title: Management of sorafenib-related adverse events: a clinician's perspective.
abstract: Sorafenib, a tyrosine kinase inhibitor, is approved for the treatment of patients with unresectable hepatocellular carcinoma (HCC) and advanced renal cell carcinoma (RCC). It is being evaluated in phase II and III clinical trials, which include treatment as a single agent (locally advanced/metastatic radioactive iodine-refractory differentiated thyroid cancer [DTC]), as part of multimodality care (HCC), and in combination with chemotherapeutic agents (metastatic breast cancer). Sorafenib-related adverse events (AEs) that commonly occur across these tumor types include hand-foot skin reaction (HSFR), rash, upper and lower gastrointestinal (GI) distress (ie, diarrhea), fatigue, and hypertension. These commonly range from grade 1 to 3, per the Common Terminology Criteria for Adverse Events (CTCAE), and often occur early in treatment. The goal for the management of these AEs is to prevent, treat, and/or minimize their effects, thereby enabling patients to remain on treatment and improve their quality of life. Proactive management, along with ongoing patient education (before and during sorafenib treatment), can help to effectively manage symptoms, often without the need for sorafenib dose modification or drug holidays. Effective management techniques for common sorafenib-related AEs, as well other important disease sequelae not directly related to treatment, are presented. Recommendations and observations are based on physician/author experience and recommendations from published literature.
authors.affiliation: Assistant Professor, Director of the Thyroid Cancer Therapeutics Program, Department of Otorhinolaryngology: Head and Neck Surgery, and the Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Marcia S
authors.initials: MS
authors.lastname: Brose
authors.affiliation: Medical Director of Liver Transplantation, Center for Organ and Cell Transplantation, Scripps Clinic, San Diego, CA. Electronic address: Frenette.Catherine@scrippshealth.org.
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Frenette
authors.affiliation: Assistant Professor, Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Keefe
authors.affiliation: Assistant Professor of Medicine, Department of Medical Oncology, Yale School of Medicine, New Haven, CT.
authors.forename: Stacey M
authors.initials: SM
authors.lastname: Stein
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D019468:Disease Management; D005221:Fatigue / Q000139:chemically induced / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000628:therapy; D060831:Hand-Foot Syndrome / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000628:therapy; D007680:Kidney Neoplasms / Q000188:drug therapy; D008113:Liver Neoplasms / Q000188:drug therapy; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D010820:Physicians; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib