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Posterior reversible encephalopathy syndrome and progressive diarrhoea: case report In a case series of 3 patients, a 71-year-old woman was described, who developed posterior reversible encephalopathy syndrome (PRES) during treatment with capecitabine. Additionally, she developed progressive diarrhoea during treatment with abemaciclib for leptomeningeal carcinomatosis and metastatic breast cancer [routes, dosages and duration of treatment to reaction onsets not stated]. The woman, who had a history of ulcerative colitis, was presented with progressive lower extremity weakness in December 2014. Subsequently, she was noted to have multiple focal metastatic lesions throughout cervical and lumbar spine and extensive leptomeningeal carcinomatosis. Later, she underwent a lumbar puncture, which revealed metastatic breast cancer. Thereafter, she received dexamethasone and palliative radiation therapy and her condition improved. Later, she started receiving systemic chemotherapy with methotrexate along with folinic acid [leucovorin]. Additionally, anastrozole was added to her therapy. Following completion of seven cycles, her symptoms improved. Hence, her treatment was switched to capecitabine for approximately 18 months. However, she developed PRES secondary to capecitabine. The woman’s treatment with capecitabine was stopped, following which her symptoms of PRES resolved. Her anastrozole therapy was continued for 7 months. However, her disease progressed. Further, palbociclib was added to her therapy, and she developed altered mental status. Her treatment with anastrozole was changed to exemestane and palbociclib therapy was continued for several months. Eventually, she developed progressive pulmonary, hepatic and CNS disease. Therefore, she started receiving abemaciclib and fulvestrant. She experienced progressive diarrhoea, which was difficult to control while receiving abemaciclib. Her treatment abemaciclib was discontinued for quality of life reasons. Treatment with fulvestrant was continued for 7 months. Her disease was progressed in the liver and osseous, CNS and leptomeningeal disease were stable. Thereafter, she was started on paclitaxel and continued till date [not all outcomes stated]. Kapke JT, et al. High-dose intravenous methotrexate in the management of breast cancer with leptomeningeal disease: Case series and review of the literature. Hematology/ 803444624 Oncology and Stem Cell Therapy 12: 189-193, No. 4, Dec 2019. Available from: URL: http://doi.org/10.1016/j.hemonc.2019.08.008

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Reactions 11 Jan 2020 No. 1786