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 and a type of liver cancer called hepatocellular carcinoma. 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 without food or with a meal that contains only low amounts of fat. A high fat meal may make sorafenib work less well. If you have a high fat meal, take the tablets at least 1 hour before 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. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first. You need to take the tablets at about the same time each day. Tell your doctor straight away if you accidentally take more than your prescribed dose. This may make side effects more likely or more severe. If you miss a dose, take it as soon as you remember. If it is nearly time for the next dose, forget about the missed one and take the next dose at the scheduled time. Don't take a double dose.

The side effects associated with sorafenib are listed below. Remember that you will probably only have a few. You can click on the links for tips on how to cope with the effects. Or you can look in our cancer drug side effects section for general information.

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) and weakness affects about 1 out of 6 people (15%) during and after treatment
• Hair thinning affects 1 in 4 people (25%)
• Feeling or being 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 – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor if you plan to have a baby in the future
• Flushing of the skin

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

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

• An 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

Some of these side effects can be life threatening, particularly infections. Contact your doctor or nurse 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

• Constipation
• Aching joints or muscles
• Pain
• A sore or dry mouth and tongue pain
• Loss of appetite
• Flu like symptoms
• A hoarse voice
• 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
• Difficulty swallowing
• Numbness or tingling in the fingers and toes – you may have trouble with fiddly tasks such as doing up buttons. This can start a few days or weeks after treatment and usually goes away within a few months of the treatment finishing
• Indigestion
• Weight loss
• Low levels of calcium in the blood – let your doctor or nurse know if you have painful muscle spasm and cramps, muscle twitching, or numbness or tingling in your feet and hands or around your mouth
• Sadness or depression
• Erection problems for some men
• A hoarse voice
• Heart problems, including chest pain – if you have any pain, contact your doctor or nurse as soon as possible
• Ringing in the ears (tinnitus)
• Kidney changes – you will have regular blood tests to check how well your kidneys are working

Fewer than 1 in 100 people have these.

• Breast tenderness and swelling because sorafenib may lower male sex hormone (testosterone) levels
• Bleeding of the stomach lining
• Some people may have changes in heart rhythm or a higher risk of a heart attack – you will have regular heart checks while having sorafenib
• A runny nose
• Pain in the tummy (abdomen) caused by inflammation of the pancreas, gallbladder or bile ducts
• Yellow skin or eyes (jaundice) caused by high levels of bile pigments in the blood
• A hole in the wall of the digestive system (gastrointestinal perforation) – let your doctor or nurse know straight away if you have a sudden abdominal pain, dizziness and feel ill
• Changes in the brain that can cause headaches, confusion, loss of consciousness, fits (seizures) and eyesight changes – let your doctor or nurse know straight away if you have these
• Non cancerous growths in the skin – some people may have slow growing skin cancers that are usually not harmful and can be removed

You may only get a few 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 they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together. 

Medicines that can react with sorafenib include

• Some blood thinning drugs
• Some antibiotics
• St John’s wort, a herbal treatment for depression
• Some anti epileptic drugs
• Some steroids
• Some other cancer drug treatments
• Some heart medicines

Sorafenib can slow wound healing so if you need to have an operation your doctor will normally advise you to stop taking it for a while beforehand. They will let you know when you can start taking it again.

Sorafenib may harm a baby developing in the womb. It is important to talk to your doctor about contraception before having this treatment if there is any chance that you or your partner could become pregnant.

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines 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.

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.