FOLFIRI-bevacizumab-induced acute toxic leukoencephalopathy

J Oncol Pharm Pract. 2023 Sep;29(6):1516-1519. doi: 10.1177/10781552231178680. Epub 2023 May 25.

Abstract

Introduction: Acute toxic leukoencephalopathy (ATL) is a rare complication of cancer treatment, with symptoms varying from mild cognitive impairment to coma. Recognition and management of ATL are important because in most cases, the cessation of the responsible agent is essential.

Case report: We report a case of a 57-year-old male with relapsed right colon cancer who had multiple steps of chemotherapy, admitted to the emergency department (ED) with confusion and inability to talk, 4 days after FOLFIRI and bevacizumab treatment. To exclude cerebrovascular events cranial computed tomography and diffusion-weighted magnetic resonance imaging were evaluated. There was bilateral and symmetric diffusion restriction on white matter, which was consistent with ATL.

Management and outcome: Supportive treatment such as optimization of blood pressure and metabolic control was applied since there is no specific treatment for ATL other than cessation of the responsible agents. 12 days after the admission to the ED his neurologic symptoms were normalized and there was no diffusion restriction on control imaging.

Discussion: ATL is a rare complication of cancer treatment and responsible agents are increasing in number due to the development of cancer treatment. ATL is associated with drugs that are used frequently such as 5-fluorouracil. ATL is mostly reversible, but the progression of neurologic symptoms was also reported. The diagnosis and cessation of the responsible agent are important in management.

Keywords: Colon cancer; acute toxic leukoencephalopathy; chemotherapy.

Publication types

  • Case Reports

MeSH terms

  • Bevacizumab / adverse effects
  • Diffusion Magnetic Resonance Imaging / methods
  • Fluorouracil / adverse effects
  • Humans
  • Leukoencephalopathies* / chemically induced
  • Leukoencephalopathies* / diagnostic imaging
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed

Substances

  • Bevacizumab
  • Fluorouracil