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Anakha J, Dobariya P, Sharma SS, Pande AH. Recombinant human endostatin as a potential anti-angiogenic agent: therapeutic perspective and current status. Med Oncol 2023; 41:24. [PMID: 38123873 DOI: 10.1007/s12032-023-02245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
Angiogenesis is the physiological process that results in the formation of new blood vessels develop from pre-existing vasculature and plays a significant role in several physiological and pathological processes. Inhibiting angiogenesis, a crucial mechanism in the growth and metastasis of cancer, has been proposed as a potential anticancer therapy. Different studies showed the beneficial effects of angiogenesis inhibitors either in patients suffering from different cancers, alone or in combination with conventional therapies. Even though there are currently a number of efficient anti-angiogenic drugs, including monoclonal antibodies and kinase inhibitors, the associated toxicity profile and their affordability constraints are prompting researchers to search for a safe and affordable angiostatic agent for cancer treatment. Endostatin is one of the endogenous anti-angiogenic candidates that have been extensively pursued for the treatment of cancer, but even over three decades after its discovery, we have not made much advancement in employing it as an anticancer therapeutic despite of its remarkable anti-angiogenic effect with low toxicity profile. A recombinant human endostatin (rh-Es) variant for non-small cell lung cancer was approved by China in 2006 and has since been used effectively. Several other successful clinical trials related to endostatin for various malignancies are either ongoing or have already been completed with promising results. Thus, in this review, we have provided an overview of existing anti-angiogenic drugs developed for cancer therapy, with a summary of tumour angiogenesis in the context of Endostatin, and clinical status of rh-Es in cancer treatment. Furthermore, we briefly discuss the various strategies to improve endostatin features (poor pharmacokinetic properties) for developing rh-Es as a safe and effective agent for cancer treatment.
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Affiliation(s)
- J Anakha
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, S.A.S. Nagar, Mohali, Punjab, 160062, India
| | - Prakashkumar Dobariya
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, S.A.S. Nagar, Mohali, Punjab, 160062, India
| | - Shyam Sunder Sharma
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, S.A.S. Nagar, Mohali, Punjab, 160062, India
| | - Abhay H Pande
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, S.A.S. Nagar, Mohali, Punjab, 160062, India.
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Lin J, Chen W, Zhong S, Qian K, Chen H, Lin L. Posterior reversible encephalopathy syndrome associated with use of anlotinib to treat squamous cell carcinoma of the cervix: case report and literature review. Front Pharmacol 2023; 14:1255785. [PMID: 38169843 PMCID: PMC10758437 DOI: 10.3389/fphar.2023.1255785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Background: Posterior reversible encephalopathy syndrome (PRES), a neurological disorder with an unknown aetiology, is characterised by visual impairment, headache, vomiting, seizures, and transient alterations in consciousness. Case report: We present the case of a 49-year-old woman with advanced cervical carcinoma who received second-line therapy with oral anlotinib (12 mg, days 1-14, every 21 days) and injectable tislelizumab (200 mg, day 1, every 21 days). After 7 days of anlotinib administration, she began experiencing symptoms suggestive of PRES and was diagnosed on day 11. Interruption of anlotinib and supportive treatment led to recovery of her binocular vision. The Naranjo score (+5) graded the causality of this reaction as probable, suggesting the possibility that the event may have been an adverse reaction to anlotinib. Ethics: This case report was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Reference no. K-2023-068, 2023/06/09). Informed consent was obtained from the patient and her family.
