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.