Sorafenib

Sorafenib is a type of targeted cancer drug. It is a possible treatment for:

• a type of liver cancer called hepatocellular carcinoma
• some types of thyroid cancer when radioactive iodine treatment has not worked
• advanced kidney cancer

You pronounce sorafenib as sor-a-feh-nib.

How does sorafenib work?

Sorafenib is a type of targeted cancer drug called a cancer growth blocker. It works in two ways. It stops:

• signals that tell cancer cells to grow
• cancer cells forming new blood vessels, which they need to be able to grow

How do you have sorafenib?

Sorafenib is a tablet you usually take twice a day, with a glass of water.

You should take it either without food or with a meal that contains low amounts of fat. A high fat meal may make sorafenib work less well.

If you are going to have a high fat meal, take the tablets at least 1 hour before or 2 hours afterwards.

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have sorafenib?

You continue taking sorafenib for as long as the treatment is working and you are not experiencing too many side effects. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of sorafenib?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

• the side effects are affecting your daily life

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Fatigue

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

High temperature, fever or chills

High temperature (fever, shivering or chills) can happen with this drug. This is because it can affect your body’s ability to control temperature. Having a fever with this drug doesn’t always mean you have an infection. But you should call your advice line, as an infection can be serious if not treated quickly.

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Bleeding

There is a risk of bleeding with sorafenib. Let your doctor or nurse know straight away if you have dizziness, fainting, loss of control of any part of the body, darker poo or if you have nose bleeds or cough up blood.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Skin changes

You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Hair thinning

Your hair may thin or you might lose hair in certain areas (patches). You're unlikely to lose all your hair. It usually grows back when you finish treatment. 

Other areas of hair that might be affected include your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. 

Pain

You might get pain in your joints, bones, mouth, tummy (abdomen) and at the site of the tumour. Tell your doctor or nurse if you have pain so they can give you painkillers and advice on what to do to help. 

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Low phosphate levels

Blood tests may show you have low phosphate levels. Your doctor can give you supplements to correct this.

Tell your doctor if you have any muscle weakness or confusion.

High levels of pancreatic enzymes in your blood

You might have high levels of substances (enzymes) called amylase and lipase in your blood. This doesn't usually cause symptoms. Changes in the enzyms levels usually return to normal when you stop the drug.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). . You might have one or more of them. They include:

• breathlessness and looking pale due to a drop in red blood cells
• low platelets which means you may bruise and bleed easily
• lower levels of hormones made by your thyroid gland - you might feel tired, cold, sad or depressed
• low levels of calcium, sodium and potassium in your blood - you have regular blood tests during treatment
• low blood sugar levels
• depression - let your doctor or nurse know if you have a change in mood
• numbness or tingling in your fingers and toes
• taste changes
• ringing in your ears (tinnitus)
• heart problems such as heart failure or heart attack - call 999 if you have chest pain
• redness in your face and other areas of the skin (flushing)
• runny nose
• changes in voice
• mouth problems such as sore or dry mouth, inflammation, mouth ulcers or a burning feeling on your tongue
• heartburn and indigestion
• difficulty swallowing
• a type of skin cancer called squamous cell cancer - tell your doctor if you notice any skin changes
• muscle pain or cramps
• high levels of protein in your wee
• your kidneys not working well (kidney failure)
• erection problems
• flu-like symptoms such as feeling hot or cold, shivery or aching - tell your doctor or nurse if you feel unwell
• feeling weak
• swollen or infected hair follicles (folliculitis)

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
• higher levels of hormones made by your thyroid gland which can cause irregular or fast heart rate (palpitations), weight loss, anxiety and mood swings
• lack of fluid in your body (dehydration)
• changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures) and changes to vision (reversible posterior leukoencephalopathy syndrome)
• lung problems such as inflammation
• inflammation of your pancreas or stomach, or a hole may develop in your stomach or bowel (perforation)
• changes in your liver that can make your skin and eyes look yellow, and have dark wee and pale coloured poo (stools)
• swollen breasts that may feel tender or painful

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know ?

Other medicines, food and drink 

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Slow wound healing

This drug can slow wound healing. If you need to have an operation you may need to stop taking it for a while beforehand. Your doctor will let you know when you can start taking it again.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunistions

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the Medicines Health and Regulatory Authority (MHRA).

You can report any side effect you have to the MHRA as part of their Yellow Card Scheme.