Reversible Posterior Leukoencephalopathy Syndrome Associated With Oxaliplatin

Pinedo, Daryl; Shah-Khan, Farheen; Shah, Prabodh

doi:10.1200/jco.2007.13.5954

Cited by 41 publications

(31 citation statements)

References 5 publications

(3 reference statements)

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“…Recent reports have ascribed this syndrome to molecular-targeted agents such as bevacizumab, sorafenib, and sunitinib, but all 7 patients with RPLS who received molecular-targeted therapy were concurrently administered platinum agents. This finding is consistent with those of previous studies reporting that RPLS is more common in patients receiving platinumbased therapy than in those receiving molecular-targeted agents [4]. All drugs can potentially cause RPLS in individual patients.…”

Section: Discussionsupporting

confidence: 83%

Reversible posterior leukoencephalopathy syndrome associated with mFOLFOX6 chemotherapy

et al. 2012

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Reversible posterior leukoencephalopathy syndrome (RPLS) is a serious neurologic disease characterized by visual disturbance, seizures, headache, and altered mental status associated with white matter changes, particularly in the occipital lobes. RPLS has been attributed to chemotherapy, including modified FOLFOX6 regimens consisting of 5-fluorouracil, oxaliplatin, and leucovorin. Although the mechanism of development of RPLS remains unclear, impaired cerebral blood flow autoregulation and endothelial dysfunction seem to be involved. In particular, endothelial dysfunction has been implicated in the pathophysiology of RPLS associated with platinum agents. Platinum-based chemotherapy is thought to have a direct toxic effect on the vascular endothelium, leading to capillary leakage, disruption of the blood-brain barrier, and axonal swelling, triggering vasogenic edema. Much progress has been made in chemotherapy for colorectal cancer, and the increasing use of molecular-targeted agents is expected to further improve the outcome of therapy. RPLS has recently been associated with such molecular-targeted therapy, particularly in patients concurrently receiving platinum agents. This finding is consistent with previous reports suggesting that RPLS occurs more often in patients receiving platinum-based therapy than in those receiving molecular-targeted agents. Because platinum agents are the most widely used in cancer chemotherapy, clinicians should strongly suspect RPLS in patients receiving treatment with this class of drug.

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Section: Discussionsupporting

confidence: 83%

Reversible posterior leukoencephalopathy syndrome associated with mFOLFOX6 chemotherapy

et al. 2012

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“…Bevacizumab (n=2) and sunitinib (n=1) were re-introduced in patients with previous history of PRES [20,29,31]. No further complication was reported in these three patients.…”

Section: Resultsmentioning

confidence: 99%

“…This case suggests that blood pressure control is critical for the management of PRES, whereas the discontinuation of the anti-VEGF per se might not be sufficient to improve the neurological status. Indeed, bevacizumab (n= 2) and sunitinib (n=1) were re-introduced in patients with previous history of PRES while under anti-VEGF, without any iterative neuro-vascular complication [20,29,31].…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome induced by anti-VEGF agents

et al. 2011

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Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity that may occur in patients receiving anti-vascular endothelial growth factor (VEGF) agents such as bevacizumab and tyrosine kinase inhibitors. Little is known about the characteristics of patients at risk for PRES under anti-VEGF agents. We carried out a comprehensive review of reports documenting the occurrence of PRES in patients receiving anti-VEGF agents. Twenty-six patients are described with a majority of females (73.1%). Almost a third of patients had a past history of hypertension. The most common symptoms included headache, visual disturbance and seizure. A vast majority of patients had hypertension at the diagnosis of PRES, and proteinuria was detectable each time it was investigated. Neurological outcome was favorable in all cases with a symptomatic treatment including blood pressure control. The risk of PRES is increased when blood pressure is poorly controlled and when proteinuria is detectable. The clinical course appears favorable with a symptomatic treatment. PRES is a potentially severe but manageable toxicity of anti-VEGF agents.

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“…Several factors, including hypertensive encephalopathy, eclampsia, renal failure, general anesthesia, cytotoxic agents, and immunosuppressant agents, have been suggested as causes of RPLS. Although its pathophysiology remains poorly understood, it has been suggested that secondary breakdown of the blood-brain barrier with transudation of fluid and protein into the extravascular space results in vasogenic edema [3].…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine and cisplatin chemotherapy induced reversible posterior leukoencephalopathy syndrome in a bladder cancer patient

et al. 2010

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Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical entity, the common clinical symptoms of which are headache, disturbance of consciousness, altered mental status, seizures, and visual disturbance. Recently, some cases have been reported in association with the increased use of cytotoxic and immunosuppressive agents in cancer patients, and relevant reports have increased with advances in radiological examinations. We describe here the case of a 50-year-old man with advanced bladder cancer who suddenly experienced diminished spontaneity and speech, and finally became semicomatose. Two months previously, he had received gemcitabine and cisplatin chemotherapy. Computed tomography and magnetic resonance imaging revealed symmetrical edema of the posterior occipital lobe and thalamus. Based on these findings, we made a diagnosis of RPLS and treated him with supportive measures. His mental status gradually improved in 2 weeks, although slight neurological symptoms persisted. When the level of consciousness of a cancer patient worsens rapidly, this syndrome should be included in the differential diagnosis and recognized at an early stage. Early supportive management and discontinuation of the causative medication may reverse the clinical and radiological manifestations of the syndrome.

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Reversible Posterior Leukoencephalopathy Syndrome Associated With Oxaliplatin

Cited by 41 publications

References 5 publications

Reversible posterior leukoencephalopathy syndrome associated with mFOLFOX6 chemotherapy

Reversible posterior leukoencephalopathy syndrome associated with mFOLFOX6 chemotherapy

Posterior reversible encephalopathy syndrome induced by anti-VEGF agents

Gemcitabine and cisplatin chemotherapy induced reversible posterior leukoencephalopathy syndrome in a bladder cancer patient

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