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Hepatic advanced soRAFENib

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Drug Dose Route
soRAFENib 400 mg TWICE a day PO

Continuous until disease progression or unacceptable toxicity

Notes:

Overall management should be in consultation with a gastroenterologist.

Drug status:

Sorafenib is PBS authority opens in a new tab or window

Sorafenib is available as 200 mg tablets. 

Cost:
~ $3,810 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Continuous treatment
soRAFENib 400 mg (PO) TWICE a day on an empty stomach one hour before food or two hours after food

Continuous until disease progression or unacceptable toxicity

Drug Dose Route
soRAFENib 400 mg TWICE a day PO

Continuous until disease progression or unacceptable toxicity

Notes:

Overall management should be in consultation with a gastroenterologist.

Drug status:

Sorafenib is PBS authority opens in a new tab or window

Sorafenib is available as 200 mg tablets. 

Cost:
~ $3,810 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Continuous treatment
soRAFENib 400 mg (PO) TWICE a day on an empty stomach one hour before food or two hours after food

Continuous until disease progression or unacceptable toxicity

Caution with oral anti-cancer drugs

Select links for information on the safe prescribing, dispensing and administration of orally administered anti-cancer drugs. 

Read more about at COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy opens in a new tab or window and oral anti-cancer therapy opens in a new tab or window
Emetogenicity minimal or low

No routine prophylaxis required. If patients experience nausea and/or vomiting, consider using the low emetogenic risk regimen.

Read more about preventing anti-cancer therapy induced nausea and vomiting
Cardiac toxicity

Tyrosine kinase inhibitors have been associated with cardiac complications of varying degrees and severity.

Patients, especially those with pre-existing cardiovascular disease, should have a baseline cardiac assessment including an electrocardiogram (ECG) and biochemistry and be closely monitored; consider an echocardiogram (ECHO) as clinically indicated.

Cardiac assessment should then be repeated as clinically indicated or when starting new medication which affects the QT interval.

Read more about cardiac toxicity associated with anti-cancer drugs
Prolongation of QT interval

This treatment may prolong the QT interval and increase the risk of cardiac arrhythmia. Use with caution in patients with a congenital long QT syndrome, patients treated with a high cumulative dose of anthracycline therapy, patients taking medications that may prolong the QT interval and those with electrolyte disturbances. Risk factors (e.g. electrolyte abnormalities) should be corrected, where possible, prior to commencement of treatment and the concurrent use of drugs that may prolong the QT interval should be avoided. Baseline and periodic monitoring of electrocardiogram (ECG) and electrolytes (potassium, magnesium, calcium) should be considered in patients at high risk of QT prolongation.

Read more about drugs that may prolong QTc interval at crediblemeds.org opens in a new tab or window (registration required).
Hypertension

Pre-existing hypertension should be adequately controlled prior to commencing treatment. Baseline blood pressure monitoring and repeat weekly for the first 6 weeks then regularly throughout treatment.

In severe or uncontrolled hypertension, treatment should be withheld until hypertension is controlled. Dose modification or permanent discontinuation may be necessary.
Diarrhoea

Antidiarrhoeals (e.g. loperamide) are usually prescribed with this treatment.

Read more about treatment induced diarrhoea
Wound healing

This treatment may impair wound healing and temporary interruption of treatment is recommended in patients undergoing major surgical procedures. Resume treatment based on clinical judgement of adequate wound healing.
Hand-foot syndrome

Hand-foot syndrome (palmar-plantar erythrodysaesthesia) and rash are common adverse effects with this treatment which generally appear during the first 6 weeks of therapy.

Read more about hand food syndrome or palmar plantar erythrodysaesthesia (PPE)
Elevations in lipase and amylase

Transient elevations of lipase and amylase have been reported. In some cases, this has been associated with pancreatitis.

Monitor patient as clinically indicated.
Blood tests

FBC, EUC, eGFR, LFTs, calcium, magnesium and phosphate at baseline, repeat at week 2, then every 4 weeks. INR as clinically indicated.
Hepatitis B screening and prophylaxis

The requirement for routine screening for HBsAg and anti-HBc for patients receiving kinase inhibitors is unknown. Clinical judgement and individual patient situations should be taken into consideration.

Read more about hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy
Vaccinations

Live vaccines are contraindicated in cancer patients receiving immunosuppressive therapy and/or who have poorly controlled malignant disease. Possible suboptimal response to inactivated vaccines.

