Small intestinal perforation caused by metastatic tumor necrosis after sorafenib (Nexavar) therapy for advanced hepatocellular carcinoma

Sorafenib (Nexavar®, BAY 43-9006) is a novel multikinase inhibitor that has been recently approved for the treatment of advanced hepatocellular carcinoma (HCC). The increased use of sorafenib has been accompanied by an increase in the number of reports on the adverse effects of this drug. Generally, the adverse effects of sorafenib are well tolerated, and the most common drug-related toxicities are hand-foot skin reaction, diarrhea, fatigue, rash, and hypertension. Here, we report the case of a 54-year-old man who developed small bowel perforation 2 months after receiving sorafenib for advanced HCC. The exact pathogenesis of the perforation is unclear. The cause of small bowel perforation in this patient was most likely metastatic tumor necrosis due to sorafenib. From this case, we can infer that treatment with antiangiogenic multikinase inhibitors may be associated with gastrointestinal (GI) perforations. Physicians should keep the possibility of this rare but potentially serious GI complication related to sorafenib treatment in mind.