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Affiliation(s)
- Jietao Lin
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
- Baiyun Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
| | - Wenmin Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Sha Zhong
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Kai Qian
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
| | - Hanrui Chen
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
| | - Lizhu Lin
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
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Buenaventura DC, Vargas-Sierra H, Aristizabal-Henao N, Torres-Grajales JL, Aguilar-Londono C, Gutierrez-Restrepo J. Posterior Reversible Encephalopathy Syndrome as an Adverse Effect of Lenvatinib in a Patient with Papillary Thyroid Carcinoma: A Case Report. Int J Endocrinol Metab 2023; 21:e136900. [PMID: 38028246 PMCID: PMC10676670 DOI: 10.5812/ijem-136900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 12/01/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon transient neuroradiological phenomenon that develops vasogenic cerebral edema and could be caused by some pharmacological agents, such as molecular-specific target agents. Lenvatinib belongs to the tyrosine kinase inhibitors and was approved in 2015 for progressive locally advanced or metastatic thyroid cancer refractory to radioactive iodine (I-131) treatment. Herein, we present the case of a 65-year-old woman who, while receiving treatment with lenvatinib for radioiodine-refractory metastatic papillary thyroid carcinoma, developed PRES without hypertension at the initial evaluation. Her clinical and radiological findings improved after withdrawing from the mentioned therapy, and later it was possible to re-incorporate lower doses of the medication, as described in the other three case reports found in the worldwide medical literature. The recognition of this entity is essential to timely suspend the drug and avoid greater comorbidity. This is the first paper reporting this kind of adverse event using lenvatinib in a Hispanic population.
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Affiliation(s)
| | - Hernando Vargas-Sierra
- Endocrinology Fellowship Program, Universidad Pontificia Bolivariana, Medellín (ZC 50001), Colombia
| | - Natalia Aristizabal-Henao
- Department of Endocrinology, Universidad Pontificia Bolivariana, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Universidad CES, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Clínica Las Americas AUNA, Medellín (ZC 50001), Colombia
| | - Jose Luis Torres-Grajales
- Department of Endocrinology, Universidad Pontificia Bolivariana, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Universidad CES, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Clínica Las Americas AUNA, Medellín (ZC 50001), Colombia
| | | | - Johnayro Gutierrez-Restrepo
- Department of Endocrinology, Clínica Somer, Medellín (ZC 50001), Colombia
- Department of Endocrinology an Metabolism, Universidad de Antioquia, Medellín (ZC 50001), Colombia
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4
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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.
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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,
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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.
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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:
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Hamidi S, Boucher A, Lemieux B, Rondeau G, Lebœuf R, Ste-Marie LG, Le XK, Mircescu H. Lenvatinib Therapy for Advanced Thyroid Cancer: Real-life Data on Safety, Efficacy and Some Rare Side Effects. J Endocr Soc 2022; 6:bvac048. [PMID: 35475024 PMCID: PMC9032633 DOI: 10.1210/jendso/bvac048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
Context The SELECT trial led to the approval of lenvatinib for the treatment of advanced radioiodine-refractory differentiated thyroid carcinomas (DTCs) but also revealed an important adverse event (AE) profile which may limit its use in clinical practice. Objective We aim to describe the efficacy and toxicity profiles of lenvatinib in real life. Methods We included all patients who received lenvatinib for an advanced DTC at our institution, enrolling 27 patients. We reviewed retrospectively electronic medical records to assess efficacy and AEs. Results Among the 24 patients with evaluation of tumor response during treatment, overall response rate (ORR) was 37.0% (95% CI, 19.4%-57.6%), and disease control rate was 85.2% (95% CI, 66.3%-95.8%). The median progression-free survival (PFS) was 12 months (95% CI, 7.5-16.5]. The most prevalent AEs were hypertension (77.8%), fatigue (55.6%), and weight loss (51.9%). At least one grade ≥ 3 AE was experienced by 25/27 patients (92.6%), mostly hypertension (59.3%). Lenvatinib was discontinued due to AEs in 13/27 patients (48.1%). Interestingly, 1 patient experienced a grade 4 posterior reversible encephalopathy syndrome, and another developed a Takotsubo cardiomyopathy. Conclusion The safety profile of lenvatinib in our cohort was similar to that reported in the literature, with a predominance of hypertension. Rigorous blood pressure control is therefore essential to avoid discontinuing therapy. We also report 2 severe and rarely described AEs that physicians should watch for. As for efficacy, although less than in the SELECT trial, ORR and PFS were similar to other real-life studies.
