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PRES Anti-VEGF — SCE Medical Oncology MCQ

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HardGI CancersPRES Anti-VEGFSCE Medical Oncology

A 65-year-old man with metastatic CRC on FOLFIRI + bevacizumab develops posterior reversible encephalopathy syndrome (PRES). After recovery, the oncologist needs to select a bevacizumab-free regimen. What alternative biologic can be used with chemotherapy?

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Correct answer: B — Cetuximab (if RAS wild-type)

After PRES from bevacizumab, all anti-VEGF agents (bevacizumab, ramucirumab, ziv-aflibercept, VEGFR-TKIs) should generally be avoided as PRES is a class effect. If the tumour is RAS wild-type, cetuximab or panitumumab (anti-EGFR, different mechanism) can be used with chemotherapy. If RAS mutant, chemotherapy alone is the safest approach. PRES from anti-VEGF is generally a contraindication to re-exposure to any VEGF pathway inhibitor.

Reference: ESMO 2024 mCRC Guidelines; BNF