell carcinoma of the cervix: case report and literature review

“…Furthermore, a Japanese patient developed PRES after treatment with the HER2 inhibitor trastuzumab. In that case, the pathogenesis may have been associated with the inhibition of tumor angiogenesis by trastuzumab, which reduced VEGF production and activated anti-angiogenic factors ( Zhang et al, 2020 ).…”

“…We searched PubMed using the terms “posterior reversible encephalopathy syndrome and anlotinib,” “reversible posterior leukoencephalopathy syndrome and anlotinib,” and “epilepsy and anlotinib.” Our search revealed only two case reports regarding the development of PRES after anlotinib use ( Nan et al, 2021 ; Zou et al, 2023 ). Furthermore, Zhang et al (2020) described a patient who developed hypertensive retinopathy after anlotinib use. The patient experienced sudden painless vision loss in both eyes, accompanied by headache, nausea, and vomiting, similar to the symptoms of PRES.…”

Novel Nanocrystal Injection of Insoluble Drug Anlotinib and Its Antitumor Effects on Hepatocellular Carcinoma

“…Anlotinib is a newly developed and orally administrated multi-targeted TKI (21)(22)(23)(24). Increasing evidence indicates that anlotinib may inhibit the proliferation of some human malignancies by blocking VEGFR2 phosphorylation and by its antagonist-activity against c-MET, c-Kit, Ret, Aurora-B, c-FMS, and the discoidin domain receptor 1 (DDR1) (25)(26)(27). Moreover, anlotinib was approved by the CFDA for the clinical treatment of NSCLC in 2018 (28).…”