Posterior reversible encephalopathy syndrome after anlotinib treatment for small cell lung cancer: A case report and literature review

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.

Keywords: anlotinib; antiangiogenic therapy; case report; posterior reversible encephalopathy syndrome; small cell lung cancer.

FIGURE 1

Brain magnetic resonance imaging images at different time points. (A) Brain metastases were newly diagnosed after second-line treatment. (B) One month after brain radiation therapy. (C) New brain metastasis after taking anlotinib 10 cycles. The PRES developed gradually after taking anlotinib for (D) 1 cycle, (E) 3 cycles, (F) 4 cycles, (G) 6 cycles, (H) 8 cycles, and (I) 10 cycles.

FIGURE 2

Chest CT scans of the patient. (A) The scan was performed after second-line treatment. (B) The scan was performed after third-line treatment. (C) The scan was performed after taking anlotinib for one cycle. (D)The scan showed tumor cavity formation after taking anlotinib for six cycles. (E) The scan showed tumor cavity was larger after taking anlotinib for eight cycles. (F) The tumor cavity didn’t change significantly after taking anlotinib for 10 cycles.