Reversible posterior leukoencephalopathy syndrome in a child treated with bevacizumab

Levy, Carolyn Fein; Oo, Khine Zin; Fireman, Fernando; Pierre, Louisdon; Bania, M; Sadanandan, Swayamprabha; Yamashiro, Darrell J.; Bender, Julia Glade

doi:10.1002/pbc.21866

Cited by 25 publications

(13 citation statements)

References 15 publications

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“…In the present case, interruption of therapy was inevitable due to development of PRES, although no risk factors for this disorder, such as renal dysfunction and hypertension, were initially identified prior to commencement of BV and CPT11. BV occasionally causes PRES in both adult and pediatric patients, especially when hypertension and proteinuria are poorly controlled, which was seen in the clinical course of the present case …”

Section: Discussionsupporting

confidence: 62%

“…BV occasionally causes PRES in both adult and pediatric patients, especially when hypertension and proteinuria are poorly controlled, which was seen in the clinical course of the present case. 8,9 Re-initiation of BV-combined therapy is feasible under close blood pressure monitoring and aggressive management of hypertension. 8 In the present case, we decided to reduce the dose of BV and extend the treatment interval in combination with aggressive anti-hypertension treatment, because of persistent proteinuria after interruption; as a result, re-initiation of therapy was possible without exacerbation of adverse effects.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term efficacy of bevacizumab and irinotecan in recurrent pediatric glioblastoma

Umeda

Shibata

Saida

et al. 2015

Pediatrics International

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A 5-year-old boy with glioblastoma relapsed soon after postoperative irradiation in combination with temozolomide. Second-line chemotherapy was also ineffective; therefore, the bevacizumab and irinotecan were given after a third gross-total resection of the tumor. Treatment was interrupted for 1 month due to development of posterior reversible encephalopathy syndrome, but was re-initiated at a lower dose of bevacizumab with prolonged intervals between treatments. The patient was alive and disease free 2 years after initial diagnosis. Bevacizumab and irinotecan are a promising regimen for pediatric cases of recurrent glioblastoma after gross-total resection, although the optimal treatment schedule must be determined on a patient-by-patient basis.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Long‐term efficacy of bevacizumab and irinotecan in recurrent pediatric glioblastoma

Umeda

Shibata

Saida

et al. 2015

Pediatrics International

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“…Increasing numbers of antineoplastic therapies have been reported to be a cause of PRES, including several platinum‐based therapies such as cisplatin and carboplatin; however, only nine cases have been described following combination therapy with oxaliplatin and a fluoropyrimidine (Table 1). 28,38–48 Patients presented with seizure‐like activity (five of nine), confusion (four of nine), visual disturbance (three of nine) or headache (three of nine). Although hypertension and renal failure have been previously described as risk factors, six of the eight patients did not have pre‐existing medical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Of the nine cases of PRES described following treatment with fluoropyrimidine and oxaliplatin, five also involved treatment with bevacizumab 38,41–43,45 . Bevacizumab is a recombinant humanized monoclonal immunoglobulin (Ig)G1 antibody that binds VEGFA inhibiting angiogenesis 49 .…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome following chemotherapy with oxaliplatin and a fluoropyrimidine: A case report and literature review

Femia

Hardy

Spies

et al. 2012

Asia-Pac J Clncl Oncology

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Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome characterized by seizures, altered level of consciousness and visual disturbance. PRES is associated with hyperintense lesions on magnetic resonance imaging (MRI) most commonly seen in the posterior regions. In most cases symptoms and radiological lesions are reversible. The aims of this article are: (i) to review the literature for all cases involving oxaliplatin, fluoropyrimidine and bevacizumab and (ii) highlight the increasing number of cases attributed to anti-neoplastic agents. An in-depth literature review was conducted by utilizing Pubmed's MEDLINE and Google Scholar databases. We found that there have been nine cases of PRES associated with oxaliplatin or fluoropyrimidine therapy; five cases also involved therapy with bevacizumab. Eight of the nine patients made a full recovery with a complete resolution of MRI changes. This is the first Australian case of PRES following treatment with oxaliplatin and a fluoropyrimidine and only the second case reported in which the patient did not recover despite appropriate medical management. It appears that PRES maybe more commonly associated with multi-agent therapies and although reversible in most cases, PRES may result in adverse outcomes despite rapid intervention.

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“…To date there have been several published case reports of RPLS in association with treatment with bevacizumab for malignancies including renal carcinoma [15], colorectal cancer [16][17][18][19][20], breast cancer [21], and pediatric hepatoblastoma [22]. A recent review of the literature estimates an incidence of RPLS of less than 0.1 percent in clinical approval studies [7].…”

Section: Introductionmentioning

confidence: 99%

Bevacizumab Related Hypertension and Reversible Posterior Leukoencephalopathy Syndrome in Gynecologic Malignancies: A case Control Study

Cross¹,

Ratner²,

Silasi³

et al. 2011

JCT

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Background: Bevacizumab is increasingly being used in the treatment of gynecologic malignancies, but has significant side-effects including hypertension and reversible posterior leukoencephalopathy (RPLS), which must be recognized by the gynecologic oncologist. Methods: A 26-month institutional retrospective review of bevacizumab in the treatment of gynecologic malignancies. Patients were grouped according to whether they had bevacizumab-related hypertension (defined as at least a grade one hypertensive toxicity) or not. There were no differences in patient demographics between the groups. Risk factors for developing bevacizumab-related hypertension were assessed using t-tests, Wilcoxon rank sum test and Fisher’s exact test. Results: Our group has treated 45 patients with bevacizumab. Fifteen (33%) patients had a pre-existing diagnosis of hypertension, 12 (80%) of whom had at least one elevated blood pressure during treatment. The 30 (67%) patients who did not have a pre-existing diagnosis of hypertension still had a high incidence of bevacizumab-related elevated blood pressure (14, 47%). The majority of patients (26, 58%) had at least one therapy cycle complicated by hypertension. Patients who experienced bevacizumab-related hypertension were significantly more likely than not to have a history of hypertension (odds ratio of 4.6, 95% CI 1.1-19.6). There was a 4.4% incidence of reversible posterior leukoencephalopathy. Patients with age equal to or greater than 75 years, stage IV disease, and creatinine elevations greater than or equal to 1.4 mg/dL were significantly more likely to develop bevacizumab-related hypertension. Other factors such as numbers of prior chemotherapies, cycles of bevacizumab, BMI, cancer site, and histology were not significantly associated with bevacizumab-related hypertension. Conclusions: Hypertension is a problem for patients on bevacizumab whether or not they have a pre-existing diagnosis. However, those with a history of hypertension were significantly more likely to have bevacizumab-related hypertension

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Reversible posterior leukoencephalopathy syndrome in a child treated with bevacizumab

Cited by 25 publications

References 15 publications

Long‐term efficacy of bevacizumab and irinotecan in recurrent pediatric glioblastoma

Long‐term efficacy of bevacizumab and irinotecan in recurrent pediatric glioblastoma

Posterior reversible encephalopathy syndrome following chemotherapy with oxaliplatin and a fluoropyrimidine: A case report and literature review

Bevacizumab Related Hypertension and Reversible Posterior Leukoencephalopathy Syndrome in Gynecologic Malignancies: A case Control Study

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