Sorafenib

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Sorafenib
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Alberto Plate [3]

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Overview

Sorafenib is a kinase inhibitor that is FDA approved for the treatment of unresectable hepatocellular carcinoma, advanced renal cell carcinoma, locally recurrent or metastatic, progressive, differentiated thyroid carcinoma refractory to radioactive iodine treatment. Common adverse reactions include hypertension, acral erythema, alopecia, Peeling of skin, rash, hypoalbuminemia, hypocalcemia, hypophosphatemia, raised TSH level, weight decreased, abdominal pain, decrease in appetite, diarrhea, Increased serum lipase level, Loss of appetite, nausea, serum amylase raised, lymphocytopenia, thrombocytopenia, ALT/SGPT level raised, Infectious diseases, fatigue and pain.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Recommended Dose for Hepatocellular Carcinoma, Renal Cell Carcinoma, and Differentiated Thyroid Carcinoma
  • Dosage: 200 mg q12h, taken 1 hour before or 2 hours after a meal. Treatment should continue until the patient is no longer clinically benefiting from therapy or until unacceptable toxicity occurs. Temporary interruption of Sorafenib is recommended in patients undergoing major surgical procedures.
Dose modifications for Hepatocellular Carcinoma and Renal Cell Carcinoma

When dose reduction is necessary, the Sorafenib dose may be reduced to 400 mg once daily. If additional dose reduction is required, Sorafenib may be reduced to a single 400 mg dose every other day. If dermatological toxicity presented, the following scheme should be followed:

Dose Modifications for Differentiated Thyroid Carcinoma
Dose Modification in Skin Toxicity

Following improvement of Grade 2 or 3 dermatologic toxicity to Grade 0–1 after at least 28 days of treatment on a reduced dose of Sorafenib, the dose of Sorafenib may be increased one dose level from the reduced dose. Approximately 50% of patients requiring a dose reduction for dermatologic toxicity are expected to meet these criteria for resumption of the higher dose and roughly 50% of patients resuming the previous dose are expected to tolerate the higher dose (that is, maintain the higher dose level without recurrent Grade 2 or higher dermatologic toxicity)

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Sorafenib in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Sorafenib in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding Sorafenib FDA-Labeled Indications and Dosage (Pediatric) in the drug label.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Sorafenib in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Sorafenib in pediatric patients.

Contraindications

Warnings

Risk of Cardiac Ischemia and/or Infarction

In the HCC study, the incidence of cardiac ischemia/infarction was 2.7% in Sorafenib-treated patients compared with 1.3% in the placebo-treated group, in RCC Study 1, the incidence of cardiac ischemia/infarction was higher in the Sorafenib-treated group (2.9%) compared with the placebo-treated group (0.4%), and in the DTC study, the incidence of cardiac ischemia/infarction was 1.9% in the Sorafenib-treated group compared with 0% in the placebo-treated group. Patients with unstable coronary artery disease or recent myocardial infarction were excluded from this study. Temporary or permanent discontinuation of Sorafenib should be considered in patients who develop cardiac ischemia and/or infarction.

Risk of Hemorrhage

An increased risk of bleeding may occur following Sorafenib administration. In the HCC study, an excess of bleeding regardless of causality was not apparent and the rate of bleeding from esophageal varices was 2.4% in Sorafenib-treated patients and 4% in placebo-treated patients. Bleeding with a fatal outcome from any site was reported in 2.4% of Sorafenib-treated patients and 4% in placebo-treated patients. In RCC Study 1, bleeding regardless of causality was reported in 15.3% of patients in the Sorafenib-treated group and 8.2% of patients in the placebo-treated group. The incidence of CTCAE Grade 3 and 4 bleeding was 2% and 0%, respectively, in Sorafenib-treated patients, and 1.3% and 0.2%, respectively, in placebo-treated patients. There was one fatal hemorrhage in each treatment group in RCC Study 1. In the DTC study, bleeding was reported in 17.4% of Sorafenib-treated patients and 9.6% of placebo-treated patients; however the incidence of CTCAE Grade 3 bleeding was 1% in Sorafenib-treated patients and 1.4% in placebo-treated patients. There was no Grade 4 bleeding reported and there was one fatal hemorrhage in a placebo-treated patient. If any bleeding necessitates medical intervention, permanent discontinuation of Sorafenib should be considered. Due to the potential risk of bleeding, tracheal, bronchial, and esophageal infiltration should be treated with local therapy prior to administering Sorafenib in patients with DTC.