For more information about vaccinations in people with cancer refer to the Australian Immunisation Handbook opens in a new tab or window.
Fertility, pregnancy and lactation

Cancer treatment can have harmful effects on fertility and this should be discussed with all patients of reproductive potential prior to commencing treatment. There is a risk of fetal harm in pregnant women. A pregnancy test should be considered prior to initiating treatment in females of reproductive potential if sexually active. It is important that all patients of reproductive potential use effective contraception whilst on therapy and after treatment finishes. Effective contraception methods and adequate contraception timeframe should be discussed with all patients of reproductive potential. Possibility of infant risk should be discussed with breastfeeding patients.

Read more about the impact of cancer treatment on fertility opens in a new tab or window
Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient’s situation including but not limited to treatment intent (curative vs palliative), the anti-cancer regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient preferences.Suggested dose modifications are based on clinical trial findings, product information, published guidelines and reference committee consensus . The dose reduction applies to each individual dose and not to the total number of days or duration of treatment cycle unless stated otherwise. Non-haematological gradings are based on Common Terminology Criteria for Adverse Events (CTCAE) opens in a new tab or window unless otherwise specified. Renal and hepatic dose modifications have been standardised where possible. For more information see dosing considerations & disclaimer.

Note: Haematological dose modifications are adapted from the trial by Llovet et al.r

Haematological toxicity
ANC x 109/L (at any stage of the cycle)
1.0 to less than 1.5 No dose modification necessary
0.5 to less than 1.0 Reduce sorafenib to 200 mg TWICE daily and continue with treatment
less than 0.5 Delay treatment until ANC is greater than or equal to 1.0 and reduce sorafenib to 200 mg TWICE daily for subsequent doses
Febrile neutropenia Delay treatment until ANC is greater than or equal to 1.0 and reduce sorafenib to 200 mg TWICE daily for subsequent doses
Platelets x 109/L (at any stage of the cycle)
50 to less than 100 No dose modification necessary
25 to less than 50 Reduce sorafenib to 200 mg TWICE daily and continue with treatment
less than 25 Delay treatment until platelets are greater than or equal to 50 and reduce sorafenib to 200 mg TWICE daily for subsequent doses
Kidney dosing recommendations 
eGFR (mL/min/1.73m2) Recommended dose
≥ 30 No dose modification necessary.
< 30 This drug has not been studied in patients with severe kidney dysfunction.
Hepatic impairment
Hepatic dysfunction
Mild No dose modification necessary
Moderate Consider starting sorafenib at 200 mg TWICE daily and dose escalate as tolerated *
Severe Omit sorafenib
Mucositis and stomatitis
Grade 3 Delay treatment until toxicity has resolved to Grade 2 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: Reduce sorafenib to 200 mg TWICE daily
2nd occurrence: Reduce sorafenib to 200 mg ONCE daily
3rd occurrence: Omit sorafenib
Grade 4 Omit sorafenib
Diarrhoea
Grade 3 Delay treatment until toxicity has resolved to Grade 2 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: Reduce sorafenib to 200 mg TWICE daily
2nd occurrence: Reduce sorafenib to 200 mg ONCE daily
3rd occurrence: Omit sorafenib
Grade 4 Omit sorafenib
Hand foot syndrome (link to  Hand foot syndrome (Palmar-plantar erythrodysaesthesia))
Grade 2 Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: No dose reduction
2nd occurrence: Reduce sorafenib to 200 mg TWICE daily
3rd occurrence: Reduce sorafenib to 200 mg ONCE daily
4th occurrence: Omit sorafenib
Grade 3

Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows:
1st occurrence: Reduce sorafenib to 200 mg TWICE daily
2nd occurrence: Reduce sorafenib to 200 mg ONCE daily
3rd occurrence: Omit sorafenib

*These recommendations have been adapted from the study by Miller et al.r 

The drug interactions shown below are not an exhaustive list. For a more comprehensive list and for detailed information on specific drug interactions and clinical management, please refer to the specific drug product information and the following key resources: 

For more information see References & Disclaimer.

