1
|
Savaliya M, Surati D, Surati R, Padmani S, Boussios S. Posterior Reversible Encephalopathy Syndrome after Pazopanib Therapy. Diseases 2023; 11:76. [PMID: 37366864 DOI: 10.3390/diseases11020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
The term posterior reversible encephalopathy syndrome (PRES) refers to an acute syndrome characterised by a range of neurological symptoms and posterior transient changes on neuroimaging. Common clinical presentation includes headache, confusion, visual disturbances, seizures, and focal neurological deficit. With the advancement and increasing availability of neuroimaging, this syndrome is increasingly recognised. There are several underlying causes for PRES, including certain medications. Tyrosine kinase inhibitors (TKIs) such as pazopanib can increase the risk of developing PRES by markedly elevating the blood pressure due to its effect of inhibition of vascular endothelial growth factor receptors (VEGFRs). We are reporting a case of a 55-year-old male patient with the clear cell type of renal cell carcinoma (RCC) who developed PRES within a short period after starting pazopanib therapy. With the effective control of his blood pressure and discontinuation of pazopanib, his typical magnetic resonance imaging (MRI) lesion of PRES resolved in the follow-up scan after four weeks.
Collapse
Affiliation(s)
- Madhavkumar Savaliya
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
- Metas Adventist Hospital, Surat 395001, India
| | - Drishty Surati
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
- Metas Adventist Hospital, Surat 395001, India
| | | | | | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
| |
Collapse
|
2
|
Zou X, Zhou P, Lv W, Liu C, Liu J. Posterior reversible encephalopathy syndrome after anlotinib treatment for small cell lung cancer: A case report and literature review. Front Pharmacol 2023; 14:1126235. [PMID: 36814495 PMCID: PMC9939648 DOI: 10.3389/fphar.2023.1126235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023] Open
Abstract
Anlotinib is an oral multi-targeted tyrosine kinase inhibitor as a third-line and subsequent treatment for patients with small cell lung cancer (SCLC) in China. The neurotoxicity is less reported. Posterior reversible encephalopathy syndrome (PRES) is characterized by headaches, seizures, encephalopathy, and visual disturbances, as well as focal reversible vasogenic edema seen on neuroimages. Here, we presented a case of PRES in a small cell lung cancer (SCLC) patient associated with anlotinib. A 37-year-old female patient, who had a history of diabetes, with extensive-stage SCLC received anlotinib after third-line chemotherapy. Ten cycles of anlotinib later, the patient experienced visual disturbance and was diagnosed with PRES based on the typical demyelination of white matter obtained in the brain magnetic resonance. During anlotinib therapy, the patient did not develop anti-VEGF therapy-induced hypertension. Subsequently, the patient stopped anlotinib, but she did not recover from symptoms. We also summarized the characteristics of fifty-four cases of PRES caused by antiangiogenic drugs in the literature. Based on our experience and the literature review, the incidence of PRES induced by antiangiogenic drugs is low, and the symptom can resolve upon stopping the medications. However, some cases still have a poor prognosis and the underlying mechanism requires further investigation. In addition, early detection and treatment of PRES are essential for physicians.
Collapse
Affiliation(s)
- Xiaomeng Zou
- Department of Clinical Medical College, Weifang Medical University, Weifang, China,Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Peng Zhou
- Department of Medical Imaging Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wei Lv
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chuanyong Liu
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China,*Correspondence: Jie Liu, ; Chuanyong Liuand,
| | - Jie Liu
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China,*Correspondence: Jie Liu, ; Chuanyong Liuand,
| |
Collapse
|
3
|
Mihalcea D, Memis H, Mihaila S, Vinereanu D. Cardiovascular Toxicity Induced by Vascular Endothelial Growth Factor Inhibitors. Life (Basel) 2023; 13:life13020366. [PMID: 36836722 PMCID: PMC9965690 DOI: 10.3390/life13020366] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Cardiotoxicity is an important side effect of vascular endothelial growth factor (VEGF) inhibitors therapy used in the treatment of various malignancies, leading to increased morbidity and mortality. Arterial hypertension, cardiac ischemia with the acceleration of atherosclerosis, arrhythmias, myocardial dysfunction and thromboembolic disease are the most feared cardiovascular adverse reactions due to VEGF inhibitors. Susceptibility for the occurrence of VEGF inhibitors-induced cardiotoxicity has multifactorial determinants, with a significant inter-individual variation. Baseline cardiovascular risk assessment of the patient, type and stage of cancer, dose and duration of VEGF inhibitors treatment and adjuvant chemotherapy or radiotherapy are the main predictors for cardiotoxicity. The role of the cardio-oncology team becomes essential for achieving maximum therapeutic anti-angiogenic effects with minimum cardiovascular side effects. This review will summarize the incidence, risk factors, mechanisms, management and treatment of VEGF inhibitors-induced cardiovascular toxicity.
