Reversible Posterior Leukoencephalopathy Syndrome following Sunitinib Therapy: A Case Report and Review of the Literature

Abstract

Sunitinib is one of the standard targeted therapies used in metastatic renal cell carcinoma. It is generally a reasonably tolerated oral systemic therapy but can be occasionally associated with life-threatening toxicities. We present a case of reversible posterior encephalopathy, which is a rare but recognised side effect of the treatment.

Axitinib-induced reversible posterior leukoencephalopathy syndrome in a patient with metastatic renal cell carcinoma

“…All of these VEGF receptor antagonists can potentially cause RPLS. While cases of RPLS due to renal carcinoma targeted therapies are rare, reports involving sunitinib have been most frequent [5][6][7][8][9][10][11][12][13]. We report herein the second case, to our knowledge with RPLS induced by axitinib [13].…”

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

“…A total of 36 case reports of PRES associated with targeted therapy were identified. Of these, 17 were associated with bevacizumab, 6,16–30 13 with TKIs (8 for sunitinib, 7,37–43 2 with sorafenib, 8,36 3 with pazopanib 44–46 ), 5 with the anti-CD20 agent rituximab, 31–35 1 with the anti-CTLA-4 agent ipilimumab. 47 Table 1 describes the patient characteristics of the selected case reports.…”

“…Sorafenib, pazopanib and sunitinib are oral multikinase inhibitors that target VEGF pathway as well. [7][8][9][36][37][38][39][40][41][42][43][44][45][46] Their use is also associated with increased blood pressure, peripheral edema and, more rarely, with clotting events. As PRES is also associated with hypertension and thrombotic events, these risk factors should certainly be kept in mind before institution of anti-VEGF(R) therapy.…”

“…3 This syndrome has also been reported to be associated with newer targeted therapies such as anti-vascular endothelial growth factor (VEGF) agents (bevacizumab), 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). 5–47…”

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

“…Parieto-occipital white matter and cortex were involved, with varying degrees of temporal lobe involvement 33 (Allen et al, 2006;Ozcan et al, 2006;Martin et al, 2007;Burki et al, 2008;Koopman et al, 2008;Peter et al, 2008;Dos Reis Simões da Silva et al, 2011;Lau and Paunipagar, 2011;Lou et al, 2011;Padhy et al, 2011;Chang et al, 2012;Chelis et al, 2012;Khan et al, 2012;Lazarus et al, 2012;Sclafani et al, 2012;Seet and Rabinstein, 2012;Abbas et al, 2013;Asaithambi et al, 2013;Goto and Mimura, 2014;Levy et al, 2014;Sawaya et al, 2014;Eryılmaz et al, 2016;Miller et al, 2016;Nakamura et al, 2017;Saraceno et al, 2017;Aanes et al, 2018;Deguchi et al, 2018;Katada et al, 2018;Li et al, 2018;Rifino et al, 2020;Van Pelt et al, 2020) Vasogenic edema in the watershed areas of the frontal, parietal, and occipital lobes 7 ( Ozcan et al, 2006;Cumurciuc et al, 2008;Koopman et al, 2008;Dersch et al, 2013;Miaris et al, 2017;Katada et al, 2018;Lv et al, 2019) Basal ganglia, frontal lobe,brainstem, cerebellar hemisphere and unilateral lesion 14 (Koopman et al, 2008;…”