Sorafenib
  Interaction Clinical management
CYP3A4 inducers (e.g. carbamazepine, phenytoin, phenobarbitone, rifampicin, St John’s wort etc.) Reduced efficacy of sorafenib possible due to increased clearance Avoid combination or monitor for decreased clinical response to sorafenib
Drugs that may prolong the QTc interval (e.g. azole antifungals, tricyclic antidepressants, antiarrhythmics etc.) Additive effect with sorafenib; may lead to torsades de pointes and cardiac arrest Avoid combination or minimise additional risk factors (e.g. correct electrolyte imbalances) and monitor ECG for signs of cardiac arrhythmia
Paracetamol Risk of liver toxicity due to inhibition of metabolism of paracetamol by sorafenib Avoid combination or monitor liver function closely
Nephrotoxic drugs (e.g. aminoglycosides, amphotericin, contrast dye, frusemide, NSAIDs) Additive nephrotoxicity Avoid combination or monitor kidney function closely
Neomycin Reduced efficacy of sorafenib possible due to increased clearance (neomycin interferes with enterohepatic recycling of sorafenib) Avoid combination or monitor for decreased clinical response to sorafenib
General
  Interaction Clinical management
Warfarin Anti-cancer drugs may alter the anticoagulant effect of warfarin. Monitor INR regularly and adjust warfarin dosage as appropriate; consider alternative anticoagulant.
Direct oral anticoagulants (DOACs) e.g. apixaban, rivaroxaban, dabigatran

Interaction with both CYP3A4 and P-gp inhibitors /inducers.

DOAC and anti-cancer drug levels may both be altered, possibly leading to loss of efficacy or toxicity (i.e. increased bleeding).

Apixaban: avoid concurrent use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window inhibitors. If treating VTE, avoid use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window inducers. 

Rivaroxaban: avoid concurrent use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window  inhibitors.

Dabigatran: avoid combination with strong P‑gp opens in a new tab or window inducers and inhibitors.

If concurrent use is unavoidable, monitor closely for efficacy/toxicity of both drugs.
Digoxin Anti-cancer drugs can damage the lining of the intestine; affecting the absorption of digoxin. Monitor digoxin serum levels; adjust digoxin dosage as appropriate.
Antiepileptics Both altered antiepileptic and anti-cancer drug levels may occur, possibly leading to loss of efficacy or toxicity. Where concurrent use of an enzyme-inducing antiepileptic cannot be avoided, monitor antiepileptic serum levels for toxicity, as well as seizure frequency for efficacy; adjust dosage as appropriate.
Also monitor closely for efficacy of the anti-cancer therapy.
Antiplatelet agents and NSAIDs Increased risk of bleeding due to treatment related thrombocytopenia. Avoid or minimise combination.
If combination deemed essential, (e.g. low dose aspirin for ischaemic heart disease) monitor for signs of bleeding.
Serotonergic drugs, including selective serotonin reuptake inhibitors (SSRIs e.g. paroxetine) and serotonin noradrenaline reuptake inhibitors (SNRIs e.g. venlafaxine) Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.) Avoid combination.
If combination is clinically warranted, monitor for signs and symptoms of serotonin syndrome (e.g. confusion, agitation, tachycardia, hyperreflexia).
For more information link to TGA Medicines Safety Update opens in a new tab or window

eviQ provides safe and effective instructions on how to administer cancer treatments. However, eviQ does not provide every treatment delivery option, and is unable to provide a comprehensive list of cancer treatment agents and their required IV line giving set/filter or address chemical compatibilities related to IV drug preparation and administration. There may be alternative methods of treatment administration, and alternative supportive treatments that are also appropriate. Please refer to the individual product information monographs via the TGA opens in a new tab or window and Australian Injectable Drugs Handbook opens in a new tab or window websites for further information.

eviQ is currently updating the way information is presented in the administration section, if you notice any discrepancies please let us know, via feedback@eviq.org.au.

Administration

This is a continuous oral treatment

Pre treatment assessment

Any toxicity grade 2 or greater may require dose reduction, delay or omission of treatment and review by medical officer before commencing treatment.

Anti-cancer drug patient assessment tool prior to each day of treatment.

Blood pressure should be assessed and monitored closely prior to and throughout treatment. 

Sorafenib

  • administer orally TWICE a day
  • to be swallowed whole with a glass of water; do not break, crush or chew
  • to be taken on an empty stomach, one hour before or two hours after food.

Note: missed doses should not be replaced; if a dose is forgotten or vomited, normal dosing should be resumed at the next scheduled dose.

