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

BACKGROUND

Posterior reversible encephalopathy syndrome (PRES) is a potentially devastating complication of bevacizumab treatment.

AIM

We examined the clinical features, treatment and outcomes of patients who developed PRES following bevacizumab treatment at our institution and those reported in the literature.

DESIGN

Retrospective audit and systematic review.

METHODS

Patients were identified from the Mayo Clinic database and the published literature using 'PubMed' and 'OVID' databases, from January 2006 to June 2010, who developed PRES features within 3 weeks of bevacizumab treatment, who had brain imaging findings of focal vasogenic edema and radiologic proof of reversibility.

RESULTS

Two patients with definite PRES were identified from our institution and a further 10 cases were identified from the published literature (total, n=12). The mean age of these patients was 52 years (range 4-68 years), four of whom were men and eight women. Headaches (n=7), seizures (n=6), visual disturbances (n=5) and nausea and vomiting (n=3) were the common presenting symptoms. In a majority of patients (n=10), an increase in blood pressure from their baseline values was observed during their acute presentation. PRES resolved following withdrawal of bevacizumab and blood pressure control in all patients.

CONCLUSIONS

PRES is a catastrophic neurological complication of bevacizumab treatment, which responds favorably to prompt bevacizumab withdrawal and blood pressure control.