Sorafenib (Nexavar ®)
Sorafenib, which is also known as Nexavar ®, may be used to treat a type of kidney cancer calledrenal cell carcinoma (RCC). Sorafenib can also be used to treat a type of liver cancer called hepatocellular carcinoma (HCC). It may be used to treat other types of cancer as part of a research trial.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Sorafenib is a type of treatment called a multi-kinase inhibitor. Kinases are important proteins in the body that regulate the way cells grow and divide.
Sorafenib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide. Blocking the signals causes the cells to die.
Sorafenib can also stop the cancer cells developing new blood vessels. This reduces their supply of oxygen and nutrients, so the tumour shrinks or stops growing. Drugs that interfere with blood vessel growth in this way are called angiogenesis inhibitors or anti-angiogenics.
When sorafenib is used
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Sorafenib is licensed to treat people with kidney cancer that has spread outside the kidney (advanced or metastatic renal cell cancer) 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.
Sorafenib is also licensed to treat a type of liver cancer called hepatocellular carcinoma (HCC). HCC is the most common primary liver cancer (cancer that starts in the liver). Sorafenib may be used to treat HCC that can’t be removed with surgery.
Sorafenib is also being studied as a possible treatment for other cancers and for kidney cancer that can be removed with an operation (early kidney cancer).
The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. Neither NICE nor the SMC recommend the use of sorafenib.
As a result, sorafenib may not be available on the NHS, although you may be given it as part of a clinical trial. We have more information on what you can do if a treatment isn't available.
What sorafenib looks like
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Sorafenib is a red, round tablet.
How sorafenib is given
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Sorafenib should be taken on an empty stomach with a glass of water at least one hour before or two hours after a meal. It is usually taken twice a day.
Sorafenib is usually taken for as long as it’s keeping the cancer under control or until side effects become too troublesome.
Possible side effects of sorafenib
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Each person’s reaction to cancer treatment is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone having this treatment.
We have outlined the most common side effects, but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
The side effects of sorafenib are generally mild. They may go away during treatment as your body adjusts to the medicine.
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 rarely, people may need to stop having the treatment completely.
Changes in the skin are quite common, such as a rash, redness, dryness or itching. 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.
Feeling tired is a common side effect, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate machinery or drive.
You may have frequent or loose bowel movements. This can usually be easily controlled with medicine, but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Your mouth may become sore, or you may notice small ulcers during this treatment. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. We have more information about coping with a sore mouth.
Feeling sick (nausea)
This is usually mild. If you do feel sick, it may begin a few hours after treatment and last for a few days. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting.
If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these, or you can buy them from a pharmacy.
You may notice your hair becomes thinner. It's very unlikely all of your hair will fall out. Hair loss is temporary and the hair grows back once treatment finishes.
You may develop a hoarse or husky voice.
Joint pains (arthralgia)
Some people have muscle, joint or bone pain while having treatment. Your doctor can prescribe painkillers if you're affected by this.
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.
Sorafenib may occasionally cause problems with the blood supply to the heart. If you have chest pain, breathlessness or other symptoms, it may mean your heart is affected, so contact your doctor immediately.
Wounds may take longer to heal while you're having treatment with sorafenib. If you have any surgery planned, you may need to stop taking sorafenib before the operation and not start taking it again for a few weeks afterwards. Your doctor will give you more advice.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Additional information about sorafenib
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Some medicines, including those that you can buy from a shop or pharmacy, can be harmful to take when you’re having sorafenib. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Little is known about the effects of sorafenib on a developing baby. Therefore it’s not advisable to become pregnant or father a child while taking this drug.
It’s not known whether sorafenib is present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There is a potential risk that sorafenib may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having sorafenib treatment. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
Things to remember about sorafenib tablets
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It is important to take your tablets as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you’re taking a course of sorafenib tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in the original packaging and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
If you’re sick just after taking the tablets, tell your doctor, as you may need to take another dose. Don't take another tablet without telling your doctor, nurse or pharmacist first.
If you forget to take a tablet, don't take a double dose. Tell your doctor and keep to your regular dose schedule.
This information has been compiled using information from a number of reliable sources, including:
321/06 - Sorafenib 200mg tablets (Nexavar). Scottish Medicines Consortium (SMC). November 2006.
482/08 - Sorafenib (Nexavar). Scottish Medicines Consortium (SMC). January 2011.
Bevacizumab (first-line), sorafenib (first- and second-line), sunitinib (second-line) and temsirolimus (first-line) for the treatment of advanced and/or metastatic renal cell carcinoma (TA178). National Institute for Health and Clinical Excellence (NICE). August 2009.
British National Formulary. 63rd edition. British Medical Association and Royal Pharmaceutical Society of Great Britain. 2012.
electronic Medicines Compendium (eMC) (accessed September 2012).
Sorafenib for the treatment of advance hepatocellular carcinoma (TA189). National Institute for Health and Clinical Excellence (NICE). May 2010.
With thanks to Dr James Larkin, Consultant Oncologist; and the people affected by cancer who reviewed this edition. Reviewing is just one of the ways you could help when you join our Cancer Voices network.