Depigmentation of hair or skin may occur during treatment. Discontinue if SJS or erythema multiforme (eg, progressive skin rash often w/ blisters or mucosal lesions); pancreatitis; necrotizing fasciitis, thrombotic microangiopathy, nephrotic syndrome, & CHF occur. Not for patients w/ NSCLC. Routine assessment for treatment-emergent bleeding events should include CBC & physical exam. Patients w/ intra-abdominal malignancies. Supportive care for GI adverse events requiring treatment may include anti-emetic or anti-diarrheal medication. Monitor LFTs (ALT, AST, bilirubin levels) before initiation of treatment, during each cycle of treatment, & as clinically indicated; monitor patients at risk of tumor lysis syndrome w/ high tumor burden, & regularly check blood glucose levels in diabetics. Interrupt treatment for Grade 3 or 4 hepatic-related adverse events & discontinue if there is no resolution. Perform CBC at the start of each treatment cycle. Patients who are at risk for or who have history of CV events eg, heart failure, cardiomyopathy, myocardial ischemia & MI. Carefully monitor for clinical signs & symptoms of CHF; development or worsening of proteinuria. Consider baseline & periodic LVEF evaluations; baseline evaluation of ejection fraction in patients w/o cardiac risk factors. Patients w/ known history of QT interval prolongation, taking antiarrhythmics, or w/ relevant preexisting cardiac disease, bradycardia or electrolyte disturbances. Concomitant treatment w/ strong CYP3A4 inhibitors; IV bisphosphonates. Screen patients for HTN & control as appropriate. Baseline laboratory measurement of thyroid function, & baseline urinalysis are recommended. Treat hypo- or hyperthyroidism, & signs & symptoms suggestive of thyroid dysfunction prior to start of therapy. Patients w/ seizures & signs/symptoms consistent w/ reversible posterior leukoencephalopathy syndrome (RPLS) eg, HTN, headache, decreased alertness, altered mental functioning & visual loss including cortical blindness. Temporarily interrupt therapy in patients undergoing major surgical procedures. Consider dental exam & appropriate preventive dentistry prior to treatment. Avoid invasive dental procedures. May affect ability to drive or operate machinery. Pregnancy & lactation. Ped patients.
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