Abstract
A 64-year-old Japanese man had started molecular-targeted therapy with sunitinib for lymph node metastasis 5 years after nephrectomy for left renal cell carcinoma (clear cell carcinoma, G2, pT2N0M0). He was transported to our emergency department because of generalized tonic-clonic seizure, vision loss, and impaired consciousness with acute hypertension after 8 cycles of treatment (2 years after the initiation of sunitinib therapy, including a drug withdrawal period for one year). MRI of the brain (FLAIR images) showed multiple high-intensity lesions in the white matter of the occipital and cerebellar lobes, dorsal brain stem, and left thalamus. Reversible posterior leukoencephalopathy syndrome caused by sunitinib was suspected. In addition to the immediate discontinuation of sunitinib therapy, the administration of antihypertensive agents and anticonvulsants improved the clinical symptoms without neurological damage. Physicians should be aware that sunitinib causes reversible posterior leukoencephalopathy syndrome. The early recognition of reversible posterior leukoencephalopathy syndrome is critical to avoid irreversible neurological damage.
Highlights
Kidney tumors comprise approximately 2% of all malignancies in adults [1], and the majority of kidney tumors are renal cell carcinomas (RCCs)
We describe the first reported Japanese case of reversible posterior leukoencephalopathy syndrome (RPLS) that developed on receiving sunitinib therapy for metastatic RCC
RPLS was first described by Hinchey et al [9], and typical clinical symptoms of RPLS include headache, seizures, visual abnormalities, acute hypertension, and an altered mental status
Summary
Kidney tumors comprise approximately 2% of all malignancies in adults [1], and the majority of kidney tumors are renal cell carcinomas (RCCs). 30% of RCCs involve metastatic disease at the diagnosis, and 50% of patients who receive curative surgery experience RCC relapse at distant sites [2]. Sunitinib is one of the tyrosine kinase inhibitors. It has been elucidated that sunitinib inhibits vascular endothelial growth factor receptors and plateletderived growth factor receptors, subsequently leading to the inhibition of tumor angiogenesis. Sunitinib was approved for advanced RCC in 2006 in Japan. Well-known adverse events caused by sunitinib include hypertension, fatigue, thyroid dysfunction, cardiotoxicity, gastrointestinal toxicities such as diarrhea, stomatitis and nausea, leukocytopenia, thrombocytopenia, and skin toxicity. We describe the first reported Japanese case of reversible posterior leukoencephalopathy syndrome (RPLS) that developed on receiving sunitinib therapy for metastatic RCC
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