Abstract
Methods: Patients were identified from the published literature using ‘PubMed’ databases using the terms ‘bevacizumab’ or ‘Avastin’, ‘reversible encephalopathy’, ‘RPLS’ and ‘RPES’ from January 2006 to December 2012, who developed RPLS (RPES) features within 3 weeks of bevacizumab treatment, who had brain imaging findings of focal vasogenic edema and radiologic proof of reversibility. Results: To date, a total of 14 cases of RPLS following the administration of bevacizumab have been reported in the literature. The mean age at presentation of these patients was 54 years (range 4-74 years), four of whom were men and eight women including three patients with breast cancer. Headaches (n = 8), seizures (n =7), visual disturbances (n = 7) and nausea and vomiting (n = 5) 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 two patients who received bevacizumab as monotherapy and the rest had received bevacizumab in combination with other chemotherapeutic agents (oxaliplatin, n = 5; fluorouracil, n = 4; leucovorin, n = 3; gemcitabine, n = 2; doxorubicin, n = 2; paclitaxel, n = 1; carboplatin, n = 1; capecitabine, n = 1; and irinotecan, n = 1). In all these patients, PRES resolved following withdrawal of bevacizumab and strict control of blood pressure except one patient who had carcinomatous meningitis. Two patients also received prednisolone and mannitol as part of their treatment for RPLS. Conclusions: A high level of suspicion for RPLS is advisable in patients who develop headache, confusion or 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.
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