Posterior Reversible Encephalopathy Syndrome Associated with Sorafenib and Successful Retreatment

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome characterized by acute hypertension, headache, decreased level of consciousness, visual disturbances and seizures associated with characteristic neuroimaging changes indicative of vasogenic edema of the posterior cerebral white matter. Several medical conditions have been associated with PRES including hypertensive encephalopathy and eclampsia. The use of cytotoxic and immunosuppressant drugs, such as those which target vascular endothelial growth factor (VEGF), have also been implicated. We report here the case of a 71-year-old woman with metastatic clear cell renal carcinoma who developed PRES 3 months after commencing sorafenib. Elevated blood pressure (BP) was recorded, and MRI of the brain) of the brain showed asymmetric areas of increased signal intensity within the supratentorial white matter suggestive of PRES. Clinical and radiological features rapidly improved with BP control and discontinuation of sorafenib. Sorafenib was resumed with no sign of PRES recurrence. The present case report supports the hypothesis that, in selected patients, the re-introduction of anti-VEGF therapies after PRES is feasible.

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

“…Many drugs can cause PRES ( Abughanimeh et al, 2018 ; Vilas-Boas and Corte-Real, 2019 ; Kaur et al, 2020 ). With new antitumor agents widely used in the clinic in recent years, accumulating case reports have reported the occurrence of PRES in patients receiving targeted therapies, particularly antiangiogenic agents, such as bevacizumab ( Hamid et al, 2018 ; Katada et al, 2018 ), sunitinib ( Saraceno et al, 2017 ; Rifino et al, 2020 ), sorafenib ( Dogan et al, 2010 ; Laruelle et al, 2018 ), pazopanib ( Deguchi et al, 2018 ; Tatsumichi et al, 2021 ) and regorafenib ( Aanes et al, 2018 ).…”

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

“…PRES was encountered in patients receiving bevacizumab in 2006 (Glusker et al, 2006). Since then, PRES has been described in patients receiving VEGF inhibitors, including sorafenib (Govindarajan et al, 2006;Laruelle et al, 2018), sunitinib (Kapiteijn et al, 2007), aflibercept (Leighl et al, 2010), Frontiers in Pharmacology frontiersin.org regorafenib (Myint et al, 2014), pazopanib (Asaithambi et al, 2013), and anlotinib (Tlemsani et al, 2011;Kaneda et al, 2012). Furthermore, a Japanese patient developed PRES after treatment with the HER2 inhibitor trastuzumab.…”

Posterior Reversible Encephalopathy Syndrome (PRES) in a Patient With Primary Myelofibrosis on Ruxolitinib

“…However, the exact timeline of initiation of the chemotherapeutic agents and development of PRES has been varied across studies. Laruelle and colleagues reported a case of PRES three months after initiation of sorafenib, a tyrosine kinase inhibitor [7]. The exact mechanism of how these drugs cause PRES is unknown; however, calcineurin inhibitors like tacrolimus and cyclosporine, vascular endothelial growth factor (VEGF) inhibitors such as bevacizumab, and tyrosine kinase inhibitors like sorafenib and sunitinib are known to cause PRES because of their propensity to cause hypertension as their side effect [8].…”