Sorafenib
Kinase inhibitors (targeted oncology)
Kinase inhibitors (targeted oncology)High alert
An error with this medicine can cause serious harm: double checks and protocols are used.
An oral multikinase inhibitor (RAF, VEGFR, PDGFR) for liver, kidney and iodine-refractory thyroid cancer; hand-foot skin reaction and hypertension are typical.
Also called: sorafenib tosylate, BAY 43-9006
Quick facts
- Group
- Kinase inhibitors (targeted oncology)
- Target
- VEGFR2 and other kinases (CRAF, BRAF, VEGFR1–3, PDGFR-β, KIT, FLT3, RET)
- Used for
- Unresectable hepatocellular carcinoma
- Key effects
- Hand-foot skin reaction · Diarrhoea · Fatigue
- Monitor
- Blood pressure weekly at first · Liver tests
- ATC
- L01EX02
No doses: the clinician sets them by the current guideline.
Mechanism of action
The crystal shows sorafenib in the kinase domain of human VEGFR2, one of its several targets.
Sorafenib inhibits several kinases at once: inside the tumour cell the RAF kinases (CRAF, BRAF and mutant BRAF) of the MAPK pathway, and on the cell surface the angiogenic receptors VEGFR1–3 and PDGFR-β, as well as KIT, FLT3 and RET. The result is less tumour-cell proliferation and, above all, less new vessel formation, with more apoptosis.
- Blocks RAF kinases of the MAPK pathway
- Blocks angiogenic VEGFR and PDGFR receptors
- Less tumour proliferation and vessel growth
- More apoptosis; tumour growth slows
Indications
- Unresectable hepatocellular carcinoma. Hepatocellular carcinoma →
- Advanced renal cell carcinoma. Renal cell carcinoma →
- Progressive differentiated thyroid carcinoma refractory to radioactive iodine. Thyroid cancer (papillary) →
Adverse effects
Common
- Hand-foot skin reaction (painful redness and blisters on palms and soles)
- Diarrhoea
- Fatigue
- Hair loss
- Rash
- High blood pressure
- Weight loss and decreased appetite
Contraindications
- Severe allergy to sorafenib
- Combination with carboplatin and paclitaxel in squamous cell lung cancer
Key interactions
- Strong CYP3A4 inducers (e.g. rifampicin)
- Lower sorafenib levels; avoided.
- Warfarin
- Bleeding and raised INR have been reported; INR is checked.
- Levothyroxine in thyroid cancer
- Sorafenib impairs TSH suppression; TSH is checked monthly and the dose adjusted.
What is monitored
- Blood pressure weekly at first, then regularly
- Skin of palms and soles
- Liver tests
- ECG and electrolytes in people at risk
- TSH in thyroid cancer
- Wound healing around surgery
Administration and safety
- Oral; swallowed whole at about the same time each day.
- Check the name carefully: kinase inhibitors with similar «-tinib» names are not interchangeable.
- Taken without food; held before elective surgery and restarted only after the wound has healed.
Pregnancy and breastfeeding
May harm the fetus; effective contraception is used and breastfeeding is not advised.
Nursing care
- Check blood pressure at every visit.
- Inspect palms and soles; advise thick cotton socks, avoiding friction and heat, and moisturising creams.
- Ask about chest pain, bleeding and black stools.
- Teaching: report blistering of hands or feet, chest pain, bleeding or yellow skin; use contraception.
Pharmacokinetics
- Absorption
- Oral; taken without food (at least an hour before or two hours after a meal); a high-fat meal lowers absorption.
- Distribution
- Almost completely bound to plasma proteins.
- Metabolism
- Liver, mainly by CYP3A4, to inactive products.
- Half-life
- About one to two days.
Test yourself
Think of the answer, then tap the question to see it.
Which kinases does sorafenib inhibit?
RAF kinases (CRAF, BRAF) and the angiogenic receptors VEGFR1–3 and PDGFR-β, plus KIT, FLT3 and RET.
What is the classic skin toxicity of sorafenib?
Hand-foot skin reaction.
Which liver cancer is treated with sorafenib?
Unresectable hepatocellular carcinoma.
Connections
← Back to the class: Kinase inhibitors (targeted oncology)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - SORAFENIB tablet, film coated (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.