There is a clear increase in the frequency of adverse events caused by sorafenib when used in patients with differentiated thyroid cancer compared with renal and hepatocellular cancers, a study published in JAMA Oncology has shown.1

Sorafenib is a kinase inhibitor indicated for the treatment of unresectable hepatocellular carcinoma, advanced renal cell carcinoma, and locally recurrent or metastatic, progressive, differentiated thyroid carcinoma refractory to radioactive iodine treatment. Because sorafenib-associated adverse effects occur at a noticeably higher rate in thyroid cancer, researchers sought to describe the frequency and etiology of selected adverse events, particularly hand-foot skin reaction.

For the review, researchers analyzed data from randomized trials, observational studies, case reports or case series, and relevant review articles.

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Researchers found that the DECISION trial, as well as other phase 2 and 3 studies, demonstrated significantly higher rates of common adverse events, including hand-foot skin reaction, diarrhea, and hypertension, in patients with differentiated thyroid cancer compared with patients with renal or hepatocellular cancers.

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The investigators noted that the underlying cause of this increase in adverse event frequency in these patients cannot be determined, but hypothesized that it may be due to the extended duration of sorafenib therapy that patients with thyroid cancer receive, which has been shown to be double the length as patients with kidney and liver cancers.

The findings ultimately suggest that clinicians should consider differences in the toxicity profiles based on tumor type in patients taking sorafenib.


  1. Jean GW, Mani RM, Jaffry A, Khan SA. Toxic effects of sorafenib in patients with differentiated thyroid carcinoma compared with other cancers [published online ahead of print February 4, 2016]. JAMA Oncol. doi: 10.1001/jamaoncol.2015.5927.