Regorafenib (Stivarga)

General information

Class/mechanism: Small molecule inhibitor of multiple tyrosine kinases, such as: VEGFR1, VEGFR2, VEGFR3, KIT, RET, PDGFR-alpha, PDGFR-beta, FGFR1, FGFR2, TIE2, DDR2, Trk2A, Eph2A, RAF-1, BRAF, BRAFV600E, SAPK2, PTK5, and Abl, which are involved in tumor cell proliferation, survival, and angiogenesis. Its major active metabolites are M-2 and M-5.
Route: PO
Extravasation: n/a
Black Box Warning: Severe and sometimes fatal hepatotoxicity has been observed in clinical trials. Monitor hepatic function prior to and during treatment. Interrupt and then reduce or discontinue regorafenib for hepatotoxicity as manifested by elevated liver function tests (LFTs) or hepatocellular necrosis, depending upon severity and persistence.

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the package insert.

Diseases for which it is established

• Colorectal cancer
• Gastrointestinal stromal tumor
• Hepatocellular carcinoma

Diseases for which it is used

• Cholangiocarcinoma
• Gallbladder cancer
• Gastric cancer
• Leiomyosarcoma
• Osteosarcoma
• Renal cell carcinoma
• Soft tissue sarcoma

Patient drug information

• Regorafenib (Stivarga) package insert
• Regorafenib (Stivarga) patient drug information (Chemocare)
• Regorafenib (Stivarga) patient drug information (UpToDate)

History of changes in FDA indication

Colorectal cancer

• 9/27/2012: Approved for patients with metastatic colorectal cancer (mCRC) who have been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, an anti-VEGF therapy, and, if KRAS wild type, an anti-EGFR therapy. (Based on CORRECT)

Gastrointestinal stromal tumor

• 2/25/2013: Approved for patients with advanced gastrointestinal stromal tumors (GIST) that cannot be surgically removed and no longer respond to other FDA-approved treatments for this disease. (Based on GRID)

Hepatocellular carcinoma

• 4/27/2017: Approved for the treatment of patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib. (Based on RESORCE)

History of changes in EMA indication

• 8/26/2013: Initial marketing authorization as Stivarga.

Also known as

• Code name: BAY 73-4506
• Brand names: Nublexa, Regonix, Renib, Resihance, Stivarga