Sorafenib (Nexavar)

Indications


Pharmacology

  • Tyrosine Kinase Inhibitor
    • PDGF Receptor (PDGFR)
    • VEGF Receptor (VEGFR)
  • Raf Kinase Inhibitor
    • B-Raf
    • C-Raf
  • Effects
    • Induces Autophagy: which may suppress tumor growth (and may also result in drug resistance)

Administration

  • PO

Dose Adjustment

  • Hepatic
  • Renal

Adverse Effects

Cardiovascular Adverse Effects

  • Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]]): common (1-10% of cases)
  • Myocardial Ischemia/Infarction (see Coronary Artery Disease, [[Coronary Artery Disease]]): common (1-10% of cases)
  • QT Prolongation (see Torsade, [[Torsade]]): rare (0.01-0.1% of cases)

Dermatologic Adverse Effects

  • Alopecia (see Alopecia, [[Alopecia]]): very common (>10% of cases)
  • Angioedema (see Urticaria-Angioedema, [[Urticaria-Angioedema]]): rare (0.01-0.1% of cases)
  • Erythema (see Erythema, [[Erythema]]): very common (>10% of cases)
  • Erythema Multiforme (see Erythema Multiforme, [[Erythema Multiforme]]): uncommon (0.1-1% of cases)
  • Exfoliative Dermatitis/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (see Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis, [[Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis]])
  • Hand Foot Syndrome (Chemotherapy-Induced Acral Erythema): very common (>10% of cases)
  • Pruritus (see Pruritus, [[Pruritus]]): very common (>10% of cases)
  • Rash: very common (>10% of cases)

Gastrointestinal Adverse Effects

  • Diarrhea (see Diarrhea, [[Diarrhea]]): very common (>10% of cases)
  • Gastrointestinal Perforation (see Intestinal Perforation, [[Intestinal Perforation]]): uncommon (0.1-1% of cases)
  • Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]]): very common (>10% of cases)
  • Pancreatitis (see Acute Pancreatitis, [[Acute Pancreatitis]]): uncommon (0.1-1% of cases)
    • Elevated Amylase/Elevated Lipase: very common (>10% of cases)

Hematologic Adverse Effects

Pulmonary Adverse Effects

Renal Adverse Effects

  • Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]]): common (1-10% of cases)
  • Hypertension(see Hypertension, [[Hypertension]]): very common (>10% of cases)
  • Hypocalcemia (see Hypocalcemia, [[Hypocalcemia]]): common (1-10% of cases)
  • Hypokalemia (see Hypokalemia, [[Hypokalemia]]): common (1-10% of cases)
  • Hypophosphatemia (see Hypophosphatemia, [[Hypophosphatemia]]): very common (>10% of cases)
  • Rhabdomyolysis (see Rhabdomyolysis, [[Rhabdomyolysis]]): rare (0.01-0.1% of cases)

Other Adverse Effects

  • Anaphylaxis (see Anaphylaxis, [[Anaphylaxis]]): rare (0.01-0.1% of cases)
  • Fever (see Fever, [[Fever]]): common (1-10% of cases)
  • Hemorrhage: very common (>10% of cases)
  • Infection: uncommon (0.1-1% of cases)
  • Pain: very common (>10% of cases)

References

  • Perforating folliculitis, angioedema, hand-foot syndrome–multiple cutaneous side effects in a patient treated with sorafenib. J Dtsch Dermatol Ges. 2009 May;7(5):449-52 [MEDLINE]