6 Best Sorafenib Alternatives For Liver And Kidney Cancer

Sorafenib has been a mainstay in the treatment arsenal for certain cancers, particularly advanced liver cancer (Hepatocellular carcinoma or HCC) and renal cell carcinoma (RCC). Sorafenib has demonstrated considerable promise with regard to prolonging survival and improving quality of life; however, the associated side effects, as well as financial constraints, may render it not an ideal treatment for some patients. Fortunately, several other alternatives to sorafenib are becoming popular in the current oncology landscape. This article will explore some of these alternatives and their potential efficacy in treating liver and kidney cancer.

Sorafenib and Its Obstacles

Sorafenib is a multikinase inhibitor that is able to target tumor development, angiogenesis, and proliferation of cancer cells, acting on pathways including but not limited to Raf kinases, vascular endothelial growth factor receptors (VEGFR), and platelet-derived growth factor receptors (PDGFR). Sorafenib tablet is effective and acts on the targeted pathways; however, it does not come without its limitations of adverse effects such as fatigue, diarrhea, hypertension, and skin problems. In addition, the cost of sorafenib may limit access to the drug for patients, and inspire patients and medical professionals to investigate alternative treatment options.

Alternative Treatments for Sorafenib in Liver and Kidney Cancer

Lenvatinib (Lenvima)

Lenvatinib, like sorafenib, is an oral multikinase inhibitor that targets various receptor tyrosine kinases such as VEGFR and FGFR. In July 2018, lenvatinib was approved as an option to sorafenib for the first-line treatment of advanced liver cancer. Clinical trials established lenvatinib as providing similar or better overall survival compared to sorafenib for patients with advanced HCC. Lenvatinib also appears to have a better side effect profile, with less likely reports of skin issues as an adverse event than sorafenib.

Regorafenib (Stivarga)

Regorafenib is an oral multikinase inhibitor, specifically used when liver cancer has progressed after treatment with sorafenib. It works on similar pathways to sorafenib in that it inhibits both VEGFR, PDGFR, and RAF pathways. Regorafenib has been shown to prolong overall survival in patients with advanced HCC not responsive to first-line treatment. Regorafenib shares similarities with sorafenib, with shared adverse events of fatigue, diarrhea, and liver toxicity, but again, these can be managed with a dose reduction.

Cabozantinib (Cabometyx)

Cabozantinib is a tyrosine kinase inhibitor (TKI) with various receptors, including MET, VEGFR, and AXL. Cabozantinib has been approved for use in advanced HCC who have previously been treated with sorafenib. Studies have shown that there are key benefits with cabozantinib regarding survival, tumor size decrease, and improvement in median survival time. Cabozantinib was noted to be most effective in patients with vascular invasion who progressed after other treatments.

Axitinib (Inlyta) 

Axitinib is a highly selective VEGFR inhibitor that is indicated in patients with metastatic RCC who have undergone prior therapies. Sorafenib, by contrast, has multiple targets and mechanisms of action. Axitinib has only a single mechanism of action, which could be beneficial for certain populations. Early clinical trials revealed that axitinib led to a superior progression-free survival compared to other options in patients with advanced RCC.

Generic Alternatives to Sorafenib

Top luxury-branded cancer products like sorafenib can be financially burdensome in long-term treatment regimens. However, there are generic alternatives available for some of the products listed above. 

• Lenvatinib (Lenvima), while not currently available as a generic, is being studied to find a low-cost alternative.

• Regorafenib (Stivarga), generic options are in the works and will be available within a few years as a second-line option.

• Sunitinib (Sutent), a generic sunitinib, is already available in some markets for implementation and will be available to more patients with RCC moving into the future. 

• Pazopanib (Votrient), like sunitinib, generic pazopanib is being initiated and could open the door for more patients to receive treatment.

Final Takeaways

Sorafenib continues to be a useful option for both liver and kidney cancer; however, many other alternatives are also effective and can have similar or better outcomes. For example, lenvatinib, regorafenib, and cabozantinib can provide good options for patients with advanced liver cancer. Likewise, sunitinib, pazopanib, and axitinib can provide alternatives for patients with renal cell carcinoma. 

The specific treatment approach should depend on the patient's overall health status, tolerance for side effects, and prognosis. As generic alternatives begin to contribute to the treatment landscape, access to potentially life-saving treatments will improve through expanded availability for greater segments of the population.

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