Progressing differentiated thyroid cancer (DTC) that can no longer be treated with radioactive iodine (RAI)

DTC is a type of cancer that starts in the cells of the thyroid gland.

The thyroid gland is located below the thyroid cartilage or Adam's apple. It has 2 lobes joined by a thin piece of tissue and is a little larger than a quarter.


Graphic icons depicting the disease site.

DTC develops from the follicular cells. It is the most common type of thyroid cancer.

Surgery is usually the first step in the treatment of thyroid cancer. You may have had surgery to remove all or part of your thyroid. It is also common to be treated with radioactive iodine, or RAI.

You can either take RAI as pills or in a liquid form. The RAI travels to the thyroid and helps destroy cancer cells. It can also help destroy thyroid cancer cells that have spread to other parts of the body.

RAI is a good treatment option for many people with thyroid cancer, but it does not work in some people, or it stops working. If RAI does not work, the thyroid cancer may progress (spread, grow, or get worse).

Also, if you have been treated numerous times with RAI, your healthcare provider may feel you should not take any more. For these reasons, your healthcare provider may feel it is time to try another treatment.

What is NEXAVAR?

NEXAVAR is a prescription medicine used to treat:

  • a type of liver cancer called hepatocellular carcinoma (HCC) that cannot be removed by surgery
  • a type of kidney cancer called renal cell carcinoma (RCC)
  • a type of thyroid cancer called differentiated thyroid carcinoma (DTC) that can no longer be treated with radioactive iodine and is progressing

It is not known if NEXAVAR is safe and effective in children.

Important Safety Information

Do not take NEXAVAR if you:

  • are allergic to sorafenib or any of the other ingredients in NEXAVAR.
  • have squamous cell lung cancer and receive carboplatin and paclitaxel.

Before taking NEXAVAR, tell your healthcare provider about all of your medical conditions, including if you:

  • have heart problems including a condition called “congenital long QT syndrome”
  • have chest pain
  • have abnormal magnesium, potassium, or calcium blood levels
  • have bleeding problems
  • have high blood pressure
  • plan to have any surgical procedures or have had recent surgery
  • are pregnant or plan to become pregnant. NEXAVAR may harm your unborn baby. Tell your healthcare provider right away if you become pregnant during treatment with NEXAVAR.

    For females who are able to become pregnant:

    • Your healthcare provider should do a pregnancy test before you start treatment with NEXAVAR.
    • Use effective birth control (contraception) during your treatment with NEXAVAR and for 6 months after the last dose of NEXAVAR.

    For males with female partners who are able to become pregnant:

    • Use effective birth control (contraception) during your treatment with NEXAVAR and for 3 months after the last dose of NEXAVAR.
    • NEXAVAR may cause fertility problems in males. This may affect your ability to father a child. Talk to your healthcare provider if this is a concern for you.
  • are breastfeeding or plan to breastfeed. It is not known if NEXAVAR passes into your breast milk. Do not breastfeed during treatment with NEXAVAR and for 2 weeks after receiving the last dose of NEXAVAR.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Especially tell your healthcare provider if you take the medicine warfarin.

What are the possible side effects of NEXAVAR?

NEXAVAR may cause serious side effects, including:

  • decreased blood flow to the heart, heart attack and heart failure. Get emergency help right away if you get symptoms such as chest pain, shortness of breath, racing heartbeat, swelling in lower legs, feet and abdomen, feel lightheaded or faint, tiredness, nausea, vomiting, or sweat a lot.
  • increased risk of bleeding. Bleeding is a common side effect of NEXAVAR that can be serious and can lead to death. Tell your healthcare provider right away if you have any signs of bleeding during treatment with NEXAVAR:
    • vomiting blood or if your vomit looks like coffee-grounds
    • red or black (looks like tar) stools
    • coughing up blood or blood clots
    • heavier than normal menstrual cycle
    • unusual vaginal bleeding
    • frequent nose bleeds
    • bruising
  • high blood pressure. High blood pressure is a common side effect of NEXAVAR and can be serious. Your blood pressure should be checked every week during the first 6 weeks of starting NEXAVAR. Your blood pressure should be checked regularly and any high blood pressure should be treated during treatment with NEXAVAR.
  • skin problems. A condition called hand-foot skin reactions and skin rash are common with NEXAVAR treatment and can be severe. NEXAVAR may also cause severe skin and mouth reactions that can be life threatening. Tell your healthcare provider if you have any of the following symptoms:
    • skin rash
    • skin redness
    • pain or swelling
    • blistering and peeling of your skin
    • blistering and peeling on the inside of your mouth
    • blisters on the palms of your hand or soles of your feet
  • an opening in the wall of your stomach or intestines (gastrointestinal perforation). Tell your healthcare provider right away if you get fever, nausea, vomiting or severe stomach (abdominal) pain.
  • possible wound healing problems. If you need to have a surgical procedure, tell your healthcare provider that you are taking NEXAVAR. NEXAVAR may need to be stopped until your wound heals after some types of surgery.
  • changes in the electrical activity of your heart called QT prolongation. QT prolongation can cause irregular heartbeats that can be life threatening. Your healthcare provider may do tests during your treatment with NEXAVAR to check the levels of potassium, magnesium, and calcium in your blood, and check the electrical activity of your heart with an electrocardiogram (ECG). Tell your healthcare provider right away if you feel faint, lightheaded, dizzy or feel your heart beating irregularly or fast during your treatment with NEXAVAR.
  • liver problems (drug-induced hepatitis). NEXAVAR may cause liver problems that may lead to liver failure and death. Your healthcare provider will do blood tests to check your liver function regularly during your treatment with NEXAVAR. Tell your healthcare provider right away if you develop any of the following symptoms:
    • yellowing of your skin or the whites of your eyes
    • dark "tea-colored" urine
    • light-colored bowel movements (stools)
    • worsening nausea or vomiting
    • pain on the right side of your stomach area
    • bleeding or bruising more easily than normal
    • loss of appetite
  • change in thyroid hormone levels. If you have differentiated thyroid cancer, you can have changes in your thyroid hormone levels during treatment with NEXAVAR. Your healthcare provider may need to change your dose of thyroid medicine during treatment with NEXAVAR. Your healthcare provider should check your thyroid hormone levels every month during treatment with NEXAVAR.

The most common side effects of NEXAVAR include:

  • diarrhea (frequent or loose bowel movements)
  • tiredness
  • infection
  • hair thinning or patchy hair loss
  • rash
  • weight loss
  • loss of appetite
  • nausea
  • stomach-area (abdomen) pain
  • low blood calcium levels in people with differentiated thyroid cancer

Tell your doctor if you have any side effects that bother you or do not go away. These are not all the possible side effects of NEXAVAR. Ask your doctor or pharmacist for more information.

You are encouraged to report negative side effects or quality complaints of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

For important risk and use information about NEXAVAR, please see the full Prescribing Information.

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When it comes to cancer and cancer treatment, there are a lot of technical terms. Below is a list of words that you will find on our website, along with definitions to help ensure you understand the information we are providing.

  • adrenal [uh-DREE-nul] gland

    • a small gland that sits on top of each kidney and produces certain hormones for the body to use
  • advanced kidney cancer

    • term that means the cancer has spread to more than one part of the kidney and possibly other parts of the body, and cannot be cured by surgery or other treatments
  • advanced liver cancer

    • term that means the cancer has spread to more than one part of the liver and possibly other parts of the body, and cannot be cured by surgery or other treatments
  • curative [KYOO-re-tiv] treatment

    • treatment aimed at getting rid of all signs of cancer (an example is surgery)
  • follicular cells

    • a cell in the thyroid, or to a type of cancer that starts in follicular cells. It can also refer to a type of non-Hodgkin lymphoma that tends to grow in follicles
  • hepatitis [HEH-puh-TY-tis]

    • a disease causing inflammation of the liver
  • immune [ih-MYOON] system

    • a group of organs and cells that help protect your body from infection and disease
  • immunotherapy (ih-MYOO-no-THAYR-uh-pee)

    • treatments that use the body's immune system to fight cancer
  • immunotherapy biologic therapy

    • treatments that use the body's immune system to fight cancer. This is done by boosting the patient's own immune system or giving man-made immune system proteins
  • kidney cancer

