Pazopanib-associated posterior reversible encephalopathy syndrome with intracerebral haemorrhage

Abstract

Pazopanib is a tyrosine kinase receptor antagonist used for renal cell carcinoma and soft tissue sarcoma that inhibits tumour growth and angiogenesis. A common side effect of pazopanib is hypertension. We report a case of a 69-year-old woman with clear cell renal cell carcinoma who developed a large right occipital intracerebral haemorrhage 3 weeks after initiating pazopanib. Although this was initially suspected to be a haemorrhagic metastasis, MRI revealed bi-occipital oedema, supporting a diagnosis of posterior reversible encephalopathy syndrome (PRES). A craniectomy was required. Immunohistochemical stains for renal cell carcinoma antigen, CA IX and PAX8 were negative. This case suggests that PRES and intracerebral haemorrhage may result from pazopanib use and are important complications to consider prior to initiating this agent.

Uterine sarcoma with posterior reversible encephalopathy syndrome associated with pazopanib

“…For patients with PRES caused by pazopanib, it was reported that PRES occurred nine days to 2 months after the initiation of pazopanib 8–13 . In contrast, PRES occurred at day 3 after the initiation of pazopanib in our patient, which is a significant feature of this case.…”

“…Studies investigating the association between PRES and anticancer drugs have reported that PRES is more common in women 5 . As such, the activation of oestrogen was proposed to be involved in the aetiology of PRES 12 . Our patient had a history of uterine leiomyosarcoma and the oestrogen receptor is expressed in 60% of patients with the disease 19 .…”

“…PRES caused by pazopanib is a rare adverse drug reaction for which the product monograph describes the incidence as unknown. There have been few reports describing this condition globally, 8–12 including one case in Asia 13 . Patients with uterine sarcoma and a history of hypertension may experience major clinical symptoms of PRES, even in the early phase(s) of pazopanib therapy.…”