Treatment Name: Regorafenib (Stivarga®)
Regorafenib (Stivarga®) is a Chemotherapy Regimen for Colon Cancer
How does regorafenib work?
Regorafenib is a chemotherapy drug that is a small molecule called a Tyrosine Kinase Inhibitor (TKI) that turns off several proteins that are not functioning properly which help cancer cells to grow and survive.
Goals of therapy:
Regorafenib is taken to shrink tumors and decrease symptoms of colon cancer and is not commonly given with the goal of cure.
- Usual starting dose: 160 mg (four 40 mg tablets) by mouth once daily for 21 consecutive days followed by 7 days off
- It is best to take each dose after eating a low-fat meal (containing less than 600 calories and less than 30% fat)
Regorafenib must be dispensed by a specialty pharmacy and is taken at home. Treatment is continued until the drug no longer works or until unacceptable side effects occur.
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.
In clinical studies, the most commonly reported side effects of regorafenib (Stivarga®) are shown here:
- Fatigue (47%)
- Redness and blisters on palms of hands and soles of feet (47%)
- Diarrhea (34%)
- Decreased appetite (30%)
- Voice changes (29%)
- High blood pressure (28%)
- Mouth sores (27%)
- Skin rash or peeling (26%)
- Nausea (14%)
- Weight loss (14%)
- Thrombocytopenia [low platelets] (13%)
- Fever (10%)
- High blood bilirubin [sign of liver injury] (9%)
- Constipation (8%)
- Dry skin (8%)
- Vomiting (8%)
- Hair loss (7%)
- Changes in taste (7%)
- Nerve pain (7%)
- Nose bleed (7%)
- Anemia [low red blood cells] (7%)
- Shortness of breath (6%)
- Muscle pain (6%)
- Headache (5%)
- Stomach pain (5%)
- Low blood phosphorous (5%)
On average, 8% of patients discontinue drug treatment due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment, every two weeks for the first two months of treatment, then monthly thereafter. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order. Blood pressure is typically checked weekly for the first six weeks of treatment, and then monthly thereafter. CEA (carcinoembryonic antigen), a tumor marker, may be checked periodically.
How often is imaging needed?
Imaging may be checked before treatment then approximately every 8 weeks. Imaging may also be checked if you have any signs or symptoms of a serious side effect. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue regorafenib as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Contact your doctor immediately if you experience severe abdominal pain or yellowing of the skin or eyes as these may be signs of severe liver injury
- If you have high blood pressure that is not well controlled, you may need to take additional medications or have your current medications adjusted before starting regorafenib
- Go to the nearest emergency room if you experience chest pain, shortness of breath, or feel dizzy and lightheaded as these may be signs of a serious heart problem
- Let your doctor know when you are going to have any surgeries or procedures as regorafenib may need to be stopped for at least two weeks prior to the surgery or procedure
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for colon cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Regorafenib (Stivarga®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Regorafenib (Stivarga®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Regorafenib (Stivarga®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Regorafenib (Stivarga®)