Incidence and management of ZIv-aflibercept related toxicities in colorectal cancer

Table 4 Special Situations about Toxicities of Zaltrap

Geriatric Use	The effect of ZALTRAP on overall survival was similar in patients < 65 yr old and ≥ 65 yr old who received ZALTRAP/FOLFIRI.
	No dose adjustment of ZALTRAP is recommended for patients ≥ 65 yr of age.
Paediatric Use	The safety in paediatric patients has not been established.
Hepatic Impairment	No dedicated clinical studies have been conducted to evaluate the effect of hepatic impairment on the pharmacokinetics of ziv-aflibercept.
Renal Impairment Contraception and Nursing Mothers	No dedicated clinical studies have been conducted to evaluate the effect of renal impairment on the pharmacokinetics of ziv-aflibercept.
	Females and males of reproductive potential should use highly effective contraception during and up to a minimum of 3 mo after the last dose of treatment.
Overdose	No information on the safety of aflibercept given at doses exceeding 7 mg/kg every 2 wk or 9 mg/kg every 3 wk is present.
	No specific antidote to ZALTRAP overdose exists.
	Patients of Zaltrap overdose should be managed with supportive measures.
Infections	The Velour study showed an increased incidence of infections in patients receiving ZALTRAP/FOLFIRI (46%, all grades; 12%, Grade 3-4) than in patients receiving placebo/FOLFIRI (33%, all grades; 7%, Grade 3-4), including urinary tract infection, nasopharyngitis, upper respiratory tract infection, pneumonia, catheter site infection, and tooth infection.
	Be vigilant about recognizing them.
	Treat them according to general guidelines.