Reversible posterior leukoencephalopathy syndrome and trastuzumab

Reversible posterior leukoencephalopathy syndrome (RPLS) is a serious condition that manifests as headache, convulsions, visual disturbance, and a characteristic magnetic resonance image (MRI) of the brain. We now describe a case of RPLS that was likely attributable to trastuzumab, a monoclonal antibody against human epidermal growth factor receptor-2 (HER2). Accumulating evidence has shown that molecular targeted agents, especially those with antiangiogenic activity cause significant hypertension which can lead to development of RPLS. Trastuzumab is also shown to inhibit tumor angiogenesis by decreasing the production of VEGF and activating antiangiogenic factors. In a clinical trial of trastuzumab, adverse effects of trastuzumab include hypertension, even though it is low incidence (∼10%). Although RPLS is potently reversible, it may result in an irreversible brain damage without prompt appropriate treatment. Given the increasing use of trastuzumab in patients with breast cancer, gastric cancer, or other solid tumors, physicians should be aware of this syndrome associated with acute hypertension during trastuzumab treatment.