Reversible posterior leucoencephalopathy syndrome in an elderly male on sunitinib therapy

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Agents inhibiting vascular endothelial growth factor can lead to development of reversible posterior leucoencephalopathy syndrome (RPLS).• Few cases of sunitinib‐induced RPLS have been reported previously.WHAT THIS STUDY ADDS• A case of sunitinib‐induced RPLS in an elderly man is described in this study.• Elevated blood pressure at presentation occurs in most cases of sunitinib‐induced RPLS.AIMS Reversible posterior leucoencephalopathy syndrome (RPLS) has been reported following the use of anti‐vascular endothelial growth factor (VEGF) agents such as bevacizumab, sorafinib and sunitinib. In this report we present a case of RPLS that occurred in an elderly male on sunitinib therapy.METHODS Other case reports of sunitinib‐induced RPLS were reviewed and causality assessment was carried out using the World Health Organization‐Uppsala Monitoring Centre criteria and the Naranjo algorithm.RESULTS Only a few cases of sunitinib‐induced RPLS had been reported previously and elevated blood pressure at presentation was common in most of the patients. Our case was clinically similar to the earlier reports and the adverse reaction had a ‘probable’ relationship with sunitinib intake.CONCLUSIONS Physicians should monitor and manage elevated blood pressure in patients with sunitinib‐induced RPLS.

Cortical blindness and posterior reversible encephalopathy syndrome in an older patient

“…Two recent cohorts studies of 19 and 113 patients have placed the mean age at 19 and 48 years, respectively 2 3. A few cases of patients over 60 have been described,4–6 but to our knowledge, no patient over 85 had been reported to be affected so far.…”

“…It has been reported to affect manly children and young adults 2 3. Older patients can also be affected,4–6 but PRES probably remains an uncommon entity among the geriatric population. To our knowledge, no case affecting a patient above 85 years old had been described so far.…”

Reversible posterior leukoencephalopathy syndrome during sunitinib therapy for metastatic renal cell carcinoma

“…Cytotoxic drugs may have direct toxic effects on the vascular endothelium leading to capillary leakage and cerebral edema, even in normotensive patients using drugs in normal therapeutic ranges (11,22,23). Angiogenesis inhibitors, including sunitinib, may trigger RPLS through the induction of endothelial dysfunction and/or hypertension (9,(12)(13)(14). In our patient, there was pre-existing hypertension and mild renal dysfunction.…”

“…Mechanistically, RPLS corresponds to a cerebral vasogenic edema associated with a variety of conditions including arterial hypertension, eclampsia, collagen vascular disorders, Guillain Barre syndrome, thrombotic thrombocytic purpura, acute porphyria and postcarotid endarterectomy. However, it is most commonly caused by immunosuppressive and cytotoxic drugs including cyclosporin A, tacrolimus, cisplatin, cytarabine, intravenous immunoglobulins, L-asparaginase, 5-fluorouracil, interferon-α, and more recently by anti-angiogenic agents including bevacizumab, sorafenib and sunitinib (9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Typical MRI findings in patients with RPLS include edema involving the white matter, predominantly in the posterior portions of the cerebral hemispheres, particularly bilaterally in the parieto-occipital regions, although other areas of the brain may also be affected (11,17).…”

Antiangiogéniques et métastases cérébrales: plus de peur que de mal ?

“…La récu-pération ad integrum est la norme après traitement des troubles ioniques, de l'hypertension et arrêt du bevacizumab. Cette complication a été décrite avec le sunitinib [25] et le sorafenib [12]. Une équipe a rapporté une réintroduction réussie de bevacizumab chez une patiente atteinte de glioblastome et ayant présenté une leucoencéphalopathie postérieure réversible [18].…”