Sorafenib (Nexavar®)

OncoLink
Last Modified: April 20, 2012

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Pronounced: soe-RAF-e-nib
Classification: Multikinase Inhibitor

About Sorafenib

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.

How to Take Sorafenib

Sorafenib comes as a tablet to take by mouth. It is usually taken twice a day and should be taken on an empty stomach, 1 hour before or 2 hours after a meal. Take sorafenib at around the same times every day. If you miss a dose, skip the missed dose and take the next dose at the scheduled time. Do not try to catch up or double the next dose.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, dexamethasone, carbamazepine, rifampin, phenytoin, St. John's wort, and phenobarbital. Be sure to tell your healthcare provider about all medications and supplements you take.

Possible Side Effects of Sorafenib

There are a number of things you can do to manage the side effects of Sorafenib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

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. Signs of hypertension to report to your team include: blurry vision, nosebleed, headache and fatigue.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Diarrhea

Your oncology team can recommend medications 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, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Decrease in Appetite

Visit OncoLink's section on Nutrition for tips on dealing with this side effect. Ask your nurse about nutritional counseling services.

  • Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
  • If you are not eating enough, nutritional supplements may help.
  • You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months.
  • Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell.
  • Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can also add flavor to vegetables.

Loss or Thinning of Scalp and Body Hair (Alopecia)

Your hair may become thin, 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 or to protect you from the sun. Read more on alopecia.

Hand and Foot Syndrome (HFS)

HFS is a skin reaction that appears on the palms of the hands and/or the soles of the feet as a result of certain chemotherapy agents. It can start as a feeling of tingling or numbness in the palms and/or soles and progress to swelling, redness, peeling skin, and tenderness or pain. Notify your healthcare team right away if you notice any of these signs of HFS. Learn more about HFS on OncoLink.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication or for at least 2 weeks after stopping the medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected. It is not known if this medication passes into breast milk and harm a baby, therefore you should not breastfeed while taking this medication.

Other Side Effects

This medication may interfere with wound healing. The manufacturer recommends stopping the drug before any surgical procedure and not restarting until there is adequate wound healing.

In rare cases, patients developed gastrointestinal perforation, which is the development of a hole in the stomach, small or large intestine. If you develop abdominal pain, nausea, vomiting, constipation or fever, you should notify your healthcare team immediately.

This medication can cause heart rhythm abnormalities (arrhythmias) caused by a prolonged QT interval. If you are at risk for this, your healthcare provider will monitor you for heart problems.

Bleeding, stroke, myocardial infarction (heart attack) and chest pain have also been seen in patients taking this medication. Let your healthcare provider know if you develop any bleeding, including nosebleeds, coughing up blood, vomiting blood or coffee ground appearing vomit, blood in the stool or black stools. If you develop symptoms of a heart attack or stroke (chest pain, numbness in the arm, jaw or back pain, nausea, changes in speech or balance), call 911 right away.


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