Collapse
Affiliation(s)
- Diana Mihalcea
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, Splaiul Independentei 169, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
| | - Hayat Memis
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, Splaiul Independentei 169, 050098 Bucharest, Romania
| | - Sorina Mihaila
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, Splaiul Independentei 169, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
| | - Dragos Vinereanu
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, Splaiul Independentei 169, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
- Correspondence: ; Tel./Fax: +40-21-3180576
| |
Collapse
|
4
|
Tseng YJ, Chen CN, Hong RL, Kung WM, Huang APH. Posterior Reversible Encephalopathy Syndrome after Lenvatinib Therapy in a Patient with Olfactory Neuroblastoma. Brain Sci 2022; 13:brainsci13010033. [PMID: 36672016 PMCID: PMC9856907 DOI: 10.3390/brainsci13010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare but severe neurological syndrome that may stem from the use of some medications. Although its mechanism is not well-known, hypertension and endothelial dysfunction have been mentioned in previous literature as being related. Lenvatinib serves as a neoplastic agent that inhibits the tyrosine kinase of vascular endothelial growth factor receptors (VEGFR). VEGFR inhibitors result in endothelial dysfunction and consequent hypertension by nitric oxide pathway suppression and endothelin (ET)-1 stimulation. We hypothesized that VEGFR inhibitors would cause PRES. Herein, we report the case of a 40-year-old man with olfactory neuroblastoma who developed PRES while undergoing treatment with lenvatinib, 7 months after initiation. The symptoms included loss of consciousness and seizures. Fortunately, the symptoms and presence of PRES in imaging resolved, 7 days and 1 month, respectively, after cessation of lenvatinib.
Collapse
Affiliation(s)
- Yu-Ju Tseng
- Department of Pharmacy, National Taiwan University Hospital, Taipei City 100, Taiwan
| | - Chun-Nan Chen
- Department of Otolaryngology, National Taiwan University Hospital, Taipei City 100, Taiwan
| | - Ruey-Long Hong
- Department of Oncology, National Taiwan University Hospital, Taipei City 100, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei City 111, Taiwan
- Division of Neurosurgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Abel Po-Hao Huang
- Department of Surgery, National Taiwan University Hospital, Taipei City 100, Taiwan
- Correspondence:
| |
Collapse
|
5
|
Tokimura R, Ito E, Sugiura Y, Ugawa Y. Nephrotic Syndrome and Atypical Posterior Reversible Encephalopathy Syndrome in a Patient with Parkinson's Disease. Intern Med 2022; 61:2061-2065. [PMID: 34924463 PMCID: PMC9334256 DOI: 10.2169/internalmedicine.8746-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 59-year-old man with advanced Parkinson's disease treated using levodopa-carbidopa intestinal gel (LCIG) presented with leg edema, hypoalbuminemia, and proteinuria at 1 year after the treatment. He subsequently developed a generalized tonic-clonic seizure, and brain magnetic resonance imaging indicated vasogenic edema in the white matter of the left frontal subcortex. He was diagnosed with nephrotic syndrome (NS) and atypical posterior reversible encephalopathy syndrome (PRES). LCIG cessation and corticosteroid treatment improved the NS. To our knowledge, this is the first case report of NS and atypical PRES in patients with Parkinson's disease. Patients being treated with LCIG should be closely monitored for NS.