Risk of Hypertension

Monitor blood pressure weekly during the first 6 weeks of Sorafenib. Thereafter, monitor blood pressure and treat hypertension, if required, in accordance with standard medical practice. In the HCC study, hypertension was reported in approximately 9.4% of Sorafenib-treated patients and 4.3% of patients in the placebo-treated group. In RCC Study 1, hypertension was reported in approximately 16.9% of Sorafenib-treated patients and 1.8% of patients in the placebo-treated group. In the DTC study, hypertension was reported in 40.6% of Sorafenib-treated patients and 12.4% of placebo-treated patients. Hypertension was usually mild to moderate, occurred early in the course of treatment, and was managed with standard antihypertensive therapy. In cases of severe or persistent hypertension despite institution of antihypertensive therapy, consider temporary or permanent discontinuation of Sorafenib. Permanent discontinuation due to hypertension occurred in 1 of 297 Sorafenib-treated patients in the HCC study, 1 of 451 Sorafenib-treated patients in RCC Study 1, and 1 of 207 Sorafenib-treated patients in the DTC study.

Risk of Dermatologic Toxicities

Hand-foot skin reaction and rash represent the most common adverse reactions attributed to Sorafenib. Rash and hand-foot skin reaction are usually CTCAE Grade 1 and 2 and generally appear during the first six weeks of treatment with Sorafenib. Management of dermatologic toxicities may include topical therapies for symptomatic relief, temporary treatment interruption and/or dose modification of Sorafenib, or in severe or persistent cases, permanent discontinuation of Sorafenib. Permanent discontinuation of therapy due to hand-foot skin reaction occurred in 4 (1.3%) of 297 Sorafenib-treated patients with HCC, 3 (0.7%) of 451 Sorafenib-treated patients with RCC, and 11 (5.3%) of 207 Sorafenib-treated patients with DTC.

There have been reports of severe dermatologic toxicities, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These cases may be life-threatening. Discontinue Sorafenib if SJS or TEN are suspected.

Risk of Gastrointestinal Perforation

Gastrointestinal perforation is an uncommon adverse reaction and has been reported in less than 1% of patients taking Sorafenib. In some cases this was not associated with apparent intra-abdominal tumor. In the event of a gastrointestinal perforation, discontinue Sorafenib.

Warfarin

Infrequent bleeding or elevations in the International Normalized Ratio (INR) have been reported in some patients taking warfarin while on Sorafenib. Monitor patients taking concomitant warfarin regularly for changes in prothrombin time (PT), INR or clinical bleeding episodes.

Wound Healing Complications

No formal studies of the effect of Sorafenib on wound healing have been conducted. Temporary interruption of Sorafenib is recommended in patients undergoing major surgical procedures. There is limited clinical experience regarding the timing of reinitiation of Sorafenib following major surgical intervention. Therefore, the decision to resume Sorafenib following a major surgical intervention should be based on clinical judgment of adequate wound healing.

Increased Mortality Observed with NEXAVAR Administered in Combination with Carboplatin/Paclitaxel and Gemcitabine/Cisplatin in Squamous Cell Lung Cancer

In a subset analysis of two randomized controlled trials in chemo-naive patients with Stage IIIB-IV non-small cell lung cancer, patients with squamous cell carcinoma experienced higher mortality with the addition of Sorafenib compared to those treated with carboplatin/paclitaxel alone (HR 1.81, 95% CI 1.19–2.74) and gemcitabine/cisplatin alone (HR 1.22, 95% CI 0.82-1.80). The use of Sorafenib in combination with carboplatin/paclitaxel is contraindicated in patients with squamous cell lung cancer. Sorafenib in combination with gemcitabine/cisplatin is not recommended in patients with squamous cell lung cancer. The safety and effectiveness of Sorafenib has not been established in patients with non-small cell lung cancer.

