Sorafenib

INTRODUCTION

Indications

Advanced renal cell carcinoma. Unresectable hepato-cellular carcinoma.

Action

Inhibits tumor growth by inhibiting multikinase enzyme, some of which are involved in angiogenesis. Therapeutic Effects: Decreased growth and spread of advanced renal cell carcinoma.

Adverse Reactions/Side Effects

CNS: depression, fatigue, weakness. Resp: hoarseness. CV: hypertension, myocardial ischemia. GI: ↑ increased lipase/amylase, constipation, diarrhea, dyspepsia, dysphagia, mucositis/stomatitis, nausea, vomiting, anorexia. GU: erectile dysfunction. Derm: acne, erythema, exfoliative dermatitis, flushing, hand-foot skin reaction, pruritus, rash, dry skin. F and E: hypophosphatemia. Hemat: anemia, bleeding, leukopenia, thrombocytopenia, lymphopenia. MS: arthralgia, myalgia. Neuro: neuropathy. Misc: weight loss.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia, coagulation disorders, or other blood dyscrasias. Report these signs to the physician or nursing staff.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Monitor and report any chest pain that might indicate myocardial ischemia.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Monitor signs of low phosphate levels (hypophosphatemia), including skeletal muscle dysfunction or weakness, respiratory muscle weakness, and mental status changes such as irritability and confusion that progresses to delirium and coma. Report these signs to the physician.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

• Advise patient and family/caregivers that fatigue and weakness are likely and may be severe. Functional abilities may be limited, and patient may need to use assistive devices during ambulation.

• Advise patient about the likelihood of GI reactions ...