Regimen: Sorafenib
Llovet JM et al. N Engl J Med 2008;359:378–90
Cheng et al. Lancet Oncol 2009;10:25–34
Sorafenib 400 mg per dose; administer orally, twice daily, continually (total dose/week = 5600 mg)
Supportive Care
Antiemetic prophylaxis
Emetogenic potential: LOW
See Chapter 39 for antiemetic recommendations
Hematopoietic growth factor (CSF) prophylaxis
Primary prophylaxis is NOT indicated
See Chapter 43 for more information
Antimicrobial prophylaxis
Risk of fever and neutropenia is LOW
Antimicrobial primary prophylaxis to be considered:
See Chapter 47 for more information
Diarrhea management
Latent or delayed-onset diarrhea✫:
Loperamide 4 mg orally initially after the first loose or liquid stool, then
Loperamide 2 mg orally every 2 hours during waking hours, plus
Loperamide 4 mg orally every 4 hours during hours of sleep
Continue for at least 12 hours after diarrhea resolves
Recurrent diarrhea after a 12-hour diarrhea-free interval is treated as a new episode
Rehydrate orally with fluids and electrolytes during a diarrheal episode
If a patient develops blood or mucus in stool, dehydration, or hemodynamic instability, or if diarrhea persists >48 hours despite loperamide, stop loperamide and hospitalize the patient for IV hydration
Alternatively, a trial of Diphenoxylate hydrochloride 2.5 mg with Atropine sulfate 0.025 mg (eg, Lomotil®)
Initial adult dose is two tablets four times daily until control has been achieved, after which the dose may be reduced to meet individual requirements. Control may often be maintained with as little as two tablets daily
Clinical improvement of acute diarrhea is usually observed within 48 hours. If improvement of chronic diarrhea after treatment with a maximum daily dose of 8 tablets is not observed within 10 days, control is unlikely with further administration
Persistent diarrhea:
Octreotide 100–150 mcg subcutaneously 3 times daily. Maximum total daily dose is 1500 mcg
Antibiotic therapy during latent or delayed-onset diarrhea:
A fluoroquinolone (eg, Ciprofloxacin 500 mg orally every 12 hours) if absolute neutrophil count <500/mm3 with or without accompanying fever in association with diarrhea
Patient Population Studied
Therapy Monitoring
At screening and every 6 weeks: Tumor measurements by computed tomography or magnetic resonance imaging