Tablets: 200 mg

for the treatment of advanced renal cell carcinoma when treatment with interferonalfa or interleukin-2 has failed or is contra-

indicated………

for the treatment of hepatocellularcarcinoma………

Sorafenib is a type of biological therapy called a protein tyrosine kinase inhibitor)TKI( . Tyrosine kinase is a protein which acts as a chemical messenger)an enzyme(. There are a number of different tyrosine kinases that encourage cancer cells to grow.Sorafenib blocks a number of protein kinases and is called.a multi kinase inhibitor

It works in two ways. It stops Signals that tell cancer cells

to grow Cancel cells forming blood vessels ,

which they need to grow Treatment that stops blood vessels forming is called anti angiogenesistreatment

Sorafenib is a tablet take with a glass of water.It should take either an hr before eat or.2 hrs after

ADULT over 18 years, 400mg twice daily

*Antibacterial:plasma conc. of sorafenib reduced by rifampicin

*Anticoagulants:sorafenib possibly enhances anticoagulanteffect of coumarins

*Antiepileptics: cytotoxics possibly reduce absorptionof phenytoin

*Antipsychotics:avoid concomitant use of cytotoxics)with clozapine )increased risk of agranulocytosis

*Cardiac Glycosides: cytotoxics reduce absorption of digoxintablets

*Cytotoxics:. sorafenib possibly increases plasma conc of doxorubicin and irinotecan, increases plasma concentration ofdocetaxel

Fecal)77% ( and renal))19%

Excretion

25-48hoursHalf life

Hepatic oxidation and glucuronidation))CYP3A4 mediated

Metabolism

99,5%Protein binding

29-49% Bioavailability

major surgical procedures

,cardiac ischaemia

hepatic impairment

)Pregnancy )category D

breast-feeding

Common side effects Diarrhoea **Hand-foot syndrome** rash, or red, dry itchy skin **Fatigue** Hair thinning **Feeling sick** **Raised blood pressure )hypertension( **Increased risk of bleeding

Rare side effectsBreast tenderness and swelling because sorafenib may lower** male sex hormone )testosterone( levels Heart problems including chest pain**

**)Bleeding of the stomach lining occurs in less than )1%

With this drug, some people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following sideeffects Increased risk of getting an infection from a drop in WBC** Tiredness and breathlessness due to a drop in RBC**

Bruising more easily due to a drop in platelets** Some of these side effects can be life threatening, particularlyinfections

Other occasional side effects includeSkin flushing, Aching joints, Constipation

sore mouth, Indigestion, Weakness , Pain Loss of appetite, Flu like symptoms A hoarse voice, Low mood

A mild effect on the liver -

BNF September 2009 page 467,489

BNF for children 2009 page 867

http//:en.wikipedia.org/wiki/Sorafenib

http://www.rxlist.com/nexavar-drug.htm

http://www.cancerhelp.org.uk/about-cancer/treatment/cancer-drugs/sorafenib