Sorafenib (Nexavar®)

Sorafenib is a targeted therapy drug that is used to treat:

  • a type of kidney cancer called renal cell carcinoma
  • the most common type of liver cancer, called hepatocellular carcinoma (HCC).

It is also used to treat some types of thyroid cancer. It is best to read this information with our general information about the type of cancer you have.

Sorafenib is given as tablets. Your cancer doctor or nurse will tell you how often you will have it.

Like all targeted therapy drugs, sorafenib can cause side effects. Some of the side effects can be serious, so it is important that you read the detailed information below. How a targeted therapy drug affects people will vary from person to person. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

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

If you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

How sorafenib works

Sorafenib is a type of targeted therapy drug called a tyrosine kinase inhibitor. It works by blocking (inhibiting) signals in the cancer cells that make them grow. Blocking the signals causes the cells to die.

Sorafenib can also stop cancer cells developing new blood vessels. This reduces their supply of oxygen and nutrients, so the tumour shrinks or stops growing.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


When sorafenib is used

Sorafenib is used to treat people with:

Sorafenib may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a clinical trial. If a drug is not routinely available on the NHS, there may be other ways you can get it. Your cancer doctor can give you advice.


Taking sorafenib tablets

You take sorafenib twice a day. Take the tablets with a glass of water at the same times each day. The tablets should be taken without food or with a low-fat meal. If you are going to have a high-fat meal, take sorafenib at least one hour before or two hours after the meal.

Always take your tablets exactly as your nurse or pharmacist has explained. This is important to make sure they work as well as possible for you.

There are some important things to remember when taking your tablets:

  • If you forget to take your tablets, take them as soon as you remember. If it is nearly time for your next dose, forget about the missed one and carry on as normal. Do not take a double dose.
  • Keep your tablets in the original package and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • Get a new prescription before you run out of tablets and make sure you have plenty for holidays.
  • Return any unused tablets to the pharmacist if your treatment is stopped.
  • If you are sick just after taking the tablets, tell your doctor. You may need to take another dose. Do not take another dose without telling your doctor, nurse or pharmacist first.

You usually take sorafenib for as long as it keeps the cancer under control. Some people may need to stop taking sorafenib because of side effects.


Possible side effects of sorafenib

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. Most side effects start to improve after your treatment has finished.

It is important to tell your doctor straight away if you feel unwell or have any severe side effects, even if they are not mentioned above.

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.

Feeling tired

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.

Sore and red hands and feet

Having sore and red palms of hands and soles of feet is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to 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 or if they get worse. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. 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.

Feeling sick

Sorafenib can make you feel sick. If you feel sick, take small sips of fluids and eat small amounts often. Your doctor may give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Changes to your taste

You may get a bitter or metallic taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste bad or have no taste. Try different foods to find out what tastes best to you. Your nurse can give you more advice.

Sore mouth

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

If your mouth 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.

Indigestion

Some people have indigestion or acid reflux when taking sorafenib. Acid reflux is when acid comes up from the stomach into the gullet. Tell your doctor if you are affected. They can prescribe treatment to help.

Loss of appetite

This treatment can affect your appetite. Do not worry if you don’t eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Joint or muscle pain

Tell your doctor if you have joint or muscle pain during treatment. They can prescribe painkillers.

Hair thinning

You may notice your hair becomes thinner. It is very unlikely that all your hair will fall out. Hair loss is temporary and the hair grows back once treatment finishes.

Increased blood pressure

This treatment can cause high blood pressure. You will have your blood pressure checked regularly. If you have headaches, nosebleeds or feel dizzy, let your doctor know. They can prescribe tablets to control high blood pressure.

If you have high blood pressure before you start treatment, your doctor will monitor you closely during treatment.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have 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.

Symptoms of an infection include:

  • feeling shaky
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine a lot.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.

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

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor or nurse if you have any bruising or bleeding that you can’t explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Hoarse voice

You may notice your voice sounds hoarse or you may feel like you have a lump in your throat. Tell your doctor if you experience this. It will usually go back to normal when treatment stops.

Thyroid changes

Sorafenib can affect the thyroid gland. You will have regular blood tests to check how well your thyroid is working during treatment. Possible symptoms of thyroid changes include:

  • tiredness
  • feeling depressed
  • difficulty concentrating
  • weight gain
  • constipation
  • feeling cold
  • dry skin and hair.

If you notice any symptoms, let your doctor know.

Reduced mineral levels in the blood

You may have reduced levels of some minerals in your blood, including:

  • calcium
  • sodium
  • phosphorus
  • potassium.

You will have regular blood tests to check the levels of these minerals in your blood. Your doctor may give you supplements to take if the levels are too low.

Flu-like symptoms

Sorafenib may cause flu-like symptoms such as:

  • feeling hot or cold
  • feeling shivery
  • having a headache
  • aching.

These symptoms can have other causes, such as an infection which may need treatment. If you feel unwell, contact your doctor for advice.

Ringing in your ears (tinnitus)

Tell your doctor if you notice ringing in your ears (tinnitus), or if you have other hearing changes.

Erectile dysfunction

Some men have difficulty getting or maintaining an erection while on this treatment.

Effects on the heart

In some people, sorafenib may 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. Contact your doctor straight away.

Slow wound-healing

Wounds may take longer to heal while you are 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.

Effects on the lungs

Rarely, sorafenib can affect the lungs. If you feel breathless, or more breathless than usual, contact your doctor for advice.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.


Other information

Other drugs

Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Fertility

Doctors don’t yet know how this treatment may affect your fertility (the ability to become pregnant or father a child). If you are worried about this, talk to you doctor before treatment starts.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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 this treatment.