Collapse
Affiliation(s)
- Ryo Tokimura
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
- Department of Neurology, The University of Tokyo Hospital, Japan
| | - Eiichi Ito
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
| | - Yoshihiro Sugiura
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Japan
| |
Collapse
|
6
|
Catalano F, Rebuzzi SE, Murianni V, Damassi A, Martelli V, Borea R, Rollandi GA, Fornarini G. Rare anti-VEGFR therapy-induced toxicity and long-term response to immunotherapy in a rare non-clear cell renal cell carcinoma patient. Anticancer Drugs 2022; 33:e724-e729. [PMID: 34261919 DOI: 10.1097/cad.0000000000001152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Advanced non-clear cell renal cell carcinoma (nccRCC) has a poor prognosis and clinical data on the therapeutic options currently available, including immunotherapy, are generally limited highlighting an unmet clinical need. Moreover, the onset of rare adverse events raises the need of a better therapeutic management of limited treatment options. We report the clinical case of a 63-year-old man with the diagnosis of metastatic mucinous tubular and spindle cell carcinoma, a rare nccRCC, with sarcomatoid differentiation who developed two episodes of posterior reversible encephalopathy syndrome (PRES) to first-line sunitinib. It appeared after 5 months the start of the targeted therapy and reappeared at the reintroduction of the therapy. PRES is a rare and unusual adverse event to anti-vascular endothelial growth factor receptor (VEGFR) therapies, which is characterized by acute neurological disorders along with typical changes on neurological imaging, especially MRI. Moreover, this rare histotype of RCC experienced a long-term response to immunotherapy which is lasting more than 2 years. This clinical case is interesting for its rarity as a rare neurological adverse event developed twice in a rare type of RCC which also experienced an unusual long-term benefit to immunotherapy.
Collapse
Affiliation(s)
| | | | | | - Alessandra Damassi
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino IST
| | | | | | | | | |
Collapse
|
7
|
Tatsumichi T, Tanaka H, Okazaki T, Takahashi K, Suzuki K, Kawakita K, Houchi H, Kuroda Y, Kosaka S. Uterine sarcoma with posterior reversible encephalopathy syndrome associated with pazopanib. J Clin Pharm Ther 2020; 46:223-226. [PMID: 33044009 DOI: 10.1111/jcpt.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Our objective is to report on a case of posterior reversible encephalopathy syndrome associated with pazopanib. CASE DESCRIPTION A 64-year-old patient with uterine sarcoma developed PRES 3 days after pazopanib was initiated. After the discontinuation of pazopanib, the symptoms of PRES improved. WHAT IS NEW AND CONCLUSION The first report worldwide to describe a patient with uterine sarcoma experiencing PRES caused by pazopanib. Patients with uterine sarcoma may experience PRES, even in the early phase of pazopanib therapy.
