Reversible posterior leukoencephalopathy syndrome during regorafenib treatment: a case report and literature review of reversible posterior leukoencephalopathy syndrome associated with multikinase inhibitors.

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare complication of angiogenesis inhibitors. Anti-vascular endothelial growth factor-directed therapies, including the novel vascular endothelial growth factor multikinase inhibitor regorafenib, are used in metastatic colorectal cancer. A 46-year-old man presented with seizures, agitation, altered mental status, and hypertension 4 days after starting regorafenib. Magnetic resonance imaging of the brain suggested RPLS. After discontinuation of regorafenib and the management of hypertension, no further seizure activity occurred and his mental status improved. Antineoplastic agents, including the new oral angiogenesis inhibitors, sunitinib, sorafenib, and pazopanib, have been linked to RPLS. The literature review indicates our case is the first published report of RPLS during regorafenib treatment.