Risk of QT Interval Prolongation

Sorafenib can prolong the QT/QTc interval. QT/QTc interval prolongation increases the risk for ventricular arrhythmias. Avoid Sorafenib in patients with congenital long QT syndrome. Monitor electrolytes and electrocardiograms in patients with congestive heart failure, bradyarrhythmias, drugs known to prolong the QT interval, including Class Ia and III antiarrhythmics. Correct electrolyte abnormalities (magnesium, potassium, calcium). Interrupt Sorafenib if QTc interval is greater than 500 milliseconds or for an increase from baseline of 60 milliseconds or greater.

Drug-Induced Hepatitis

Sorafenib-induced hepatitis is characterized by a hepatocellular pattern of liver damage with significant increases of transaminases which may result in hepatic failure and death. Increases in bilirubin and INR may also occur. The incidence of severe drug-induced liver injury, defined as elevated transaminase levels above 20 times the upper limit of normal or transaminase elevations with significant clinical sequelae (for example, elevated INR, ascites, fatal, or transplantation), was two of 3,357 patients (0.06%) in a global monotherapy database. Monitor liver function tests regularly. In case of significantly increased transaminases without alternative explanation, such as viral hepatitis or progressing underlying malignancy, discontinue Sorafenib.

Embryofetal Risk

Based on its mechanism of action and findings in animals, Sorafenib may cause fetal harm when administered to a pregnant woman. Sorafenib caused embryo-fetal toxicities in animals at maternal exposures that were significantly lower than the human exposures at the recommended dose of 400 mg twice daily. Advise women of childbearing potential to avoid becoming pregnant while on Sorafenib because of the potential hazard to the fetus.

Impairment of Thyroid Stimulating Hormone Suppression in Differentiated Thyroid Carcinoma

Sorafenib impairs exogenous thyroid suppression. In the DTC study, 99% of patients had a baseline thyroid stimulating hormone (TSH) level less than 0.5 mU/L. Elevation of TSH level above 0.5 mU/L was observed in 41% of Sorafenib-treated patients as compared with 16% of placebo-treated patients. For patients with impaired TSH suppression while receiving Sorafenib, the median maximal TSH was 1.6 mU/L and 25% had TSH levels greater than 4.4 mU/L. Monitor TSH levels monthly and adjust thyroid replacement medication as needed in patients with DTC

Adverse Reactions

Clinical Trials Experience

Adverse Reactions in HCC Study

Adverse Reactions Reported in at Least 10% of Patients and at a Higher Rate in Sorafenib Arm than the Placebo Arm – HCC Study:

Constitutional symptoms
Dermatological/skin Effects
Gastrointestinal Effects
Hepatobiliary/Pancreas Effects

Hypertension was reported in 9% of patients treated with Sorafenib and 4% of those treated with placebo. CTCAE Grade 3 hypertension was reported in 4% of Sorafenib-treated patients and 1% of placebo-treated patients. No patients were reported with CTCAE Grade 4 reactions in either treatment group. Hemorrhage/bleeding was reported in 18% of those receiving Sorafenib and 20% of placebo-treated patients. The rates of CTCAE Grade 3 and 4 bleeding were also higher in the placebo-treated group (CTCAE Grade 3 – 3% Sorafenib and 5% placebo and CTCAE Grade 4 – 2% Sorafenib and 4% placebo). Bleeding from esophageal varices was reported in 2.4% in Sorafenib-treated patients and 4% of placebo-treated patients. Renal failure was reported in <1% of patients treated with Sorafenib and 3% of placebo-treated patients. The rate of adverse reactions (including those associated with progressive disease) resulting in permanent discontinuation was similar in both the Sorafenib and placebo-treated groups (32% of Sorafenib-treated patients and 35% of placebo-treated patients).

