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The first drug ever to extend life in advanced liver cancer (2007), now mostly a comparator arm that newer combinations are measured against.
SHARP: OS 10.7 vs 7.9 months versus placebo (HR 0.69). Standard first-line therapy for a decade until REFLECT (lenvatinib non-inferior) and IMbrave150 (atezolizumab-bevacizumab superior). Also approved in RCC and radioiodine-refractory thyroid cancer. Hand-foot skin reaction and diarrhoea dominate toxicity.
Oral inhibitor of VEGFR1-3, PDGFR-β, KIT, FLT3 and RAF kinases; anti-angiogenic and anti-proliferative. Connects to VEGF / VEGFR and BRAF.
1.Enters tumour and endothelial cells
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026). Generic sorafenib is available.
Multi-source generic on low-cost tiers; usually no prior authorisation. Cash prices without insurance are modest. Plans require the generic.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE TA474 · SMC advice: sorafenib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Unresectable HCC on SHARP
| Region | Year | Indication |
|---|---|---|
| US | 2005 | Advanced RCC |
| US | 2007 | Unresectable HCC |
| US | 2013 | Radioiodine-refractory differentiated thyroid cancer |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Diarrhoea | 39% | 8% |
| Hand-foot skin reaction | 21% | 8% |
| Fatigue | 22% | 4% |
SHARP. Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
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FLT3 inhibitors are now incorporated into frontline paediatric AML therapy for FLT3-ITD, with gilteritinib being studied in the successor trial.
Lenvatinib is a first-line alternative to sorafenib and the preferred kinase inhibitor when immunotherapy is contraindicated, such as after liver transplantation.
No adjuvant systemic therapy is recommended after curative treatment of hepatocellular carcinoma, a conclusion reinforced by the later failure of IMbrave050.
Sorafenib is an approved option for iodine-refractory thyroid cancer, now usually used after or instead of lenvatinib depending on tolerability.
Sorafenib became the reference standard against which lenvatinib, atezolizumab-bevacizumab and durvalumab-tremelimumab were tested, and remains an option where immunotherapy is unsuitable.
Query for this drug: (TITLE:"Sorafenib" OR ABSTRACT:"Sorafenib" OR TITLE:"Nexavar" OR ABSTRACT:"Nexavar") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Sorafenib, not a curated reading list.
Shares ZGDH3 (donafenib vs sorafenib), Hepatocellular carcinoma (KEGG map), VEGF / VEGFR, BRAF.
Shares DECISION: sorafenib in radioactive iodine-refractory differentiated thyroid cancer, Bayer, VEGF / VEGFR, BRAF.
Shares REFLECT: lenvatinib versus sorafenib in first-line treatment of unresectable hepatocellular carcinoma, Study to Evaluate Adverse Events, and Change in Disease Activity, When Intravenously (IV) Infused With Livmoniplimab in Combination With IV Infused Bu, REFLECT, Radioiodine therapy (I-131).
Shares STORM: adjuvant sorafenib after resection or ablation of hepatocellular carcinoma, Early hepatocellular carcinoma (BCLC 0 and A), Advanced hepatocellular carcinoma (BCLC C), Hepatocellular carcinoma.
Shares Study of Cabozantinib in Combination With Atezolizumab Versus Sorafenib in Participants With Advanced Hepatocellular Carcinoma (HCC) Who Have Not Rece, Hand-foot syndrome and hand-foot skin reaction, Thyroid cancer (KEGG map), The angiogenic switch & tumour vessels.
Shares CRAF (RAF1), Hand-foot syndrome and hand-foot skin reaction, The angiogenic switch & tumour vessels, Hepatocellular carcinoma (KEGG map).
Shares SARAH and SIRveNIB, Early hepatocellular carcinoma (BCLC 0 and A), Advanced hepatocellular carcinoma (BCLC C), Hepatocellular carcinoma.
Shares Bayer, Advanced hepatocellular carcinoma (BCLC C), Anti-angiogenic therapy, Hepatocellular carcinoma.