Post administration

Continue safe handling precautions (reproductive risk only) for 7 days after completion of drug(s).

Discharge information

Discharge medications

Sorafenib tablets - with written instructions on how to take them.

Antidiarrhoeals - as/if prescribed.

Patient information

Ensure patient receives protocol patient information sheet.

The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.

Immediate (onset hours to days)
Nausea and vomiting

Read more about prevention of treatment induced nausea and vomiting

Early (onset days to weeks)
Neutropenia

Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively. 

Read more about immediate management of neutropenic fever
Thrombocytopenia

A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding.  

Read more about thrombocytopenia
Oral mucositis and stomatitis

Erythematous and ulcerative lesions of the gastrointestinal tract (GIT). It commonly develops following anti-cancer treatment, radiation therapy to the head, neck or oesophagus, and high-dose chemotherapy followed by a blood and marrow transplant (BMT).

Read more about oral mucositis and stomatitis
Anorexia

Loss of appetite accompanied by decreased food intake.

Read more about anorexia
Diarrhoea

Read more about treatment induced diarrhoea
Fatigue

Read more about fatigue
Arthralgia and myalgia

Generalised joint pain or and/or stiffness and muscle aches, often worse upon waking or after long periods of inactivity. Can improve with movement. May be mild or severe, intermittent or constant and accompanied by inflammation. 

Read more about arthralgia and myalgia
Palmar-plantar erythrodysaesthesia (PPE) - hand-foot syndrome (HFS)

Bilateral erythema, tenderness, pain, swelling, tingling, numbness, pruritus, dry rash, or moist desquamation and ulceration of the palms and soles. It is also known as hand-foot syndrome (HFS). Symptoms appear to be dose dependent and palms are affected more than soles.

Read more about hand-foot syndrome associated with chemotherapy
Skin rash

Anti-cancer drugs can cause a number of changes in the skin with maculo-papular rash the most common type of drug-induced skin reaction. 

Read more about skin rash
Hypertension

High blood pressure is commonly associated with many anti-cancer drugs. Pre-existing hypertension should be controlled prior to initiation of drugs capable of causing hypertension.
Haemorrhage
Cardiotoxicity

Cardiotoxicity may manifest as asymptomatic reduction in left ventricular ejection fraction (LVEF), arrhythmia, cardiomyopathy, hypertension, cardiac ischaemia and congestive heart failure (CHF). The risk of cardiotoxicity is increased by a number of factors, particularly a history of heart disease and electrolyte imbalances.

Read more about cardiotoxicity associated with anti-cancer drugs
Hypocalcaemia

Abnormally low levels of calcium in the blood.
Hypokalaemia

Abnormally low levels of potassium in the blood.

Late (onset weeks to months)
Anaemia

Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. 

Read more about anaemia
Alopecia - partial

Hair thinning and/or patchy hair loss. Patients can also experience mild to moderate discomfort of the hair follicles, and rarely pain as the hair is falling out.

Read more about alopecia and scalp cooling
Nail changes

Hyperpigmentation, paronychia, onycholysis, splinter haemorrhage, pyogenic granuloma formation, subungual haematoma and subungual hyperkeratosis are some of the nail changes associated with anti-cancer drugs.   

Read more about nail toxicities

eviQ is currently updating the way information is presented in the evidence section to improve usability, consistency and facilitate easier update and maintenance. An updated evidence template is being implemented in a staged approach, first across new protocols, then existing protocols as they are reviewed. Find out more

The evidence for this protocol comes from a randomised, multicenter, phase III, double blind, placebo-controlled trial conducted by the Sorafenib Hepatocellular Carcinoma Assessment Randomised Protocol (SHARP) Investigators Study Group reported by Llovet et al.r

Between March 10 2005 and April 11 2006, a total of 602 patients were randomised to either the sorafenib group (299 patients) or the placebo group (303 patients).

The primary endpoints were overall survival and time to symptomatic progression and the secondary endpoints included time to radiologic progression, disease control rate and safety.

