Abstract. Sorafenib is an oral multikinase inhibitor that acts by inhibiting tumor growth and disrupting tumor microvasculature through antiproliferative, anti-angiogenic and proapoptotic effects. It exerts these effects via inhibition of multiple targets including Raf serine/threonine kinases, vascular endothelial growth factor receptor tyrosine kinases; VEGFR-1, VEGFR-2, VEGFR-3 and platelet-derived growth factor receptor β (PDGFR-β). Current literature shows that the deregulated signaling through these receptors is commonly seen in human tumors. In addition, sorafenib is also shown to induce apoptosis through downregulation of Mcl-1 in many cancer types. Hence, sorafenib as a single agent has shown promising activity in some cancers such as renal cell carcinoma (RCC), hepatocellular carcinoma (HCC) and thyroid cancers. Currently, the drug holds FDA approval for the treatment of advanced RCC and unresectable HCC. However, many clinical studies have indicated several limitations to the application of sorafenib as a single agent in various other cancers. Owing to these reasons and the potential of sorafenib to synergize with other anticancer therapies, its combination with other targeted agents and chemotherapy has been widely explored with promising results. In addition, it has also shown synergistic results when combined with radiation. This review summarizes the current basic and clinical studies on the effects and mechanisms of sorafenib either administered alone or in combination with other anticancer treatments.
IntroductionSince the 1980s, the field of cancer treatment has experienced a major paradigm shift from broad-spectrum cytotoxic chemotherapeutics to the development of targeted therapies tailored to inhibit cancer-specific pathways (1). This change was prompted by the limitations of the treatment mainstays in those days, which were surgery, chemotherapy and radiotherapy. Surgery was limited to early non-metastatic diseases, however, research demonstrates that solid tumors are frequently metastatic at presentation (2). Radiation and chemotherapy has limited capacity to discriminate between cancerous and normal cells and hence, results in severe side effects (3). Furthermore, solid tumors are inherently resistant to both radiation and chemotherapy. Therefore, the rationale for development of molecular targeted therapies was to overcome drug resistance, to make malignant cells more susceptible to suppression and damage whilst avoiding substantial toxicity to the rest of the body tissues and also to provide a higher therapeutic index.The molecular targeted therapies include monoclonal antibodies, tyrosine kinase inhibitors, rapamycin pathway inhibitors, proteasome inhibitors and inhibitors of Raf kinase (4). Many of these drugs have shown therapeutic benefit in various cancers, however, several challenges are yet to be conquered by the developers. These include overcoming certain amount of acquired resistance in cancer cells, selecting suitable dosage schedules, determining the stage to start treatmen...