Nexavar (Sorafenib)

Sorafenib is indicated for several advanced solid tumours that rely on kinase‑driven growth and angiogenesis.

• Advanced renal cell carcinoma: prolongs progression‑free survival in adults with metastatic disease.
• Unresectable hepatocellular carcinoma: improves overall survival in patients not amenable to curative therapy.
• Radioiodine‑refractory differentiated thyroid carcinoma: delays disease progression in patients with progressive disease.

• Sorafenib inhibits multiple intracellular and cell‑surface kinases, including RAF kinases, VEGFR‑2/3, PDGFR‑β, c‑KIT, FLT‑3 and RET. By blocking these pathways it reduces tumor cell proliferation and angiogenesis, leading to slowed tumour growth and potential tumour regression in responsive cancers.

Sorafenib is associated with a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Diarrhoea: frequent loose stools, may require supportive care.
• Fatigue: persistent tiredness affecting daily activities.
• Hand‑foot skin reaction: redness, swelling or pain on palms and soles.
• Hypertension: elevated blood pressure, often requiring antihypertensive therapy.
• Nausea and vomiting: gastrointestinal upset common during treatment.
• Rash: skin eruptions of varying intensity.

Serious or Rare Side Effects

• Severe hypertension or hypertensive crisis.
• Cardiac ischaemia or myocardial infarction.
• Hepatic failure or marked transaminase elevation.
• Gastrointestinal perforation or bleeding.
• Severe skin reactions such as Stevens‑Johnson syndrome.
• Arterial thromboembolic events including stroke.

Before initiating Sorafenib, clinicians should assess several safety parameters and counsel patients on potential risks.

• Monitor blood pressure: check regularly and treat hypertension promptly.
• Assess liver function: perform baseline and periodic hepatic enzyme tests.
• Evaluate cardiac status: consider ECG and cardiac history, especially in patients with risk factors.
• Counsel on hand‑foot skin reaction: advise patients to report early signs and use moisturisers.
• Avoid use in pregnancy: drug is contraindicated due to fetal risk.
• Store at room temperature: keep in the original pack, protect from moisture and light.

Sorafenib may interact with other medicines, altering its effectiveness or increasing toxicity.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine, St. John's wort): markedly reduce sorafenib exposure.
• Concomitant use with anticoagulants (e.g., warfarin) or antiplatelet agents: heightened risk of bleeding.
• QT‑prolonging drugs (e.g., sotalol, quinidine): may increase the risk of cardiac arrhythmias.

Moderate Interactions (Monitor Closely)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): increase sorafenib plasma levels.
• Antihypertensive agents: sorafenib‑induced hypertension may require dose adjustment.
• Drugs affecting gastric pH (e.g., proton‑pump inhibitors): may modestly affect absorption.
• Herbal supplements with cardiovascular activity: monitor for additive effects on blood pressure.