Regorafenib (Stivarga®)

Regorafenib is a type of targeted therapy drug called a cancer growth inhibitor. It is used to treat primary liver cancer and gastrointestinal stromal tumours (GISTs).

What is regorafenib (Stivarga®)?

Regorafenib (Stivarga®) is used to treat: 

It may sometimes be used to treat other cancers. It is best to read this information with our general information about the type of cancer you have.

Regorafenib is a type of targeted therapy drug called a cancer growth inhibitor.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How regorafenib is given

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.

Your course of treatment

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.

Taking regorafenib tablets

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.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Possible side effects

Risk of infection

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.

Bruising and bleeding

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 or purple spots on the skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

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.

Tummy (abdominal) pain

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.

Sore and red palms of hands and soles of feet

You may get sore and red palms of hands and soles of feet. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.

Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:

  • keep your hands and feet cool
  • moisturise your hands and feet regularly
  • avoid tight-fitting socks, shoes and gloves.

Skin changes

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.

Diarrhoea

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.

Sore mouth and throat

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.

Sucking ice chips may sometimes help relieve mouth or throat pain. 

Feeling sick

If you feel sick, tell your doctor or nurse. They can give you anti-sickness drugs to help. Take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.

Constipation

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 for advice. Your doctor can give you drugs called laxatives to help.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Loss of appetite

This treatment can affect your appetite. Don't worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. 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.

Tiredness

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Voice changes

Your voice may sound croaky or hoarse while you are taking this treatment.

Hair loss

Your hair may get thinner while you are taking this treatment. Your nurse can give you advice about coping with hair loss.

High blood pressure

This treatment may cause high blood pressure. Your doctor or nurse will check your blood pressure regularly during your treatment.

Effects on the liver

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).

Slow wound healing

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.

Effects on the heart

This treatment can affect the way your heart works. Your doctor may do tests to see how well your heart is working. You may have these tests before, during, and sometimes after treatment.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms. But it is important to get them checked by a doctor.

Effects on the nervous system

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.

Effects on the thyroid

This treatment can affect the levels of hormones (chemical messengers) usually made by the thyroid. You will have regular blood tests to check the levels. Your doctor may give you tablets to replace these hormones if your levels are low.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • throbbing pain, redness or swelling in a leg or arm
  • suddenly feeling breathless or coughing
  • sharp chest pain, which may be worse when you cough or take a deep breath.

If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.

You can help reduce the risk of developing a blood clot by:

  • staying active during treatment
  • drinking plenty of fluids, especially water.

You may be given anticoagulants to help prevent a clot.

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus (covid) vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations. 

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

About our information

References


Reviewers

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.