Journal of Gastrointestinal Cancer

, Volume 50, Issue 1, pp 123–126 | Cite as

Posterior Reversible Encephalopathy Syndrome During Treatment with Aflibercept, 5-Fluorouracil, Leucovorin, and Irinotecan for Metastatic Colorectal Cancer

  • Nikolaos MiarisEmail author
  • Joseph Sgouros
  • Margarita Gerolympou
  • Basilios Spyropoulos
  • Dionysios Drakopoulos
  • Stefania Gkoura
  • Helen Res
  • Epaminondas Samantas
Case Report


Posterior reversible encephalopathy syndrome (PRES) is an urgent neurologic condition that is associated with white and gray matter vasogenic edema primarily in parietal and occipital lobes [1]. Clinical features usually involve headache, altered mental status, seizures, and visual disturbances [1]. Although PRES is generally a rare reversible condition, it is increasingly reported in the literature, especially in the setting of cancer patients treated with chemotherapy and antiangiogenic drugs targeting the vascular endothelial growth factor (VEGF) pathway.

The combination of aflibercept with 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) has been approved for the treatment of patients with metastatic colorectal cancer (mCRC) after the failure of oxaliplatin-based chemotherapy to control the disease [2]. To the best of our knowledge, no cases of PRES related to aflibercept-FOLFIRI can be found in the published literature.


We present the case of a 64-year-old...


Compliance with Ethical Standards

Informed Consent

Informed consent was obtained from the patient for publication of this manuscript and any accompanying images.

Conflict of Interest

The authors declare that they have no competing interests.

Financial Support



  1. 1.
    Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914–25. doi: 10.1016/S1474-4422(15)00111-8.CrossRefPubMedGoogle Scholar
  2. 2.
    Van Cutsem E, Tabernero J, Lakomy R, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol. 2012;30(28):3499–506. doi: 10.1200/JCO.2012.42.8201.CrossRefGoogle Scholar
  3. 3.
    Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494–500. doi: 10.1056/NEJM199602223340803.CrossRefPubMedGoogle Scholar
  4. 4.
    Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. Am J Neuroradiol. 2007;28(7):1320–7. doi: 10.3174/ajnr.A0549.CrossRefPubMedGoogle Scholar
  5. 5.
    Kamiya-Matsuoka C, Paker AM, Chi L, et al. Posterior reversible encephalopathy syndrome in cancer patients: a single institution retrospective study. J Neuro-Oncol. 2016;128(1):75–84. doi: 10.1007/s11060-016-2078-0.CrossRefGoogle Scholar
  6. 6.
    Lamy C, Oppenheim C, Mas JL. Posterior reversible encephalopathy syndrome. Handb Clin Neurol. 2014;121:1687–701. doi: 10.1016/B978-0-7020-4088-7.00109-7.CrossRefPubMedGoogle Scholar
  7. 7.
    Miaris N, Maltezou M, Papaxoinis G, et al. Posterior reversible encephalopathy syndrome with concurrent nephrotic syndrome in a patient treated with pazopanib for metastatic renal cell carcinoma: case report and review of the literature. Clin Genitourin Cancer. 2017; doi: 10.1016/j.clgc.2016.08.005.
  8. 8.
    Tlemsani C, Mir O, Boudou-Rouquette P, et al. Posterior reversible encephalopathy syndrome induced by anti-VEGF agents. Target Oncol. 2011;6(4):253–8. doi: 10.1007/s11523-011-0201-x.CrossRefPubMedGoogle Scholar
  9. 9.
    Granata G, Greco A, Iannella G, et al. Posterior reversible encephalopathy syndrome—insight into pathogenesis, clinical variants and treatment approaches. Autoimmun Rev. 2015;14(9):830–6. doi: 10.1016/j.autrev.2015.05.006.CrossRefPubMedGoogle Scholar
  10. 10.
    How J, Blattner M, Fowler S, et al. Chemotherapy-associated posterior reversible encephalopathy syndrome: a case report and review of the literature. Neurologist 2016;21(6):112–7. doi: 10.1097/NRL.0000000000000105.
  11. 11.
    Myint ZW, Sen JM, Watts NL, et al. Reversible posterior leukoencephalopathy syndrome during regorafenib treatment: a case report and literature Review of reversible posterior leukoencephalopathy syndrome associated with multikinase inhibitors. Clin Colorectal Cancer. 2017;13(2):127–30. doi: 10.1016/j.clcc.2013.12.003.CrossRefGoogle Scholar
  12. 12.
    Truman N, Nethercott D. Posterior reversible encephalopathy syndrome (PRES) after treatment with oxaliplatin and 5-fluorouracil. Clin Colorectal Cancer. 2013;12(1):70–2. doi: 10.1016/j.clcc.2012.06.003.CrossRefPubMedGoogle Scholar
  13. 13.
    Dedić Plavetić N, Rakušić Z, Ozretić D, et al. Fatal outcome of posterior “reversible” encephalopathy syndrome in metastatic colorectal carcinoma after irinotecan and fluoropyrimidine chemotherapy regimen. World J Surg Oncol. 2014;12(1):264. doi: 10.1186/1477-7819-12-264.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Allen JA, Adlakha A, Bergethon PR. Reversible posterior leukoencephalopathy syndrome after bevacizumab/FOLFIRI regimen for metastatic colon cancer. Arch Neurol. 2006;63(10):1475–8. doi: 10.1001/archneur.63.10.1475.CrossRefPubMedGoogle Scholar
  15. 15.
    Singer S, Grommes C, Reiner AS, et al. Posterior reversible encephalopathy syndrome in patients with cancer. Oncologia. 2015;20:806–11. doi: 10.1634/theoncologist.2014-0149.CrossRefGoogle Scholar
  16. 16.
    Holash J, Davis S, Papadopoulos N, et al. VEGF-Trap: a VEGF blocker with potent antitumor effects. Proc Natl Acad Sci. 2002;99(17):11393–8. doi: 10.1073/pnas.172398299.CrossRefPubMedGoogle Scholar
  17. 17.
    Ciombor KK, Berlin J, Chan E. Aflibercept. Clin Cancer Res. 2013;19(8):1920–5. doi: 10.1158/1078-0432.CCR-12-2911.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Chen H, Modiano MR, Neal JW, et al. A phase II multicentre study of ziv-aflibercept in combination with cisplatin and pemetrexed in patients with previously untreated advanced/metastatic non-squamous non-small cell lung cancer. Br J Cancer. 2014;110(3):602–8. doi: 10.1038/bjc.2013.735.CrossRefPubMedGoogle Scholar
  19. 19.
    Leighl NB, Raez LE, Besse B, et al. A multicenter, phase 2 study of vascular endothelial growth factor trap (Aflibercept) in platinum- and erlotinib-resistant adenocarcinoma of the lung. J Thorac Oncol. 2010;5(7):1054–9. doi: 10.1097/JTO.0b013e3181e2f7fb.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Third Department of Medical Oncology‘Agioi Anargyroi’ General Oncology Hospital of KifisiaAthensGreece
  2. 2.First Department of Internal Medicine401 General Military Hospital of AthensAthensGreece
  3. 3.Department of Radiology401 General Military Hospital of AthensAthensGreece

Personalised recommendations