title: Reversible posterior leukoencephalopathy syndrome induced by pazopanib.
abstract: BACKGROUND
  The reversible posterior leukoencephalopathy syndrome is a clinical/radiological syndrome characterized by headache, seizures, impaired vision, acute hypertension, and typical magnetic resonance imaging findings. There are several reports in the literature that depict its occurrence in cancer patients. The list of common anticancer and supportive care drugs that predispose to reversible posterior leukoencephalopathy syndrome is expanding and includes not only a large number of chemotherapeutic agents but also an increased number of new targeted drugs, particularly angiogenesis inhibitors such as bevacizumab,sorefenib and sunitinib. Pazopanib is an oral tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and c-Kit which after a positive phase III randomized clinical trial in patients with advanced renal cell cancer received FDA approval for the treatment of advanced renal cell carcinoma. Until now no cases of reversible posterior leukoencephalopathy syndrome induced by pazopanib have been reported.
  
  
  METHODS
  We present the case of a 40 years old female patient with heavily pre-treated metastatic renal cell carcinoma who received pazopanib as salvage treatment. After 21 days of pazopanib therapy the patient referred to the emergency department with epileptic seizure, impaired vision at both eyes and headache. MRI of the brain revealed subcortical oedema at the occipital and parietal lobes bilaterally. She was treated with anticonvulsants, i.v. administration of mannitol and antihypertensives and she recovered completely from her symptoms and was discharged on the tenth hospital day. A brain MRI performed 3 weeks after showed that the subcortical oedema had been subsided.
  
  
  CONCLUSIONS
  In conclusion this is the first case of pazopanib induced reversible posterior leukoencephalopathy syndrome. Although usually reversible, this syndrome is a serious and potentially life threatening adverse effect, if untreated, that should be considered by physicians treating metastatic renal cell carcinoma patients with pazopanib.
authors.affiliation: Department of Medical Oncology, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Thrace, Greece. chelisleonidas@yahoo.gr
authors.forename: Leonidas
authors.initials: L
authors.lastname: Chelis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Souftas
authors.forename: Kiriakos
authors.initials: K
authors.lastname: Amarantidis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Xenidis
authors.forename: Eleni
authors.initials: E
authors.lastname: Chamalidou
authors.forename: Prokopios
authors.initials: P
authors.lastname: Dimopoulos
authors.forename: Prodromos
authors.initials: P
authors.lastname: Michailidis
authors.forename: Evagelos
authors.initials: E
authors.lastname: Christakidis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Prassopoulos
authors.forename: Stylianos
authors.initials: S
authors.lastname: Kakolyris
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007191:Indazoles; D007680:Kidney Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D009362:Neoplasm Metastasis; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced*; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D007191:Indazoles; D011743:Pyrimidines; D013449:Sulfonamides; C516667:pazopanib