Posterior reversible encephalopathy syndrome induced by anti-VEGF agents

Abstract

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.

A Phase I First-in-Human Study of Nesvacumab (REGN910), a Fully Human Anti–Angiopoietin-2 (Ang2) Monoclonal Antibody, in Patients with Advanced Solid Tumors

“…3 reported with the Ang1/Ang2 inhibitors trebananib and AMG780 (25,26), Except for one patient with vena cava thrombosis, occurring in the context of progressive retroperitoneal disease, there were no other thrombotic events. Reversible CNS abnormalities seen on MRI in 3 patients were atypical in their clinical and radiologic appearance from those seen with other antiangiogenic agents (32,33). The MRI findings suggest foci of restricted diffusion, distinct from the typical T2 weighted hyperintensity signal generally seen in the population at large over the age of 50 years (34,35), and will require further elucidation.…”

Clinical, imagiological and etiological spectrum of posterior reversible encephalopathy syndrome

“…In fact, there is a growing number of PRES cases occurring in patients treated with anti-vascular endothelial growth factor agent (anti-VEGF) as bevacizumab. This drug interferes with vascular permeability and with endothelium intracellular signaling pathways supporting the endothelial dysfunction role in this disease 18 . Concerning topography of lesions, most patients presented predominantly posterior parietal-occipital lesions which may be explained by the lower density of sympathetic fibers in the vertebrobasilar territory, making it more susceptible to systemic blood pressure oscillations 1,19 .…”

Bortezomib-induced Posterior Reversible Encephalopathy Syndrome in a Patient with Newly Diagnosed Multiple Myeloma

“…Examining the four cases of bortezomib-induced PRES, including the present case, the following were found to be common features. First, the condition appears to be prevalent in women, as previously suggested for other molecular targeting agents, such as anti-vascular endothelial growth factor (VEGF) (11,12). Second, PRES occurred at a relatively early phase; in fact, two patients developed PRES within the first cycle of administration of bortezomib, which is in contrast to that observed in cases related to anti-VEGF or RAF kinase inhibitor.…”