Fruquintinib-Associated Posterior Reversible Encephalopathy Syndrome in a Patient With Multiply Metastatic Rectal Cancer

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  Antiangiogenic agents are frequently used in the treatment of malignancies, such as colorectal cancer. Posterior reversible encephalopathy syndrome (PRES), a clinicoradiographic syndrome characterized by headache, encephalopathy, seizures, and characteristic magnetic resonance imaging (MRI) changes, is a rare but known complication of antiangiogenic therapies.
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  Fruquintinb is a tyrosine kinase inhibitor targeting vascular endothelial growth factor (VEGF) receptors and has been recently approved for the treatment of colorectal cancer refractory to prior standard of care therapies. To date, only 1 other case of PRES associated with fruquintinib has been described. Our case highlights the possibility of PRES association with this novel antiangiogenic and emphasizes the importance of early recognition and management of this rare but potentially life-threatening treatment complication.
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  Our case underscores that prior tolerance of 1 antiangiogenic does not preclude occurrence of PRES associated with another agent from the same class.