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Affiliation(s)
- Sarah Hamidi
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Andrée Boucher
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Bernard Lemieux
- Division of Medical Oncology, Department of Medicine, CHUM, Montréal, QC, Canada
| | - Geneviève Rondeau
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Rebecca Lebœuf
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Louis-Georges Ste-Marie
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Xuan Kim Le
- Division of Medical Oncology, Department of Medicine, CHUM, Montréal, QC, Canada
| | - Hortensia Mircescu
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
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Elamarthi P. Regorafenib: A narrative drug review. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_110_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Reed DR, Sen JM, Pierce EJ, Elsarrag RZ, K Keng M. Gilteritinib: An FMS-like tyrosine kinase 3/AXL tyrosine kinase inhibitor for the treatment of relapsed or refractory acute myeloid leukemia patients. J Oncol Pharm Pract 2020; 26:1200-1212. [PMID: 32338136 DOI: 10.1177/1078155220918006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Acute myeloid leukemia has recently undergone a significant transition into identifying and successfully inhibiting driver mutations leading to disease. One of the most common mutations in acute myeloid leukemia involves the protein FMS-like tyrosine kinase 3 (FLT3), which leads to ligand-independent activation of intracellular signaling cascades leading to the survival and proliferation of the acute leukemia blast cell. Preclinical studies have demonstrated the presence of two dominant types of mutations of this protein: internal tandem duplication and tyrosine kinase domain mutations. Successful inhibition of this protein has proven to be challenging. While FLT3 has been shown to be successfully inhibited and shown to improve overall survival in the frontline therapy of acute myeloid leukemia in combination with cytarabine and anthracycline, relapsed and refractory (R/R) patients have not been shown to be a successful population until recently. A phase III trial (ADMIRAL trial) demonstrated significant overall survival benefit in patients receiving gilteritinib compared to patients receiving salvage chemotherapy. This review will provide an overview of the preclinical, clinical, and practical use of gilteritinib in the treatment of patients with relapsed and refractory acute myeloid leukemia with FLT3 mutation.
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Affiliation(s)
- Daniel R Reed
- Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, USA
| | - Jeremy M Sen
- Department of Pharmacy Services, University of Virginia, Charlottesville, USA
| | - Eric J Pierce
- Department of Medicine, University of Virginia, Charlottesville, USA
| | - Ramey Z Elsarrag
- School of Medicine, University of Virginia, Charlottesville, USA
| | - Michael K Keng
- Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, USA
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Complications and Toxicities Associated with Cancer Therapies in the Intensive Care Unit. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7121489 DOI: 10.1007/978-3-319-74588-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Advances in the management of hematologic malignancies and solid tumors have given rise to diverse modalities to treat cancer other than cytotoxic chemotherapy, including targeted therapies, immunotherapies, and cellular therapies. Currently, there are over 175 FDA-approved antineoplastic agents in the United States, many with a diverse and profound toxicity profile. Complications of antineoplastic therapy may result in the need for intensive care unit (ICU) admission to provide acute symptom management. Accordingly, ICU providers caring for cancer patients should have a working knowledge of the toxicities and complications associated with antineoplastic therapy.
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10
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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.
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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
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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: 1] [Impact Index Per Article: 0.2] [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.
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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
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12
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Daptomycin-Induced Posterior Reversible Encephalopathy Syndrome (PRES). Case Rep Neurol Med 2019; 2019:8756932. [PMID: 30918728 PMCID: PMC6408990 DOI: 10.1155/2019/8756932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/04/2019] [Accepted: 02/05/2019] [Indexed: 11/17/2022] Open
Abstract
AIMS To present a 60-year-old female patient who manifested clinical and radiological features of posterior reversible encephalopathy syndrome (PRES) following the administration of Daptomycin for glycopeptide-resistant Enterococcal urinary tract infection. MATERIAL Case report. METHOD Posterior reversible encephalopathy syndrome was diagnosed in our patient following the administration of Daptomycin based on clinical suspicion as well as brain CT and MRI imaging. RESULTS The temporal association between the initiation of Daptomycin and the onset of PRES is highly suggestive of causality, and this is further supported by clinical and radiological resolution after Daptomycin was withdrawn. CONCLUSION This is the first report of Daptomycin-induced posterior reversible encephalopathy syndrome.
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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.
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Osawa Y, Gozawa R, Koyama K, Nakayama T, Sagoh T, Sunaga H. Posterior Reversible Encephalopathy Syndrome after Lenvatinib Therapy in a Patient with Anaplastic Thyroid Carcinoma. Intern Med 2018; 57:1015-1019. [PMID: 29225265 PMCID: PMC5919864 DOI: 10.2169/internalmedicine.9593-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare reversible neurological syndrome that causes subcortical vasogenic brain edema and which is associated with the use of target-specific agents. Lenvatinib is a target-specific agent that was recently approved for inoperable thyroid cancer. We herein describe the case of a 66-year-old woman with anaplastic thyroid cancer (ATC) who was treated with lenvatinib and who subsequently developed PRES. The clinical and radiological findings improved after suspending therapy for 1 week, and there was no recurrence with intermittent lower-dose lenvatinib treatment. Lenvatinib may prolong survival in patients with ATC and can be administered intermittently, even after PRES onset.
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Affiliation(s)
- Yoko Osawa
- Department of Otorhinolaryngology, Fukui Red Cross Hospital, Japan
| | - Rikako Gozawa
- Department of Otorhinolaryngology, Fukui Red Cross Hospital, Japan
| | - Keisuke Koyama
- Department of Otorhinolaryngology, Fukui Red Cross Hospital, Japan
| | - Takeo Nakayama
- Department of Neurology, Fukui Red Cross Hospital, Japan
| | - Tadashi Sagoh
- Department of Radiology, Fukui Red Cross Hospital, Japan
| | - Hiroshi Sunaga
- Department of Otorhinolaryngology, Fukui Red Cross Hospital, Japan
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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.
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Affiliation(s)
- Rashmi R Shah
- Pharmaceutical Consultant, 8 Birchdale, Gerrards Cross, Buckinghamshire, UK.
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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
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Quirino M, Rossi S, Schinzari G, Basso M, Strippoli A, Cassano A, Barone C. Unexpected side effect in mCRC: A care-compliant case report of regorafenib-induced hyperammonemic encephalopathy. Medicine (Baltimore) 2017; 96:e6522. [PMID: 28422839 PMCID: PMC5406055 DOI: 10.1097/md.0000000000006522] [Citation(s) in RCA: 3] [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: 11/26/2022] Open
Abstract
RATIONALE Regorafenib represents a treatment option in heavily pretreated patients affected by metastatic colorectal cancer (mCRC). Its safety profile is typical of small-molecule tyrosine-kinase inhibitors (TKIs) and most adverse events are manageable. PATIENT CONCERNS A 56 years-old Caucasian man affected by mCRC with normal hepatic reserve was treated with regorafenib as second-line treatment. After only 2 days of therapy, the patient presented to the emergency department due to impairment of both spatial and temporal orientation and motor function with bradylalia. INTERVENTIONS Serum ammonia level was 191 mmol/L, liver function tests and complete blood count were normal. Regorafenib was withheld and branched chain amino acids and lactulose were administered. OUTCOMES Serum ammonia level returned within the normal range, but when regorafenib was restarted at a lower dose level, a new episode of acute confusion arised. MAIN LESSON Discontinuation of regorafenib after confirmation of hyperammonemia is strongly recommended; reintroduction of the therapy at lower doses after resolution of symptoms related to hyperammonemic encephalopathy has to be discouraged.