The efficacy and safety of sorafenib for hepatocellular in the Asia-Pacific population was studied in a multicentre, double-blind, placebo-controlled RCT involving 271 patients. Median overall survival was 6.5 vs 4.2 months (HR=0.68; 95% CI 0.50-0.93; p=0.014) and median time to treatment progression was 2.8 vs 1.4 months (HR=0.57; 95% CI 0.42-0.79;p=0.0005) in the sorafenib and placebo arms respectively. Sorafenib was generally well tolerated with hand-foot skin reaction (10.7%), diarrhoea (6%), and fatigue (3.4%) the most frequently reported adverse events.r

Efficacy

The median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group (hazard ratio in the sorafenib group, 0.69; p<0.001).

There was no significant difference in the median time to symptomatic progression between the sorafenib group and the placebo group (4.1 months vs 4.9 months respectively; p=0.77).

The median time to radiologic progression was 5.5 months in the sorafenib group and 2.8 months in the placebo group (p<0.001). 7 patients in the sorafenib group and 2 patients in the placebo group had a partial response; no patient had a complete response.

Efficacyr  Sorafenib (n=299) Placebo (n=303) p-value
Overall Survival  10.7 months 7.9 months <0.001
Time to symptomatic progression  4.1 months 4.9 months  0.77
Time to radiologic progression  5.5 months  2.8 months <0.001

Kaplan-Meier Analysis of Overall Survival and Time to Symptomatic Progressionr

© New England Journal of Medicine 2008

Toxicity

The overall incidence of treatment-related adverse events, predominantly grade 1 or 2, was 80% in the sorafenib group and 52% in the placebo group. Diarrhoea, weight loss, hand-foot skin reaction, alopecia, anorexia, voice changes, hypophosphataemia and thrombocytopenia occurred at a higher frequency in the sorafenib group than in the placebo group.

Rates of discontinuation of treatment were similar in the two groups (38% in the sorafenib and 37% in the placebo). Gastrointestinal events (6%), fatigue (5%), and liver dysfunction (5%) were the most frequent causes of discontinuation of sorafenib.

Toxicityr Sorafenib (%) Placebo (%) p-value
Diarrhoea 39 11 <0.001
Weight loss 9 1 <0.001
Hand-foot skin reaction 21 3 <0.001
Alopecia 14 2 <0.001
Anorexia 14 3 <0.001
Voice changes 6 1 <0.001
Hypertension 5 2 0.05
Bleeding 7 4 0.07
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Version 5

Date Summary of changes
31/01/2024

Protocol assessed by eviQ medical oncology reference committee and deemed suitable to be reviewed as required. Flag added, review date removed and version number increased to V.5. Read more about as required review protocol status in this factsheet.

Version 4

Date Summary of changes
07/09/2023

Protocol updated with ADDIKD guideline recommendations. 

PDF of previous protocol.

Version number changed to V.4.

Version 3

Date Summary of changes
23/03/2010 Approved and transferred to eviQ.
01/09/2010 Administration of tablets with reference to a fatty meal was considered confusing and updated to a general statement "taken on an empty stomach, at least 1 hour before or 2 hours after the meal".
03/04/2012 New format to allow for export of protocol information.
Protocol version number changed to V.2.
Additional Clinical Information, Key Prescribing table and Key Administration table combined into new section titled Clinical Considerations.
Drug specific information placed behind the drug name link.
13/09/2013

Protocol reviewed at Medical Oncology Reference Committee meeting.
Evidence updated to include study in the Asia-pacific population.
Dose modifications updated as per recommendations in SHARP study.
Side effects: Added hypocalcaemia and hypokalaemia.
Next review in 2 years.
16/12/2015 Protocol reviewed electronically by Medical Oncology Reference committee. No changes and next review in 2 years.
09/11/2016 The following change made post Medical Oncology Reference Committee meeting held on 21 October 2016: Link to AGITG and ANZCTR added.
31/05/2017

Transferred to new eviQ website. Version number changed to V.3.

Hepatitis B screening changed to NOT recommended.
16/02/2018 Protocol reviewed at Medical Oncology Reference Committee Meeting, no changes. Review in 2 years.
25/09/2020 Protocol reviewed electronically by the Medical Oncology Reference committee. Nil changes. Next review in 2 years.
21/12/2021 Changed antiemetic clinical information block to minimal or low, to align with new categories. See ID 7 Prevention of anti-cancer therapy induced nausea and vomiting (AINV) v5.
20/10/2022

Protocol reviewed electronically by Medical Oncology Reference Committee. No changes. Next review 2 years.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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https://www.eviq.org.au/p/92

26 Jul 2025