PRES Secondary to the LenvatinibPembrolizumab Combination in a Patient with Serous Endometrial Adenocarcinoma

The combination of Lenvatinib and Pembrolizumab has benefited from Early Access Authorization in France since March 2022 in the treatment of advanced or recurrent endometrial cancer.We present a case of PRES secondary to the combination of Lenvatinib and Pembrolizumab in the treatment of an invasive endometrial serous adenocarcinoma.A 66-year-old woman with serous endometrial adenocarcinoma diagnosed two years earlier in the context of peritoneal carcinomatosis, with dissociated response after 6 courses of CARBOPLATIN TAXOL, was put on second-line treatment with LENVATINIB and PEMBROLIZUMAB.The patient presented, five days after the third course, headaches of rapidly increasing intensity.Cerebral imaging was performed revealing T2 hypersignals, bilateral, subcortical, posterior, asymmetrical, and predominant on the right without ADC restriction, in favor of a PRES, motivating the discontinuation of the two incriminated molecules.The evolution was marked by the regression of clinical and radiological signs.The patient subsequently underwent a Pet scan, which revealed progressive disease with uterine, peritoneal, hepatic, adrenal, lymph node and pulmonary lesions, indicating the use of third-line CAELYX.Our case highlights the importance of considering this new therapeutic combination (Lenvatinib and Pembrolizumab) as likely to be associated with PRES.Rigorous neurological clinical monitoring and the use of brain imaging in the face of signs suggestive of PRES are necessary in patients benefiting from this treatment.