Sorafenib is a multi kinase inhibitor mainly used for the treatment of advanced liver and kidney cancer. Its use should focus on liver toxicity, skin reactions, and cardiovascular risks. The following explanation focuses on the classification of indications and key precautions, emphasizing the monitoring of liver function and early intervention for adverse reactions.

1. Indications

(1) Hepatocellular carcinoma: suitable for patients with unresectable advanced liver cancer, can prolong progression free survival.

(2) Renal cell carcinoma: Used for first-line or second-line treatment of advanced renal cancer, especially effective for those who have failed treatment with sunitinib.

(3) Thyroid cancer: Targeted therapy options for differentiated thyroid cancer.

2. Medication precautions

(1) Hepatotoxicity

Monitor liver function every 3 weeks for the first 3 months of treatment. If transaminase>5 times ULN or bilirubin>3 times ULN occurs, medication should be suspended and reduced or terminated after recovery.

(2) Skin reaction

Hand and foot skin reactions are common, and moderate to severe cases require interruption of treatment; The rash can be treated with local medication, and antibiotics are needed for infection.

(3) Hypertension

During the initial stage of medication, blood pressure should be monitored weekly, and medication should be suspended for grade 3 hypertension. After control, the dosage should be reduced and continued.

(4) Risk of bleeding

The incidence of severe bleeding is about 3%. For gastrointestinal or pulmonary bleeding, medication should be permanently discontinued and stopped for at least 10 days before surgery.

(5) Cardiac ischemia

Myocardial ischemia or infarction requires immediate interruption of treatment, and the decision to continue treatment should be made after assessing cardiovascular status.

(6) Drug interactions

Avoid using potent CYP3A4 inducers in combination, and increase INR monitoring frequency when using warfarin.