Collapse
Affiliation(s)
| | - Hiroaki Tanaka
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Tomoya Okazaki
- Emergency Medical Centre, Kagawa University Hospital, Kagawa, Japan
| | - Koichi Takahashi
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Kiyo Suzuki
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Kenya Kawakita
- Emergency Medical Centre, Kagawa University Hospital, Kagawa, Japan
| | - Hitoshi Houchi
- Tokushima Bunri University Kagawa school of Pharmaceutical Sciences, Kagawa, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Centre, Kagawa University Hospital, Kagawa, Japan
| | - Shinji Kosaka
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| |
Collapse
|
8
|
Wong So J, Largeau B, Beau-Salinas F, Ehrmann S, Magni C, Meunier J. Pazopanib-induced posterior reversible encephalopathy syndrome with possible syndrome of inappropriate secretion of antidiuretic hormone: an incidental or pathophysiological association? Neural Regen Res 2019; 15:1166-1168. [PMID: 31823899 PMCID: PMC7034268 DOI: 10.4103/1673-5374.270420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Bérenger Largeau
- CHRU de Tours, Centre d'Investigation Clinique - CIC INSERM 1415, Tours, France
| | - Frédérique Beau-Salinas
- CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France
| | - Stephan Ehrmann
- Université de Tours, INSERM, Centre d'étude des pathologies respiratoires (CEPR) - UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC INSERM 1415, réseau CRICS-TRIGGERSEP, Tours, France
| | | | - Jérôme Meunier
- CHR d'Orléans, Service d'Oncologie Médicale, Orléans, France
| |
Collapse
|
9
|
Lv Y, Zhang Y, Zhang J, Liang N, Liu F, Liu R. Reversible posterior leukoencephalopathy syndrome following apatinib for gastric cancer in an adult: A case report and a review of the literature. Medicine (Baltimore) 2019; 98:e17787. [PMID: 31725620 PMCID: PMC6867717 DOI: 10.1097/md.0000000000017787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by rapidly progressive hypertension, headache, and disturbance of consciousness. Moreover, RPLS is rarely reported after apatinib treatment. PATIENT CONCERNS We present a case of RPLS induced by apatinib in this report. The patient had dizziness and bilateral lower limb weakness after apatinib use for 12 days. DIAGNOSIS AND INTERVENTIONS Cranial T2-weighted magnetic resonance imaging (MRI) revealed symmetrical increased signal intensity in bilateral areas of the basal ganglia, radiation crown, frontal lobe, parietal lobe, and occipital lobe, which was suggestive of RPLS. The patient discontinued apatinib use and was administered dexamethasone, mannitol, and antihypertensive drugs. OUTCOMES The patient's blood pressure returned to normal and neurological symptoms improved after 3 days of discontinuation of apatinib use. Moreover, brain MRI showed complete resolution of previous changes after 44 days of discontinuation of apatinib use. LESSONS Increased blood pressure may damage the normal blood-brain barrier, resulting in the extravasation of the fluid into the brain parenchyma. Hypertension is a significant cause of RPLS. It is important to strictly monitor blood pressure during apatinib treatment.
Collapse
Affiliation(s)
- Yajuan Lv
- Department of Radiotherapy,The First Affiliated Hospital of Shandong First Medical University, Shandong
| | - Yan Zhang
- Department of Radiotherapy,The First Affiliated Hospital of Shandong First Medical University, Shandong
| | - Jiandong Zhang
- Department of Radiotherapy,The First Affiliated Hospital of Shandong First Medical University, Shandong
| | - Ning Liang
- Department of Radiotherapy,The First Affiliated Hospital of Shandong First Medical University, Shandong
| | - Fengjun Liu
- Department of Radiotherapy,The First Affiliated Hospital of Shandong First Medical University, Shandong
| | | |
Collapse
|
10
|
Pucci G, Milan A, Paini A, Salvetti M, Cerasari A, Vaudo G. Acute blood pressure elevation associated with biological therapies for cancer: a focus on VEGF signaling pathway inhibitors. Expert Opin Biol Ther 2019; 19:433-442. [PMID: 30888868 DOI: 10.1080/14712598.2019.1594770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Treatment with biological agents interfering with mechanisms of angiogenesis, such as vascular endothelial growth factor (VEGF) signaling pathway (VSP) inhibitors, was associated with an enhanced risk of acute and severe blood pressure (BP) increase and development of hypertensive emergencies. Areas covered: The present article will review the scientific literature reporting hypertensive emergencies as a complication of biological treatment with VSP inhibitors. Hypertensive emergency is a life-threatening condition characterized by very high BP values (>180/110 mmHg) associated with acute organ damage. The exact mechanism of action is still incompletely clarified. Endothelial dysfunction following reduced bioavailability of nitric oxide has been hypothesized to play an important role in promoting hypertension and the occurrence of acute organ damage. Expert opinion: Prevention, prompt recognition and treatment of hypertensive emergencies associated with treatment with VSP-inhibitors are essential to reduce the risk of adverse events. Not infrequently, the occurrence of hypertensive emergency led to VSP treatment discontinuation, with potential negative consequences on patient overall survival. The present review aims at providing detailed knowledge for the clinician regarding this specific issue, which could be of high impact in usual clinical practice, given the increasing burden of indications to treatment with biological agents targeted to the VEGF pathway.
