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This information is about sorafenib, a treatment for people with cancer. Sorafenib is also called Nexavar®. It is used to treat people with a type of kidney cancer called renal cell carcinoma (RCC). Sorafenib can also be used to treat people with a type of liver cancer called hepatocellular carcinoma (HCC). Sorafenib may be used to treat other types of cancer as part of a research trial.
Sorafenib is a type of drug called a multi-targeted kinase inhibitor. It interferes with the growth of kidney cancer cells. It also works by slowing the growth of new blood vessels within the tumour.
It is used to treat people with kidney cancer that has spread outside the kidney and who are no longer being helped by treatment with interferon-alpha (IFN) or interleukin-2 (IL-2), or for whom these drugs are not suitable.
Hepatocellular carcinoma is the commonest type of primary liver cancer (cancer that starts in the liver). Sorafenib can be used when the cancer cannot be removed with surgery.
Although sorafenib is licensed and can be prescribed in the UK, it has not yet been assessed by the National Institute for Health and Clinical Excellence (NICE). NICE gives advice on which new drugs or treatments should be available on the NHS. As a result, sorafenib may not be widely available on the NHS.
For more information see our section on what you can do if a treatment isn't available.
Sorafenib is also being studied as a possible treatment for many other cancers, including melanoma, non small-cell lung cancer and mesothelioma.
Multi-targeted kinase inhibitors work by interfering with proteins called kinases. Kinases are important in regulating how cells work and grow. They send signals within the cell that tell it to divide and make new cells. Kinase inhibitors block these signals and so affect the cancer’s ability to grow.
Some types of kinase stimulate cells to make new blood vessels. Making blood vessels is called angiogenesis. Cancer cells need to make new blood vessels so that they can grow and spread. In kidney cancer, higher-than-normal amounts of a type of protein called vascular endothelial growth factor (VEGF) are made. Stimulation of VEGF increases the production of blood vessels, thus helping the cancer to grow. Sorafenib blocks the activity of VEGF.
Sorafenib is a red, round tablet.
Sorafenib should be taken on an empty stomach with a glass of water, at least one hour before or two hours after a meal. The usual dose is two 200mg tablets twice daily. Your doctor may adjust the dose.
Each person's reaction to an anti-cancer drug is different. Some people have very few side effects, while others may experience more. If you notice any effects which you think may be due to the drug, but which aren’t mentioned here, please discuss them with your doctor.
The side effects of sorafenib are generally mild and may go away during treatment as your body adjusts to the medicine. As it is still a new drug it is too early to know everything about the possible side effects. Check with your doctor if any side effects continue or are troublesome.
Hand/foot skin reaction This is common. You may notice redness of the palms of your hands and soles of your feet. Sometimes the hands and feet become sore or swollen. There may also be changes of sensation, such as numbness or tingling. If you notice this, let your specialist know. Occasionally, if soreness doesn’t settle or if blistering develops, your doctors may need to reduce the dose of sorafenib or interrupt the treatment. Very occasionally, people may need to stop having the treatment completely.
Effects on the skin Changes in the skin such as a rash, redness, dryness or itching are quite common. These side effects are usually mild. Speak to your doctor or nurse if you have any of these symptoms. They can advise you about creams or lotions to use, or prescribe medicines to relieve itching.
High blood pressure Sorafenib can cause high blood pressure in some people. If this develops, it is most likely to happen within the first few weeks of taking the drug. Your blood pressure will be checked every week for the first six weeks of treatment. If you develop high blood pressure you may be prescribed medicines to control this.
Tiredness (fatigue) and a general feeling of weakness This is common, but fatigue is usually mild. It’s important to allow yourself plenty of time to rest.
Diarrhoea You may have frequent or loose bowel movements. Tell your doctor if this is severe or if it continues. It's important to drink plenty of fluids if you have diarrhoea.
Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly can help. Tell your nurse or doctor if you have mouth problems. They may prescribe mouthwashes and medicines to prevent or clear any mouth infection.
Feeling sick (nausea) Mild nausea is quite common, but is usually easy to control. Your doctor can prescribe effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce this.
Constipation It usually helps to drink plenty of fluids, eat a high fibre diet and take gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. Your doctor can prescribe these.
Thinning hair You may notice your hair becomes thinner. It is very unlikely all of your hair will fall out. Hair loss is temporary and the hair re-grows once treatment has finished.
Hoarseness You may develop hoarseness or a husky voice.
Muscle pains (arthralgia) Some people have muscle, joint or bone pain while on treatment. Your doctor can prescribe painkillers if you are affected.
Bleeding problems Sorafenib may increase your chance of bleeding. This is a less common side effect and can affect people in different ways. For example, your gums may bleed, or you may bruise more easily or notice blood in your urine or stools. If you notice any unusual bleeding contact your doctor immediately.
Heart problems This drug may occasionally cause problems with the blood supply to the heart. If you have chest pain, breathlessness or other symptoms that may mean your heart is affected, contact your doctor immediately.
Other medicines Some medicines can interact with sorafenib and may make it less effective. Let your doctor know about any medicines you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Contraception It is not advisable to become pregnant or father a child while taking sorafenib, as the drug may harm a developing foetus. It is important to use effective contraception while taking this drug, and for at least a few months afterwards.
Fertility It is not yet known how sorafenib may affect fertility.
This section has been compiled using information from:
For further references, please see the general bibliography.
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