Laboratory Abnormalities

The following laboratory abnormalities were observed in patients with HCC:

  • Hypophosphatemia was a common laboratory finding, observed in 35% of Sorafenib-treated patients compared to 11% of placebo-treated patients; CTCAE Grade 3 hypophosphatemia (1–2 mg/dL) occurred in 11% of Sorafenib-treated patients and 2% of patients in the placebo-treated group; there was 1 case of CTCAE Grade 4 hypophosphatemia (<1 mg/dL) reported in the placebo-treated group. The etiology of hypophosphatemia associated with Sorafenib is not known.
  • Elevated lipase was observed in 40% of patients treated with Sorafenib compared to 37% of patients in the placebo-treated group. CTCAE Grade 3 or 4 lipase elevations occurred in 9% of patients in each group. Elevated amylase was observed in 34% of patients treated with Sorafenib compared to 29% of patients in the placebo-treated group. CTCAE Grade 3 or 4 amylase elevations were reported in 2% of patients in each group. Many of the lipase and amylase elevations were transient, and in the majority of cases Sorafenib treatment was not interrupted. Clinical pancreatitis was reported in 1 of 297 Sorafenib-treated patients (CTCAE Grade 2).
  • Elevations in liver function tests were comparable between the 2 arms of the study. Hypoalbuminemia was observed in 59% of Sorafenib-treated patients and 47% of placebo-treated patients; no CTCAE Grade 3 or 4 hypoalbuminemia was observed in either group.
  • INR elevations were observed in 42% of Sorafenib-treated patients and 34% of placebo-treated patients; CTCAE Grade 3 INR elevations were reported in 4% of Sorafenib-treated patients and 2% of placebo-treated patients; there was no CTCAE Grade 4 INR elevation in either group.
  • Lymphopenia was observed in 47% of Sorafenib-treated patients and 42% of placebo-treated patients.
  • Thrombocytopenia was observed in 46% of Sorafenib-treated patients and 41% of placebo-treated patients; CTCAE Grade 3 or 4 thrombocytopenia was reported in 4% of Sorafenib-treated patients and less than 1% of placebo-treated patients.
  • Hypocalcemia was reported in 27% of Sorafenib-treated patients and 15% of placebo-treated patients. CTCAE Grade 3 hypocalcemia (6–7 mg /dL) occurred in 2% of Sorafenib-treated patients and 1% of placebo-treated patients. CTCAE Grade 4 hypocalcemia (<6 mg/dL) occurred in 0.4% of Sorafenib-treated patients and in no placebo-treated patients.
  • Hypokalemia was reported in 9.5% of Sorafenib- treated patients compared to 5.9% of placebo-treated patients. Most reports of hypokalemia were low grade (CTCAE Grade 1). CTCAE Grade 3 hypokalemia occurred in 0.4% of Sorafenib-treated patients and 0.7% of placebo-treated patients. There were no reports of Grade 4 hypokalemia.

Adverse Reactions in RCC Study 1

Adverse Reactions Reported in at Least 10% of Patients and at a Higher Rate in Sorafenib Arm than the Placebo Arm – RCC Study 1:

Cardiovascular Effects
Constitutional Symptoms
Dermatologic Effects
Gastrointestinal Effects
Hemorragic Effects
Neurological Effects
Pain
Respiratory Effects
Laboratory Findings

The following laboratory abnormalities were observed in patients with RCC in Study 1:

