Posterior reversible encephalopathy syndrome after anlotinib treatment for small cell lung cancer: A case report and literature review

Abstract

Anlotinib is an oral multi-targeted tyrosine kinase inhibitor as a third-line and subsequent treatment for patients with small cell lung cancer (SCLC) in China. The neurotoxicity is less reported. Posterior reversible encephalopathy syndrome (PRES) is characterized by headaches, seizures, encephalopathy, and visual disturbances, as well as focal reversible vasogenic edema seen on neuroimages. Here, we presented a case of PRES in a small cell lung cancer (SCLC) patient associated with anlotinib. A 37-year-old female patient, who had a history of diabetes, with extensive-stage SCLC received anlotinib after third-line chemotherapy. Ten cycles of anlotinib later, the patient experienced visual disturbance and was diagnosed with PRES based on the typical demyelination of white matter obtained in the brain magnetic resonance. During anlotinib therapy, the patient did not develop anti-VEGF therapy-induced hypertension. Subsequently, the patient stopped anlotinib, but she did not recover from symptoms. We also summarized the characteristics of fifty-four cases of PRES caused by antiangiogenic drugs in the literature. Based on our experience and the literature review, the incidence of PRES induced by antiangiogenic drugs is low, and the symptom can resolve upon stopping the medications. However, some cases still have a poor prognosis and the underlying mechanism requires further investigation. In addition, early detection and treatment of PRES are essential for physicians.

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

“…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.…”

“…Yes No Don't konw Score Frontiers in Pharmacology frontiersin.org The risk of PRES in patients receiving anti-VEGF drugs is unclear. Zou et al (2023) searched PubMed reports of PRES associated with anti-angiogenic therapy that were published between 2006 and 2023. The results showed that hypertension and increased serum levels of pro-inflammatory including interleukin-6 and tumor necrosis factor-alpha, lead to endothelial damage or dysfunction in patients with PRES.…”

“…Although blood pressure increases beyond the upper brain blood pressure autoregulation limits play a pivotal pathophysiological role in 70%–80% of PRES cases ( Fugate and Rabinstein, 2015 ; Lava et al, 2017 ), the exact mechanism and aetiology of PRES is still not completely elucidated, and few reports have described its occurrence after the administration of anti-angiogenic agents. A search of the PubMed database revealed only two documented cases of PRES after treatment with anlotinib, an anti-tumor therapy ( Nan et al, 2021 ; Zou et al, 2023 ). Here, we describe a patient with advanced squamous cell cervical cancer who developed PRES shortly after the initiation of anlotinib treatment.…”

Zanubrutinib-induced aseptic meningitis: a case report and literature review

“…Despite the lack of studies reporting aseptic meningitis induced by zanubrutinib and other BTK inhibitors except for our case, BTK inhibitors may cause some other serious and rare CNS AEs, including progressive multifocal encephalopathy (PML) and posterior reversible encephalopathy syndrome (PRES) ( Zukas and Schiff, 2018 ). The mechanism may be associated with impaired cellular immunity caused by BTK inhibitors ( Fugate and Rabinstein, 2015 ; Tattevin et al, 2019 ; Cortese et al, 2021 ; Zou et al, 2023 ). To distinguish aseptic meningitis from other rare complications induced by BTK inhibitors, Table 2 summarizes the pathogenesis, clinical manifestations, imaging features, CSF analysis, diagnostic criteria, treatment strategies, and prognosis of these three rare CNS complications to provide information regarding their management.…”