Sorafenib

How it works

It inhibits multiple tyrosine and serine/threonine kinases, including VEGFR, PDGFR, and RAF kinases, suppressing tumour-cell proliferation and angiogenesis.

Prescribing in practice

• Hand-foot skin reaction, hypertension, and bleeding are characteristic adverse effects, and severe or persistent toxicity requires dose interruption or specialist adjustment.
• It can cause QT-interval prolongation and gastrointestinal perforation, so use with caution in patients with relevant risk factors.
• It is a CYP-interacting drug, so review concomitant medicines and avoid potent enzyme inducers where possible.

Monitoring

Monitor blood pressure regularly, especially early in treatment, and review skin, liver function, and signs of bleeding at oncology follow-up.

Counselling the patient

• Report skin changes on the palms and soles, unusual bleeding, or severe abdominal pain.
• Attend for blood pressure checks and do not stop or change the dose without specialist advice.

Evidence & guidelines

Sorafenib is an established systemic therapy for advanced hepatocellular carcinoma with preserved liver function.