Toxicity of sorafenib: clinical and molecular aspects

Expert Opin Drug Saf. 2010 Mar;9(2):275-87. doi: 10.1517/14740330903510608.


Importance of the field: Sorafenib is a novel oral bis-aryl urea compound originally developed as an inhibitor of RAF kinase for its anti-proliferative property. Sorafenib also inhibits receptor tyrosine kinases of multiple pro-angiogenic factors such as VEGFR-1/2/3, Flt-3 and PDGFR-beta. The combination of both its anti-proliferative and anti-angiogenic properties makes sorafenib an attractive agent in cancer treatment. Sorafenib has been approved for the treatment of metastatic renal cell carcinoma as well as hepatocellular cancer. Despite its inherent selectivity, sorafenib can cause unusual adverse events whose the management represents a challenge for oncologists.

Areas covered in this review: Relevant literature was identified using a Pubmed search of articles published up to June 2009. Search terms included 'sorafenib' and 'toxicity'. Original articles were reviewed and relevant citations from these articles were also considered.

What the reader will gain: The clinical aspect of sorafenib-induced adverse events and the molecular basis behind this toxicity are discussed. Finally, recommendations for the management of these adverse events are proposed.

Take home message: Although not life-threatening, toxicity of sorafenib can severely impact the physical, psychological and social well-being of patients. The management of this unusual toxicity highlights the particular need of new pluridisciplinarities linking oncologist, cardiologist and dermatologist.

Publication types

  • Review

MeSH terms

  • Animals
  • Benzenesulfonates / adverse effects*
  • Benzenesulfonates / therapeutic use
  • Benzenesulfonates / toxicity*
  • Carcinoma, Renal Cell / drug therapy
  • Carcinoma, Renal Cell / metabolism
  • Clinical Trials as Topic
  • Exanthema / chemically induced
  • Exanthema / metabolism
  • Humans
  • Kidney Neoplasms / drug therapy
  • Kidney Neoplasms / metabolism
  • Niacinamide / analogs & derivatives
  • Phenylurea Compounds
  • Pyridines / adverse effects*
  • Pyridines / therapeutic use
  • Pyridines / toxicity*
  • Receptors, Vascular Endothelial Growth Factor* / metabolism
  • Signal Transduction / drug effects
  • Signal Transduction / physiology
  • Sorafenib
  • raf Kinases* / metabolism


  • Benzenesulfonates
  • Phenylurea Compounds
  • Pyridines
  • Niacinamide
  • Sorafenib
  • Receptors, Vascular Endothelial Growth Factor
  • raf Kinases