Posterior reversible encephalopathy syndrome due to targeted agents: vemurafinib among suspects!

Abstract

Posterior reversible encephalopathy syndrome features reversible cortical neurologic dysfunction and characteristic findings on brain imaging studies. This syndrome can be caused by several agents including traditional chemotherapy and immunosuppressive drugs. Targeted therapies such as agents binding vascular endothelial growth factor/VEGFR, CD20 and cytotoxic T-cell lymphocyte antigen 4 (CTLA-4) antigens are also among the culprits. Vemurafenib is a BRAF gene inhibitor that has not been previously linked with posterior reversible encephalopathy syndrome. We report herein the first such case and believe that further studies confirming this association are warranted. We further review the existing posterior reversible encephalopathy syndrome cases associated with targeted therapies in the scientific literature.

Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

“…Erythropoietin and certain colony stimulating factors such as G-CSF have been associated with PRES as well. This syndrome has also been reported to be associated with newer targeted therapies such as antivascular endothelial growth factor (VEGF) agents (bevacizumab), A B anti-CD20 antibodies (rituximab), tyrosine kinase inhibiting (TKI) agents (sorafenib, sunitinib, pazopanib) and, most recently, with anti-cytotoxic T-cell lymphocyte antigen 4 (CTLA-4) agents (ipilimumab) (24).…”

“…This as a domino phenomenon triggers mild and reversible ischemia and oedema of the white matter (23). Moreover, chemotherapeutic agents (MTX, L-asparaginase, adriamycin, cyclophosphamide, cytosine arabinoside, vincristine) contribute to PRES also by inducing or exacerbating hypertension due to corticosteroids treatment or renal dysfunction (24). Erythropoietin and certain colony stimulating factors such as G-CSF have been associated with PRES as well.…”

Imaging Patterns and Outcome of Posterior Reversible Encephalopathy Syndrome During Childhood Cancer Treatment

“…Magnetic resonance imaging (MRI) evidence of hyperintense signal change in the cortical–subcortical areas, typically in posterior circulation distribution, is required to confirm PRES diagnosis . Initially described in hypertensive encephalopathy and eclampsia, subsequent reports have suggested an association with drugs, particularly immune system and vascular endothelial system modulating agents . Outcome of PRES in noncancer patients is usually good, but permanent sequelae and life‐threatening complications have been described .…”

“…[1,2] Initially described in hypertensive encephalopathy and eclampsia, subsequent reports have suggested an association with drugs, particularly immune system and vascular endothelial system modulating agents. [3][4][5] Outcome of PRES in noncancer patients is usually good, but permanent sequelae and life-threatening complications have been described. [6,7] Reports on outcomes of PRES in children with cancer have been limited by small number of patients and inadequate follow-up data.…”

Posterior reversible encephalopathy syndrome in a melanoma patient with dabrafenib and trametinib treatment following immunotherapy

“…To the best of our knowledge, there are only four case reports on PRES under novel melanoma treatments [8][9][10][11]. However, the diagnosis of PRES in these cases was not completely reliable because an MRI was not performed [8,10].…”