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Affiliation(s)
- Michela Quirino
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome
| | - Sabrina Rossi
- Department of Medical Oncology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giovanni Schinzari
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome
| | - Michele Basso
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome
| | - Antonia Strippoli
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome
| | - Alessandra Cassano
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome
| | - Carlo Barone
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome
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18
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Khan RB, Sadighi ZS, Zabrowski J, Gajjar A, Jeha S. Imaging Patterns and Outcome of Posterior Reversible Encephalopathy Syndrome During Childhood Cancer Treatment. Pediatr Blood Cancer 2016; 63:523-6. [PMID: 26469881 PMCID: PMC4724342 DOI: 10.1002/pbc.25790] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diagnosis of posterior reversible encephalopathy syndrome (PRES) requires presence of headache, seizures, impaired vision, or altered mentation accompanied by specific imaging findings. We aimed to study long-term clinical and radiologic outcome of PRES in children with cancer to augment limited available data. PROCEDURE Retrospective review of children with cancer who were diagnosed with PRES. RESULTS We identified PRES in 21 males and 16 females among 5,217 children treated during the study period. Median time from cancer diagnosis to PRES was 6.6 months in 25 leukemia (1.6%), five brain tumor (0.3%), and seven other solid tumor (0.4%) patients; P = <0.0001 for leukemia versus all other tumors. Symptoms included seizures (97%), headaches (40%), altered mentation (68%), and vision impairment (27%). Hypertension was seen in 97%, and steroids use was seen in 78%. Headaches, visual disturbance, and mental status resolved within a median of <3 days, whereas epilepsy developed in 19%. T2 hyperintense signal was present in 100% of occipital, 47% of temporal, 75% of parietal, and 55% of frontal lobes, as well as 22% of cerebellum and 5% of basal ganglia. Follow-up magnetic resonance imaging (MRI) in 34 patients showed partial or complete T2 resolution in 79%, development of laminar necrosis in five, microhemorrhages in six, and focal atrophy in three. CONCLUSION PRES in children is more common in hematological malignancy compared with other tumors and is associated with hypertension and steroid use. Seizure is the most common acute manifestation. Most MRI changes resolve, but persistent imaging abnormality and epilepsy may develop in a significant minority.
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Affiliation(s)
- Raja B. Khan
- Division of Neurology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Zsila S. Sadighi
- Division of Neurology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jennifer Zabrowski
- Division of Neurology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Amar Gajjar
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Raissouni S, Quraishi Z, Al-Ghamdi M, Monzon J, Tang P, Vickers MM. Acute liver failure and seizures as a consequence of regorafenib exposure in advanced rectal cancer. BMC Res Notes 2015; 8:538. [PMID: 26438070 PMCID: PMC4593199 DOI: 10.1186/s13104-015-1502-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/21/2015] [Indexed: 12/19/2022] Open
Abstract
Background Regorafenib is a multi-targeted
tyrosine kinase inhibitor approved for use in refractory colorectal cancer. We report the first case of seizures secondary to acute liver failure, shortly after initiation of regorafenib in a patient with advanced rectal carcinoma. Case presentation A 64 year-old Caucasian female presented with confusion and generalized tonic–clonic seizures, 5 days after initiation of regorafenib for advanced rectal cancer. Investigations revealed significant elevations in bilirubin and alanine aminotransferase. No other cause for seizures and liver dysfunction were found. After interruption of regorafenib, no further seizures occurred, the symptoms of confusion resolved and liver function returned to normal. Conclusions We report the first case of regorafenib-induced acute liver failure resulting in seizures. We suggest early monitoring for side effects, both clinically and biochemically after initiation of regorafenib.
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Affiliation(s)
- Soundouss Raissouni
- Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada.
| | - Zarqa Quraishi
- Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada.
| | - Mohammed Al-Ghamdi
- Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada. .,King Saud University, Riyadh, Saudi Arabia.
| | - Jose Monzon
- Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada.
| | - Patricia Tang
- Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada.
| | - Michael M Vickers
- Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada.
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