  • Hypophosphatemia was a common laboratory finding, observed in 45% of Sorafenib-treated patients compared to 11% of placebo-treated patients. CTCAE Grade 3 hypophosphatemia (1–2 mg/dL) occurred in 13% of Sorafenib-treated patients and 3% of patients in the placebo-treated group. There were no cases of CTCAE Grade 4 hypophosphatemia (<1 mg/dL) reported in either Sorafenib or placebo-treated patients. The etiology of hypophosphatemia associated with Sorafenib is not known.
  • Elevated lipase was observed in 41% of patients treated with Sorafenib compared to 30% of patients in the placebo-treated group. CTCAE Grade 3 or 4 lipase elevations occurred in 12% of patients in the Sorafenib-treated group compared to 7% of patients in the placebo-treated group. Elevated amylase was observed in 30% of patients treated with Sorafenib compared to 23% of patients in the placebo-treated group. CTCAE Grade 3 or 4 amylase elevations were reported in 1% of patients in the Sorafenib-treated group compared to 3% of patients in the placebo-treated group. Many of the Sorafenib and amylase elevations were transient, and in the majority of cases Sorafenib treatment was not interrupted. Clinical pancreatitis was reported in 3 of 451 Sorafenib-treated patients (one CTCAE Grade 2 and two Grade 4) and 1 of 451 patients (CTCAE Grade 2) in the placebo-treated group.
  • Lymphopenia was observed in 23% of Sorafenib-treated patients and 13% of placebo-treated patients. CTCAE Grade 3 or 4 lymphopenia was reported in 13% of Sorafenib-treated patients and 7% of placebo-treated patients. Neutropenia was observed in 18% of Sorafenib-treated patients and 10% of placebo-treated patients. CTCAE Grade 3 or 4 neutropenia was reported in 5% of Sorafenib-treated patients and 2% of placebo-treated patients.
  • Anemia was observed in 44% of Sorafenib-treated patients and 49% of placebo-treated patients. CTCAE Grade 3 or 4 anemia was reported in 2% of Sorafenib-treated patients and 4% of placebo-treated patients.
  • Thrombocytopenia was observed in 12% of Sorafenib-treated patients and 5% of placebo-treated patients. CTCAE Grade 3 or 4 thrombocytopenia was reported in 1% of Sorafenib-treated patients and in no placebo-treated patients.
  • Hypocalcemia was reported in 12% of Sorafenib-treated patients and 8% of placebo-treated patients. CTCAE Grade 3 hypocalcemia (6–7 mg/dL) occurred in 1% of Sorafenib-treated patients and 0.2% of placebo-treated patients, and CTCAE Grade 4 hypocalcemia (<6 mg/dL) occurred in 1% of Sorafenib-treated patients and 0.5% of placebo-treated patients.
  • Hypokalemia was reported in 5.4% of Sorafenib-treated patients compared to 0.7% of placebo-treated patients. Most reports of hypokalemia were low grade (CTCAE Grade 1). CTCAE Grade 3 hypokalemia occurred in 1.1% of Sorafenib-treated patients and 0.2% of placebo-treated patients. There were no reports of Grade 4 hypokalemia.

Adverse Reactions in DTC Study

Per-Patient Incidence of Selected Adverse Reactions Occurring at a Higher Incidence in Sorafenib-Treated Patients [Between Arm Difference of ≥ 5% (All Grades)1 or ≥ 2% (Grades 3 and 4)]:

Gastrointestinal Effects
General Disorders and Administration Site Conditions
Investigations
Metabolism and Nutrition Disorders
Musculoskeletal and connective tissue disorders
Neoplasms benign, malignant and unspecified
Central Nervous System Effects
Respiratory, thoracic and mediastinal disorders
Skin and Subcutaneous Tissue Disorders
Vascular Disorders
Laboratory Findings
  • Elevated TSH levels are discussed elsewhere in the labeling. The relative increase for the following laboratory abnormalities observed in Sorafenib-treated DTC patients as compared to placebo-treated patients is similar to that observed in the RCC and HCC studies: lipase, amylase, hypokalemia, hypophosphatemia, neutropenia, lymphopenia, anemia, and thrombocytopenia.
  • Serum ALT and AST elevations were observed in 59% and 54% of the Sorafenib-treated patients as compared to 24% and 15% of placebo-treated patients, respectively. High grade (≥ 3) ALT and AST elevations were observed in 4% and 2%, respectively, in the Sorafenib-treated patients as compared to none of the placebo-treated patients.
  • Hypocalcemia was more frequent and more severe in patients with DTC, especially those with a history of hypoparathyroidism, compared to patients with RCC or HCC. Hypocalcemia was observed in 36% of DTC patients receiving Sorafenib (with 10% ≥ Grade 3) as compared with 11% of placebo-treated patients (3% ≥ Grade 3). In the DTC study, serum calcium levels were monitored monthly.

