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PRES Class Contraindication — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyPRES Class ContraindicationSCE Medical Oncology

A 62-year-old man on lenvatinib for HCC develops a posterior reversible encephalopathy syndrome (PRES). After recovery, can he receive another VEGFR-TKI?

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Correct answer: D — PRES is generally a class-effect contraindication to ALL anti-VEGF agents — rechallenge with any VEGFR-TKI or anti-VEGF antibody carries significant PRES recurrence risk; alternative non-VEGF systemic therapy (e.g. ICI monotherapy) should be considered

PRES from anti-VEGF therapy is a class effect (shared mechanism: endothelial dysfunction + hypertension → BBB disruption). Rechallenge with ANY anti-VEGF agent (different TKI or antibody) carries significant recurrence risk. For HCC post-PRES: ICI-based regimens without anti-VEGF component (durvalumab + tremelimumab/HIMALAYA) are the safest alternative.

Reference: ESMO Supportive Care; BNF; Fugate et al Lancet Neurol 2015