Sorafenib (Nexavar)

Sorafenib is pronounced so-raf-en-ib. It is a type of biological therapy called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinase is a protein which acts as a chemical messenger (an enzyme). There are a number of different tyrosine kinases that encourage cancer cells to grow.

Sorafenib blocks a number of protein kinases and is called a multi kinase inhibitor. It works in two ways. It stops signals that tell cancer cells to grow. It also stops cancer cells forming blood vessels, which they need to grow. Treatment that stops blood vessels forming is called anti angiogenesis treatment.

Sorafenib is a treatment for advanced kidney cancer. It is also known by its brand name Nexavar.

Sorafenib is a tablet you take with a glass of water. You should take it either an hour before you eat or 2 hours afterwards.

You take sorafenib twice a day. You usually carry on taking sorafenib for as long as it works.

It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. Whether you have a full or empty stomach, for example, can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

The side effects associated with sorafenib are listed below. Remember most people don’t have all of them. And if you do have them, they are usually mild.

More than 10 in every 100 people have one or more of these.

• Diarrhoea – this affects 3 out of 10 people (30%) and is usually mild but do tell your doctor or nurse as you can have medicines to control it
• Hand-foot syndrome – soreness and redness of the palms of the hands and soles of the feet happens in 3 out of 10 people (30%) with 1 in 10 (10%) having a more severe reaction
• A rash, or red, dry itchy skin happens in about 3 out of 10 people (30%)
• Fatigue (tiredness) affects about 1 out of 6 people (15%) during and after treatment
• Hair thinning affects 1 in 4 people (25%)
• Feeling sick affects about 1 in 6 people (15%), but is usually well controlled with anti sickness medicines
• Raised blood pressure (hypertension)
• Increased risk of bleeding such as nosebleeds or bleeding gums – if you notice blood in your stool or vomit, contact your doctor straight away
• Loss of fertility – we don’t know exactly what effect this drug may have on your fertility, so do talk to your doctor before starting treatment if having a baby is important to you
• May harm a developing baby – we don’t know how this drug may affect a pregnancy. It is important to talk to your doctor about contraception before having this treatment if there is any chance you or your partner could become pregnant

Between 1 and 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other occasional side effects include

• Skin flushing
• Constipation
• Aching joints
• Pain
• A sore mouth
• Indigestion
• Loss of appetite
• Flu like symptoms
• A hoarse voice
• Low mood
• A mild effect on the liver – you are unlikely to notice any symptoms from this. Your liver will almost certainly go back to normal after the treatment ends. You will have regular blood tests to keep an eye on how your liver is working
• Weakness

Fewer than 1 in 100 people have these.

• Breast tenderness and swelling because sorafenib may lower male sex hormone (testosterone) levels
• Heart problems, including chest pain – if you have any pain, contact your doctor or nurse as soon as possible
• Bleeding of the stomach lining occurs in less than 1 in 100 patients (1%)
• Erection problems for some men
• Some people may have changes in heart rhythm or an increased risk of a heart attack – you will have regular heart checks while having sorafenib

You may only get one or two of the side effects above. They may be mild or more severe. A side effect may get worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your specialist, clinic or ward nurse should give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together. It is especially important to tell your doctor if you are taking warfarin as it can interact with the sorafenib.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.