Collapse
Affiliation(s)
- Giacomo Pucci
- a Department of Medicine , University of Perugia , Perugia , Italy.,b Unit of Internal Medicine , Terni University Hospital , Terni , Italy
| | - Alberto Milan
- c Department of Medical Sciences - Hypertension Center , University of Torino - AOU Città della Salute e della Scienza di Torino , Torino , Italy
| | - Anna Paini
- d Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Massimo Salvetti
- d Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Alberto Cerasari
- a Department of Medicine , University of Perugia , Perugia , Italy.,b Unit of Internal Medicine , Terni University Hospital , Terni , Italy
| | - Gaetano Vaudo
- a Department of Medicine , University of Perugia , Perugia , Italy.,b Unit of Internal Medicine , Terni University Hospital , Terni , Italy
| |
Collapse
|
11
|
Posterior reversible encephalopathy syndrome and takotsubo cardiomyopathy associated with lenvatinib therapy for thyroid cancer: a case report and review. Oncotarget 2018; 9:28281-28289. [PMID: 29963277 PMCID: PMC6021337 DOI: 10.18632/oncotarget.25606] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/19/2018] [Indexed: 12/02/2022] Open
Abstract
As immunotherapies including tyrosine kinase inhibitors become more widely used for the treatment of a variety of malignancies, it is important for prescribers and patients to understand the potential adverse effects associated with these drugs. It is especially important to understand the potentially fatal side effects associated with these drugs to further determine risk factors for their development. The review presents a case of posterior reversible encephalopathy syndrome with concomitant Takotsubo cardiomyopathy, associated with use of lenvatinib therapy for thyroid cancer. It discusses the interventions performed and outcome. Potential mechanisms for development of these rare adverse effects, as well as cases in which these adverse effects are seen with use of other tyrosine-kinase inhibitors will be presented. It is important to continue to report these side effects, and further studies are needed to elucidate potential risk factors for their development, as well as to determine prognosis after development.
Collapse
|
12
|
Maruyama K, Nakagawa N, Suzuki A, Kabara M, Matsuki M, Shindo M, Ogawa Y, Hasebe N. Pazopanib-induced Endothelial Injury with Podocyte Changes. Intern Med 2018; 57:987-991. [PMID: 29269661 PMCID: PMC5919858 DOI: 10.2169/internalmedicine.9576-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Pazopanib has been reported to induce proteinuria; however, no pathological findings have been reported. We herein report the case of a 31-year-old man with rhabdomyosarcoma treated with pazopanib who developed nephrotic syndrome. A renal biopsy revealed endothelial injury with podocyte changes. Based on the biopsy findings, we diagnosed the patient with nephrotic syndrome caused by pazopanib. Following the discontinuation of pazopanib, the patient's proteinuria gradually decreased without any specific treatment. We should be careful when encountering drug-induced proteinuria in patients taking pazopanib.
Collapse
Affiliation(s)
- Keisuke Maruyama
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Ayana Suzuki
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Maki Kabara
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Motoki Matsuki
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Motohiro Shindo
- Division of Gastroenterology and Hematology/Oncology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | | | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| |
Collapse
|
13
|
Shah RR. Anti-Angiogenic Tyrosine Kinase Inhibitors and Reversible Posterior Leukoencephalopathy Syndrome: Could Hypomagnesaemia Be the Trigger? Drug Saf 2017; 40:373-386. [PMID: 28181126 DOI: 10.1007/s40264-017-0508-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS), also known frequently as posterior reversible encephalopathy syndrome (PRES), is a characteristic acute neuro-radiology syndrome with clinical presentation that typically includes acute hypertension, seizures and other neurological symptoms and signs. Many patients with RPLS have (a history of) pre-existing hypertension and in receipt of diuretics. It is being diagnosed more frequently and in association with an increasing number of morbidities and medications. Drugs most frequently implicated are immunosuppressant drugs and anticancer agents, including a number of anti-angiogenic tyrosine kinase inhibitors (TKIs). Hypomagnesaemia is a frequent finding at presentation in RPLS patients, which is known to lead to or aggravate hypertension. Pre-eclampsia, a variant of RPLS, responds effectively to intravenous magnesium. Cyclosporin, tacrolimus and some TKIs that induce RPLS are also known to give rise to both hypertension and hypomagnesaemia. This raises an interesting hypothesis that hypomagnesaemia may play a contributory role in triggering RPLS in some patients by acutely raising the blood pressure further. Additional systematic studies are required to test this hypothesis. If the hypothesis is confirmed, hypomagnesaemia offers an effective target for risk mitigation and prevention of RPLS in patients identified at risk.