Additional Data from Multiple Clinical Trials

The following additional drug-related adverse reactions and laboratory abnormalities were reported from clinical trials of Sorafenib (very common 10% or greater, common 1 to less than 10%, uncommon 0.1% to less than 1%, rare less than 0.1 %):

Rare: drug-induced hepatitis (including hepatic failure and death)

In addition, the following medically significant adverse reactions were uncommon during clinical trials of Sorafenib: transient ischemic attack, arrhythmia, and thromboembolism. For these adverse reactions, the causal relationship of Sorafenib has not been established.

Postmarketing Experience

The following adverse drug reactions have been identified during post-approval use of Sorafenib. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Drug Interactions

Effect of Strong CYP3A4 Inducers on Sorafenib

Rifampin, a strong CYP3A4 inducer, administered at a dose of 600 mg once daily for 5 days with a single oral dose of Sorafenib 400 mg in healthy volunteers resulted in a 37% decrease in the mean AUC of sorafenib. Avoid concomitant use of strong CYP3A4 inducers (such as, carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, rifabutin, St. John’s wort), when possible, because these drugs can decrease the systemic exposure to sorafenib.

Effect of Strong CYP3A4 Inhibitors on Sorafenib

Ketoconazole, a strong inhibitor of CYP3A4 and P-glycoprotein, administered at a dose of 400 mg once daily for 7 days did not alter the mean AUC of a single oral dose of Sorafenib 50 mg in healthy volunteers.

Effect of Sorafenib on Other Drugs

Sorafenib 400 mg twice daily for 28 days did not increase the systemic exposure of concomitantly administered midazolam (CYP3A4 substrate), dextromethorphan (CYP2D6 substrate), and omeprazole (CYP2C19 substrate)

Neomycin

Neomycin administered as an oral dose of 1 g three times daily for 5 days decreased the mean AUC of sorafenib by 54% in healthy volunteers administered a single oral dose of Sorafenib 400 mg. The effects of other antibiotics on the pharmacokinetics of sorafenib have not been studied.

Drugs that Increase Gastric pH

The aqueous solubility of sorafenib is pH dependent, with higher pH resulting in lower solubility. However, omeprazole, a proton pump inhibitor, administered at a dose of 40 mg once daily for 5 days, did not result in a clinically meaningful change in sorafenib single dose exposure. No dose adjustment for Sorafenib is necessary.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Sorafenib in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Sorafenib in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Sorafenib during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Sorafenib in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Sorafenib in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Sorafenib in geriatric settings.

Gender

There is no FDA guidance on the use of Sorafenib with respect to specific gender populations.

Race

There is no FDA guidance on the use of Sorafenib with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Sorafenib in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Sorafenib in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Sorafenib in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Sorafenib in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Sorafenib Administration in the drug label.

Monitoring

There is limited information regarding Sorafenib Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Sorafenib and IV administrations.

Overdosage

There is limited information regarding Sorafenib overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Sorafenib Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Sorafenib Mechanism of Action in the drug label.

Structure

There is limited information regarding Sorafenib Structure in the drug label.

Pharmacodynamics

There is limited information regarding Sorafenib Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Sorafenib Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Sorafenib Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Sorafenib Clinical Studies in the drug label.

How Supplied

There is limited information regarding Sorafenib How Supplied in the drug label.

Storage

There is limited information regarding Sorafenib Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Sorafenib Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Sorafenib interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Sorafenib Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Sorafenib Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

Sorafenib
Clinical data
SynonymsNexavar
Sorafenib tosylate
[[Regulation of therapeutic goods |Template:Engvar data]]
Pregnancy
category
  • AU: D
  • US: D (Evidence of risk)
Routes of
administration		Oral
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability29-49%
Protein binding99.5%
MetabolismHepatic oxidation and glucuronidation (CYP3A4-mediated)
Elimination half-life25–48 hours
ExcretionFecal (77%) and renal (19%)
Identifiers
CAS Number
PubChem CID
DrugBank
E number{{#property:P628}}
ECHA InfoCard{{#property:P2566}}Lua error in Module:EditAtWikidata at line 36: attempt to index field 'wikibase' (a nil value).
Chemical and physical data
FormulaC21H16ClF3N4O3
Molar mass464.825 g/mol
3D model (JSmol)