    • cancer that forms in tissues of the kidneys
  • laparoscope

    • a long, flexible, thin tube with a lens on the end that's put into the belly (abdomen) through a very small cut. The laparoscope lets the surgeon see organs and lymph nodes inside the abdomen, and remove them using special surgical tools that fit through the laparoscope
  • laparoscopic nephrectomy [LA-puh-ruh-SKAH-pik neh-FREK-toh-mee]

    • a type of surgery to remove a kidney, or part of a kidney in which small incisions, or cuts, are made and a small laparoscope (a thin, tubelike instrument with a light and a lens for viewing) is inserted into one incision to see the kidney and small surgical tools are inserted into the other small incisions. The surgeon looks into the laparoscope to guide the removal of the kidney using the surgical tools
  • locoregional therapy

    • treatment of cancer at its site, so that the rest of the body is not affected. Surgery and radiation are examples of local therapy
  • lymph [limf] nodes

    • filter lymph (lymphatic fluid) and store lymphocytes [LIM-foh-sites] (white blood cells). Lymph nodes are part of the immune system
  • metastases [meh-TAS-tuh-sis]

    • the spread of cancer from one part of the body to other parts of the body. New tumors, which are called "metastatic tumors" or "metastases," contain cells that are like those in the original (primary) tumor
  • metastatic [meh-tah-sta-tik]

    • cancer that has spread from the place where it first started to another place in the body
  • nephrectomy [neh-FREK-toh-mee]

    • a surgery to remove a kidney
  • noncurative care

    • treatment that can make symptoms better and keep the cancer from getting worse for as long as possible but will not cure the cancer. Also called palliative [pa-lee-uh-tiv] care
  • partial nephrectomy [PAR-shul neh-FREK-toh-mee]

    • a surgery to remove part of one kidney or a kidney tumor, but not an entire kidney
  • percutaneous ethanol injection (PEI) [per-kyoo-TAY-nee-us EH-thuh-nol in-JEK-shun]

    • a process that destroys tumors by injecting them with a form of alcohol (ethanol)
  • perforated bowel [pur-FOR-A-tid BOW-ul]

    • a hole directly in the wall of the stomach, small intestine, or large intestine. A perforated bowel requires surgery, as food and other substances can leak into the abdomen, causing severe infection
  • radiation therapy

    • treatment with high-energy rays or particles to kill cancer cells and shrink tumors. The radiation may come from outside the body (external radiation) or from radioactive materials placed in the body (brachytherapy or internal radiation)
  • radical nephrectomy [RA-dih-kul neh-FREK-toh-mee]

    • a surgery that removes the entire kidney along with the adrenal gland and some tissue around the kidney
  • radiofrequency ablation [RAY-dee-oh-FREE-kwen-see uh-BLAY-shun]

    • a procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity). Radiofrequency ablation may be used to treat cancer and other conditions
  • radiotherapy [RAY-dee-oh-THAYR-uh-pee]

    • a ray or beam of high-energy particles that is used to kill cancer cells and shrink tumors
  • regional lymphadenectomy [LIMF-a-de-NEK-toh-mee]

    • Sometimes performed when cancers are removed by surgery, such as in the case of a radical nephrectomy, a regional lymphadenectomy removes nearby lymph nodes to see whether the cancer has spread to them
  • specialty pharmacy

    • a special pharmacy that fills prescriptions and delivers medications that are not available in local or chain pharmacies
  • staging

    • the use of exams and tests to learn the extent of the cancer within the body, especially how far the disease has spread. Staging usually takes into account the size and location of tumor(s)
  • systemic therapy

    • treatment using substances that travel through the bloodstream, reaching and affecting cells all over the body
  • transarterial chemoembolization (TACE) [trans-ar-TEER-ee-ul KEE-moh-EM-boh-lih-ZAY-shun]

    • a procedure in which chemotherapy drugs are injected into the blood vessels that feed the tumors. This delivers a high dose of chemotherapy to the tumor while lowering the blood supply that feeds the tumor
  • unresectable (UN-ree-SEK-tuh-bul)

    • a cancer tumor that cannot be removed by surgery