Clinical features and outcomes of reversible posterior encephalopathy syndrome following bevacizumab treatment.

Abstract

e14045 Background: Reversible posterior leukoenchephalopathy syndrome (RPLS), also known as Posterior reversible encephalopathy syndrome (PRES) is a distinct clinicoradiological entity characterized by a constellation of clinical features, and a potentially devastating complication of bevacizumab treatment. Methods: Patients were identified from the published literature using ‘PubMed’ databases using the terms ‘bevacizumab’ or , ‘RPLS’ and ‘RPES’ from 2006 to 2016, who developed RPLS features within 3 weeks of bevacizumab treatment, who had brain imaging findings of focal vasogenic edema and radiologic proof of reversibility Results: A total of 22 cases of RPLS following the administration of bevacizumab have been reported. The mean age of these patients was 50 years (range 34–74 years), 6 of whom were male and 14 female. Headaches ( n = 11), seizures ( n = 10), visual disturbances ( n = 9) and nausea and vomiting ( n = 8) were the common presenting symptoms. In a majority of patients, an increase in blood pressure from their baseline values was observed during their hospitalization. RPLS occurred in 3 patients who received bevacizumab as monotherapy and the rest had received bevacizumab in combination with other chemotherapeutic agents (oxaliplatin, n = 8; fluorouracil, n = 6; leucovorin, n = 5; gemcitabine, n = 3; paclitaxel, n = 3; capecitabine, n = 3; doxorubicin, n = 2; carboplatin, n = 2; and irinotecan, n = 1). In 20 out of 22 patients, PRES resolved following withdrawal of bevacizumab and strict control of blood pressure. 3 patients also received prednisolone and mannitol as part of their treatment for RPLS. However, 2 out of 22 patients could not recover from severe coma, and died. Conclusions: A high level of suspicion for RPLS is advisable in patients who develop headache, seizures, visual disturbances, during bevacizumab treatment, either as monotherapy or in combination with other chemotherapeutic agents. These data support the need for close vigilance of neurological features and blood pressure monitoring of patients undergoing bevacizumab treatment. Prompt withdrawal of bevacizumab and blood pressure control appear to portend favorable outcomes in these patients.