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This information is about sorafenib, which is also known as Nexavar®. It may be used to treat people with a type of kidney cancer| called renal cell carcinoma (RCC), a type of liver cancer| called hepatocellular carcinoma| (HCC) and 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 some types of cancer cells. It also works by slowing the growth of new blood vessels within the tumour.
Multikinase inhibitors work by interfering with proteins called kinases. Kinases are important in regulating how cells work and grow. They send signals to the cell that tell it to divide and make new cells. Kinase inhibitors block these signals and 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 kinase called vascular endothelial growth factor (VEGF) are made. VEGF stimulates the production of blood vessels, which helps the cancer to grow. Sorafenib blocks the activity of VEGF.
It is used to treat people with kidney cancer that has spread outside the kidney (advanced 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 used to treat a type of liver cancer called hepatocellular carcinoma (HCC). HCC is the commonest primary liver cancer (cancer that starts in the liver). It may be used to treat HCC that cannot 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).
Sorafenib is licensed and can be prescribed in the UK but may not be widely available on the NHS. The National Institute for Health and Clinical Excellence (NICE|) is an independent body that currently gives advice on which new drugs or treatments should be available on the NHS.
NICE has not recommended sorafenib as a treatment for people with kidney cancer or liver cancer on the NHS.
We can give you more information on what you can do if a treatment isn't available| .
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).
Sorafenib is a red, round tablet.
It should be taken on an empty stomach with a glass of water at least one hour before or two hours after a meal.
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.
The side effects of sorafenib are generally mild and may go away during treatment as your body adjusts to the medicine. As it's still a new drug, it's too early to know everything about the possible side effects. Check with your doctor if any side effects continue or are troublesome.
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 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.
This is common, but fatigue is usually mild. Fatigue| may be helped by balancing periods of rest with some gentle exercise such as walking.
Sorafenib can cause high blood pressure in some people. If this develops, it's 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.
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|.
Your mouth may become sore|, or you may notice small ulcers during this treatment. 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 may prescribe mouthwashes and medicines to prevent or clear any mouth infections.
Mild nausea| is quite common, but is usually easy to control. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce this.
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.
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 hoarseness or a husky voice.
Some people have muscle, joint or bone pain while on treatment. Your doctor can prescribe painkillers| if you're affected.
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.
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.
Some medicines can interact with sorafenib and may make it less effective. Let your doctor know about any medicines you're taking, including non-prescribed drugs such as complementary therapies| and herbal drugs|.
If you're going to have treatment with surgery or radiotherapy|, you may be advised to stop taking sorafenib for a period of time beforehand. This is because there is a possibility that the effects of sorafenib could interact with these treatments.
It's not advisable to become pregnant or father a child while having sorafenib, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether biological therapies can be 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 treatment.
It's not yet known how sorafenib may affect fertility|.
This section has been compiled using information from:
Product and Patient Information: Nexavar (Sorafenib). 26 August 2010. Bayer Pharmaceuticals Corporation.
British National Formulary. 60th edition. 2010. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Renal cell carcinoma TA178. August 2009. National Institute for Health and Clinical Excellence (NICE).
Hepatocellular carcinoma (advanced and metastatic) – sorafenib (first line) TA189. May 2010. National Institute for Health and Clinical Excellence (NICE).
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