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Cancer Treatment Information

Treatment Options > Chemotherapy > OncoLink Rx

Sorafenib (Nexavar®, BAY43-9006)

Carolyn Vachani, RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: April 13, 2006

Sorafenib is a type of targeted therapy. This means it works by targeting something specific to the cancer cells, therefore decreasing side effects caused by damage to the healthy cells. Sorafenib actually works by targeting two specific receptors, RAF kinase and VEGF receptors. Blocking the first receptor (RAF kinase) slows down cell division and tumor growth. VEGF receptors are responsible for angiogenesis, or the development of new blood vessels by and for the tumor, so blocking these receptors essentially attacks the tumor's source of nutrients.

Facts about sorafenib

• Sorafenib is approved by the U.S. Food & Drug Administration to treat patients with advanced renal cell cancer.
• Sorafenib is also being studied in many other diseases, including: melanoma, hepatocellular (primary liver cancer), lung, breast, colorectal, and sarcomas.

How to take sorafenib

Sorafenib is given in a pill form, 400 mg taken twice a day without food (two hours after a meal or 1 hour before).

How long should you take sorafenib? You can receive sorafenib as long as the cancer cells continue to respond to this therapy and you are tolerating any side effects.

Side effects of sorafenib

Some of the possible side effects and suggestions for dealing with them include:

High Blood Pressure

High blood pressure (hypertension) occurred in clinical trials within the first few weeks of therapy. Patients should have their blood pressure checked weekly for the first 6 weeks of therapy. Any hypertension should be treated appropriately.

Hand Foot Syndrome

Hand and foot syndrome or reaction is common with sorafenib, occurring in 30-40% of patients in clinical trials. This can begin as a mild tingling, numbness, pins-and- needles feeling, or pain or swelling of the hands and/or feet. This can then progress to painful swelling, redness, blistering or peeling skin that can interfere with a patient's ability to do normal activities. Sorafenib is stopped if this occurs, and can be safely restarted, often at a lower dose, after the skin is allowed to heal. If this reaction continues to occur, the medication may need to be stopped permanently.

Diarrhea

Your doctor or nurse can recommend medication to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads and cereals, and seeds. Soluble fiber is a type of fiber found in some foods. Soluble fiber absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat and farina. Drink 8-10 glasses of non-alcoholic fluid a day to prevent dehydration.

Nausea and/or Vomiting

There are many effective drugs that will prevent, eliminate, or lessen the severity of nausea and vomiting if you need them, so just ask your doctor which is best for you. In addition, dietary adjustments may help. Avoid things that worsen the symptoms, try antacids, like milk of magnesia and calcium tablets (like Tums), saltines, or ginger ale to lessen symptoms.

Loss or thinning of scalp and body hair (alopecia)

Your hair may become thinned, brittle or may fall out. This typically begins two to three weeks after treatment starts. This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes and nose hairs. The use of scarves, wigs, hats and hairpieces may help. Hair generally starts to regrow soon after treatment is completed. Remember your hair helps keep you warm in cold weather, so a hat is particularly important in cold weather.

 

Muscle or Joint Pain/Aches and Headache

Your doctor or nurse can recommend medication and other strategies to relieve pain.

Fatigue

See OncoLink's section on fatigue for helpful tips.

Decrease in Appetite

Sorafenib may affect your appetite. See OncoLink's section on Nutrition for tips on dealing with this side effect.

Low White Blood Cell Count

White blood cells are important for fighting infection. While receiving treatment, you are at a higher risk of getting infections. You should wash your hands frequently and avoid large crowds or people who are sick (i.e.: have colds). You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, or a sore that doesn't heal. This side effect is much more likely when sorafenib is given in conjunction with chemotherapy.