Care During Chemotherapy and Beyond
Trade name: Nexavar
Drug type: Sorafenib is a targeted therapy. Sorafenib is
classified as a, Tyrosine Kinase inhibitor, Angiogenesis Inhibitor, VEGF inhibitor.
(For more detail, see "How this drug works," below.)
What Sorafenib Is Used For:
- Treatment of advanced renal cell cancer
- Hepatocellular carcinoma (HCC)
- Thyroid cancer
Note: If a drug has been approved for one use, physicians may elect to use this
same drug for other problems if they believe it may be helpful.
How Sorafenib Is Given:
- As tablets by mouth.
- It is recommended that tablets are taken without food (at least 1 hour before
or 2 hours after eating).
- The amount of sorafenib that you will receive depends on many factors. Your doctor
will determine your exact dosage and schedule.
Important things to remember about the side effects of sorafenib:
- You will not get all of the side effects mentioned below.
- Side effects are often predictable in terms of their onset, duration, and severity.
- Side effects are almost always reversible and will go away after therapy is complete.
- Side effects are quite manageable. There are many options to minimize or prevent
The following side effects are common (occurring in greater than 30%) for
patients taking sorafenib, when compared with those receiving placebo:
- Hand -
foot syndrome (Palmar-plantar erythrodysesthesia or PPE) –skin rash, swelling,
redness, pain and/or peeling of the skin on the palms of hands and soles of feet.
Usually mild, starting 5-6 weeks after start of treatment. May require reductions
in the dose of the medication.
These are less common side effects for patients receiving sorafenib, when
compared with those receiving placebo:
- High blood pressure(particularly
in first 6 weeks of treatment)
- Hair loss(thinning or patchy
- Low white blood cell count. This
could put you at increased risk for infection.
- Poor appetite
- Increased amylase/lipase blood counts
- Low phosphorus level
- Shortness of breath
- Numbness, tingling or pain in hands and feet.
- Low platelet count. This could increase your risk for bleeding
- Dry skin
- Abdominal pain
- Bone, muscle, joint pain
- Weight loss
A rare but serious effect reported in studies of sorafenib when compared with placebo,
was heart problems (2.9%) including heart attack, compared to (0.4%) in
Not all side effects are listed
above. Some that are rare (occurring in less than 10% of patients) are not listed
here. However, you should always inform your health care provider if you experience
any unusual symptoms.
When to contact your doctor or health care provider:
Sorafenib may cause unwanted effects on the heart. Check with your doctor and/or
get emergency help immediately if you experience any signs or symptoms related to
your heart such as:
- Anxiety, cold sweating, increased heart rate, severe pain in the chest and/or
the jaw, neck, back, or arms, and shortness of breath.
Contact your health care provider immediately, day or night, if you should
experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
The following symptoms require medical attention, but are not an emergency. Contact
your health care provider within 24 hours of noticing any of the following:
- Tingling or burning, redness, swelling of the palms of the hands or soles of feet.
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Diarrhea (4-6 episodes in a 24-hour period).
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools.
- Blood in the urine.
- Extreme fatigue (unable to carry on self-care activities).
- Constipation unrelieved by laxative use.
- Signs of infection such as redness or swelling, pain on swallowing, coughing up
mucous, or painful urination.
Always inform your health care provider if you experience any unusual symptoms.
- Before starting sorafenib treatment, make sure you tell your doctor about any
other medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.).
- Sorafinib and certain other medicines can interact with each other and cause serious
side effects. Especially, tell your doctor if you take warfarin (Coumadin®).
- Do not take aspirin, products containing aspirin unless your doctor specifically
- Do not receive any kind of immunization or vaccination without your doctor’s approval
while taking sorafenib.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (Sorafenib may be hazardous to
the fetus. Women who are pregnant or become pregnant must be advised of the
potential hazard to the fetus.)
- For both men and women: Use contraceptives, and do not conceive a child (get pregnant)
while taking sorafenib. Barrier methods of contraception, such as condoms, are recommended.
- Do not breast feed while taking this medication.
- Prevention of hand-foot syndrome. Modification of normal activities of daily living
to reduce friction and heat exposure to hands and feet, for about a week after treatment.
(for more information see - Managing side effects: hand foot syndrome)
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- You may be at risk of infection so try to avoid crowds or people with colds, and
report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- For flu-like symptoms, keep warm with blankets and drink plenty of liquids. There
are medications that can help reduce the discomfort caused by chills.
- Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or
generalized aches and pains. However, be sure to talk with your doctor before taking
- Keep your bowels moving. Your health care provider may prescribe a stool softener
to help prevent constipation that may be caused by this medicine.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that are
effective in managing such problems.
Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking
sorafenib, to monitor side effects and check your response to therapy. Periodic
blood work to monitor your complete blood count (CBC) as well as the function of
other organs (such as your kidneys and liver) will also be ordered by your doctor.
How Sorafenib Works:
Targeted therapy is the result of about 100 years of research dedicated to understanding
the differences between cancer cells and normal cells. To date, cancer treatment
has focused primarily on killing rapidly dividing cells because one feature of cancer
cells is that divide rapidly. Unfortunately, some of our normal cells divide rapidly
too, causing multiple side effects.
Targeted therapy is about identifying other features of cancer cells. Scientists
look for specific differences in the cancer cells and the normal cells. This information
is used to create a targeted therapy to attack the cancer cells without damaging
the normal cells, thus leading to fewer side effects. Each type of targeted therapy
works a little bit differently but all interfere with the ability of the cancer
cell to grow, divide, repair and/or communicate with other cells.
There are different types of targeted therapies, defined in three broad categories.
Some targeted therapies focus on the internal components and function of the cancer
cell. The targeted therapies use small molecules that can get into the cell and
disrupt the function of the cells, causing them to die. There are several types
of targeted therapy that focus on the inner parts of the cells. Other targeted therapies
target receptors that are on the outside of the cell. Therapies that target
receptors are also known as monoclonal antibodies. Antiangiogenesis
inhibitors target the blood vessels that supply oxygen to the cells, ultimately
causing the cells to starve.
Sorafenib is designed to block tumor cell growth in several ways. Sorafenib
targets several enzymes on the surface of cancer cells, as well as targets
within the cell. Several of these targets are thought to be involved in angiogenesis
(making of blood vessels).
Research continues to identify which cancers may be best treated with targeted
therapies and to identify additional targets for more types of cancer.
Note: We strongly encourage you to
talk with your health care professional about your specific medical condition and
treatments. The information contained in this website is meant to be helpful and
educational, but is not a substitute for medical advice.
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