WikiDoc Resources for Sorafenib

Articles

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Review articles on Sorafenib

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Media

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Evidence Based Medicine

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Clinical Trials

Ongoing Trials on Sorafenib at Clinical Trials.gov

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Guidelines / Policies / Govt

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NICE Guidance on Sorafenib

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Books

Books on Sorafenib

News

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Be alerted to news on Sorafenib

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Commentary

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Definitions

Definitions of Sorafenib

Patient Resources / Community

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Healthcare Provider Resources

Symptoms of Sorafenib

Causes & Risk Factors for Sorafenib

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Treatment of Sorafenib

Continuing Medical Education (CME)

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International

Sorafenib en Espanol

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Business

Sorafenib in the Marketplace

Patents on Sorafenib

Experimental / Informatics

List of terms related to Sorafenib


Overview

Sorafenib (rINN), marketed as Nexavar by Bayer, is a drug approved for the treatment of advanced renal cell carcinoma (primary kidney cancer). It has also received "Fast Track" designation by the FDA[1] for the treatment of advanced hepatocellular carcinoma (primary liver cancer), and has since performed well in Phase III trials[2].

Pharmacology

It is a small molecular inhibitor of Raf kinase, PDGF (platelet-derived growth factor), VEGF receptor 2 & 3 kinases and c Kit the receptor for Stem cell factor. A growing number of drugs target most of these pathways. The originality of Sorafenib lays in its simultaneous targeting of the Raf/Mek/Erk pathway.[3]

Approval

Sorafenib was approved by the U.S. Food and Drug Administration (FDA) on December 20, 2005 and received a E.U. marketing authorisation on July 19, 2006[4].

The European Commission has granted marketing authorization to Nexavar® (sorafenib) tablets for the treatment of patients with hepatocellular carcinoma (HCC), the most common form of liver cancer, on October 30, 2007. [5].

Studies

A New England Journal of Medicine article published in January 2007 showed compared with placebo, treatment with sorafenib prolongs progression-free survival in patients with advanced clear-cell renal-cell carcinoma in whom previous therapy has failed; the median progression-free survival was 5.5 months in the sorafenib group and 2.8 months in the placebo group (hazard ratio for disease progression in the sorafenib group, 0.44; 95% confidence interval [CI], 0.35 to 0.55; P<0.01). The first interim analysis of overall survival in May 2005 showed that sorafenib reduced the risk of death, as compared with placebo (hazard ratio, 0.72; 95% CI, 0.54 to 0.94; P=0.02), although this benefit was not statistically significant according to the O'Brien–Fleming threshold. Partial responses were reported as the best response in 10% of patients receiving sorafenib and in 2% of those receiving placebo (P<0.001).

At ASCO 2007, results from the SHARP trial were presented, which showed efficacy of sorafenib in hepatocellular carcinoma. The primary endpoint was overall survival, which showed a 44% improvement in patients who received sorafenib compared to placebo (hazard ratio 0.69; 95% CI, 0.55 to 0.87; p=0.0001). Both median survival and time to progression showed 3-month improvements.

Regulatory filing is planned.

Side effects

Side effects of sorafenib included skin rash, hand-foot skin reactions, diarrhea, and hypertension.

Footnotes

  1. ↑ https://lnn605.aus.us.siteprotect.com/medicalnews.php?newsid=45119
  2. ↑ http://www.healthtech.com/news/top_news/2007/June/Nexavar_Extends_Survival.asp
  3. ↑ "SorafenibSunitinibdifferences". Retrieved 2007-08-15.
  4. ↑ European Commission - Enterprise and industry. Nexavar. Retrieved April 24,2007.
  5. ↑ DGnews [1]. Retrieved November 02, 2007.

External links

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