Regorafenib (Stivarga®)

Regorafenib comes in tablets, so you can take it at home.

During treatment, you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

You will have regular blood samples taken during your treatment. These allow your doctor to check:

• the levels of different blood cells in your body – your blood count
• how your liver and kidneys are working.

The nurse or pharmacist will give you the regorafenib tablets to take home. They may also give you anti-sickness drugs and other medicines to take home. Always take these exactly as explained. This is important to make sure they work as well as possible for you.

You usually take regorafenib tablets once a day for 21 days. You then have a break for 7 days. The total 28 days is called a cycle of treatment.

You usually keep taking regorafenib for as long as it works for you and the side effects are manageable. Your nurse, pharmacist or doctor will discuss your treatment plan with you.

You take regorafenib once a day. Try to take the tablets at the same time each day. You should take them after a light, low-fat meal. For example, 1 light, low-fat meal could include all of the following:

• a small bowl of cereal
• a glass of skimmed milk or apple juice
• a slice of toast with jam
• a cup of tea or coffee.

Swallow the tablets whole with a glass of water. Do not chew, break or crush them.

You should avoid eating grapefruit or drinking grapefruit juice while taking regorafenib. It may affect how this treatment works.

If you forget to take the tablets, you should take the missed dose as soon as possible on the same day. Do not take 2 doses on the same day to make up for a missed dose.

If you are sick just after taking the tablets, contact the hospital. Do not take another dose.

Other things to remember about your tablets:

• Keep them in the original package.
• Keep them safe and out of sight and reach of children.
• If your treatment is stopped, return any unused tablets to the pharmacist.

This treatment can increase your risk of infection. Any infection is usually mild, but it is important to get it treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

• your temperature goes over 37.5°C (99.5°F)
• you suddenly feel unwell, even with a normal temperature
• you have symptoms of an infection
• your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) a lot, or discomfort when you pass urine.

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red cells is low, this is called anaemia. You may have symptoms such as:

• pale skin
• lack of energy
• feeling breathless
• feeling dizzy and light-headed.

Tell your doctor or nurse if you have these symptoms.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Sometimes doctors prescribe a drug called erythropoietin. This helps the body to make more red blood cells. You have it as an injection under the skin. But it is more common to have a blood transfusion for anaemia.

Sometimes this treatment may cause a perforation (hole) in the bowel. This is not common but needs urgent treatment. Contact the hospital straight away if:

• you have severe pain in the tummy, and you feel sick and are vomiting
• you are bleeding from the back passage
• you have black stools (poo)
• you are vomiting blood
• your vomit looks like coffee grounds.

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

• be sore
• be painful, tingle, or swell
• peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

• keeping your hands and feet cool by washing in cool water
• gently moisturising your hands and feet regularly
• wearing gloves to protect your hands and nails when working in the house or garden
• wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

This treatment may affect your skin. It can cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Rarely, a much more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. You may also feel unwell with flu-like symptoms, such as a high temperature and joint pain. If you have any of these symptoms, contact your doctor or hospital immediately.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

• try to drink at least 2 litres (3½ pints) of fluids each day, unless your medical team gives you different advice
• avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
• contact the hospital for advice.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

• tell your nurse or doctor – they can give you a mouthwash or medicines to help
• try to drink plenty of fluids
• avoid alcohol, tobacco, and foods that irritate your mouth and throat.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

This treatment can affect how your liver works. You will have regular blood tests to check this.

Sometimes liver changes can be serious. Contact the hospital straight away if you:

• have yellow skin or eyes
• feel very sleepy
• have dark urine (pee).

Wounds may take longer to heal while you are taking regorafenib. If you have any wounds which are not healing or look infected, speak to your doctor straight away.

If you need surgery, regorafenib will be stopped before it. You can usually start taking it again when the wound is fully healed.

This treatment might increase certain risk factors for heart problems. Tell your doctor if you have:

• had any problems with your heart
• high blood pressure
• high levels of cholesterol – a fatty substance in your blood. 

They can monitor or treat these if needed. Talk to your doctor if you are worried about this. 

Things you can do to take care of your heart include:

• not smoking
• maintaining a healthy weight 
• being physically active.

This treatment may affect the nerves. This can cause numb, tingling or painful hands or feet. Tell your doctor if you have these symptoms or if you find it hard to fasten buttons or do other fiddly tasks.

Rarely, this treatment can cause symptoms including:

• headaches
• confusion
• changes in your eyesight
• seizures (fits).

If you have these symptoms:

• contact the hospital straight away
• do not drive or operate machinery.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.