A 50 Year old gentleman presented with caudate lobe metastases after 1 year of left radical nephrectomy and IVC thrombectomy.
The patient had also IVC involvement as diffuse thickening at the hepatic veins confluence.As the recurrence was appearing irresectable a plan was made to start sorafenib 200 mg twice a day and review with MRI scan after a period of 3 months.
Sorafenib has been approved for treatment of advanced renal cell carcinoma.An article in New England Journal of Medicine published January 2007, showed compared with placebo, treatment with sorafenib prolongs progression free survival in patients with advanced clear cell renal cell carcinoma in whom previous therapy has failed. The median progression-free survival was 5.5 months in the sorafenib group and 2.8 months in the placebo group.
It works with inhibition of tyrosine kinase and Raf kinase pathways.
There are many side effects of this molecule. Our patient developed a strong hand and foot syndrome for which the drug had to be stopped temporarily.He developed rectal bleed too.
Other side effects that have been documented are hypophosphatemia,thrombocytepenia,anemia , altered liver enzymes .
We have decided to stop sorafenib temporarily till the hand and foot syndrome resolves and then to reintroduce the medication in low dosage .If the patient tolerates the drug then reinstitute the drug therapy in full dosage.