Collapse
Affiliation(s)
- Rashmi R Shah
- Pharmaceutical Consultant, 8 Birchdale, Gerrards Cross, Buckinghamshire, UK.
| |
Collapse
|
14
|
Deguchi S, Mitsuya K, Nakasu Y, Hayashi N, Katagiri H, Murata H, Wasa J, Takahashi M, Endo M. Posterior reversible encephalopathy syndrome (PRES) induced by pazopanib, a multi-targeting tyrosine kinase inhibitor, in a patient with soft-tissue sarcoma: case report and review of the literature. Invest New Drugs 2017; 36:346-349. [PMID: 29067537 PMCID: PMC5869870 DOI: 10.1007/s10637-017-0521-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 01/16/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by acute neurological symptoms such as severe headache, seizures, and visual disturbance, and by typical reversible lesion on brain magnetic resonance (MR) images. Since PRES is thought to be caused by vascular endothelial injury due to cytotoxic agents or acute systemic hypertension, the number of reports on PRES associated with angiogenesis inhibitors has been increasing. Although five cases that developed PRES due to pazopanib for renal cell carcinoma have already been reported, none of PRES due to pazopanib for soft-tissue sarcoma has been reported thus far. We describe a case of a 49-year-old woman with retroperitoneal soft-tissue sarcoma who developed PRES during pazopanib administration. Pazopanib at 800 mg/day was administered as her third-line treatment at relapse. After 38 days of pazopanib, she was admitted to our hospital with severe headache, vomiting, and systemic hypertension. The next day, she developed consciousness deterioration and visual disturbance together with exacerbated systemic hypertension. Brain MR images revealed hyper-intense signals on FLAIR sequences in the bilateral occipital lobes and the left thalamus. Intravenous nicardipine injection was immediately started to control her blood pressure and pazopanib was discontinued. Her symptoms gradually improved and disappeared on the fifth hospital day. After 2 weeks, hyper-intense signals on a FLAIR sequence disappeared completely. She restarted a low dose of pazopanib under good blood pressure control and experienced no subsequent recurrence of PRES.
Collapse
Affiliation(s)
- Shoichi Deguchi
- Divisions of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Koichi Mitsuya
- Divisions of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Naga-izumi, Shizuoka, 411-8777, Japan.
| | - Yoko Nakasu
- Divisions of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Nakamasa Hayashi
- Divisions of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Naga-izumi, Shizuoka, 411-8777, Japan
| | | | - Hideki Murata
- Orthopedic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junji Wasa
- Orthopedic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Masahiro Endo
- Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| |
Collapse
|
15
|
Miaris N, Sgouros J, Gerolympou M, Spyropoulos B, Drakopoulos D, Gkoura S, Res H, Samantas E. Posterior Reversible Encephalopathy Syndrome During Treatment with Aflibercept, 5-Fluorouracil, Leucovorin, and Irinotecan for Metastatic Colorectal Cancer. J Gastrointest Cancer 2017; 50:123-126. [PMID: 28660523 DOI: 10.1007/s12029-017-9986-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Nikolaos Miaris
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece.
| | - Joseph Sgouros
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Margarita Gerolympou
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Basilios Spyropoulos
- First Department of Internal Medicine, 401 General Military Hospital of Athens, Athens, Greece
| | | | - Stefania Gkoura
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Helen Res
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Epaminondas Samantas
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| |
Collapse
|