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Antineoplastic Agents

Antineoplastic Agents


Stivarga, Stivarga



Regorafenib is an orally-administered inhibitor of multiple kinases. It is used for the treatment of metastatic colorectal cancer and advanced gastrointestinal stromal tumours. FDA approved on September 27, 2012.

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The T-value in the score for hazard refers to chronic toxicity.

Regorafenib is considered to have particularly hazardous properties. According to EU established criteria, regorafenib is considered a PBT/vPvB substance. The toxicity of aquatic organisms is very high, the substance is capable of bioaccumulation and degradation is slowly in the environment.

Below is Hazard and Risk according to data from the assessment report for Stivarga (regarofenib) 4 July 2017, EMA / 467788/2017

Persistence: DT50water = <1 day, DT50system = >> 100 days at 22-24 degrees Celsius and DT50soil = 181 days at 20 +/- 2 degrees Celsius.

Bioaccumulation: BCF = 3 241 L/kg

Chronic toxicity: There is NOEC for three trophic levels, lowest NOEC for fish 0.007 microg/L.

"PBT-statement: regorafenib is considered PBT, not vPvB."

The risk, PEC/PNEC, calculated from data in the assessment report from a European perspective:
PEC = 0.6 microg/L
PNEC = Lowest NOEC, 0.007 microg/L/10 (Assessment Factor (AF) chronic studies with three species) = 0.0007 microg/L
PEC/PNEC = 857

Risk from Fass environmental information for Stivarga (downloaded 2018-05-03)
PEC/PNEC is based on sales data in Sweden in 2015. PEC / PNEC = 0.08

"The calculated PEC/PNEC value is <0.1. Hence, risk assessment procedures would indicate that regorafenib has insignificant long-term risk to the environment. However, the half-life in freshwater sediment is >120d, the BCF is >2000, and the chronic toxicity is <0.01 mg/L (NOEC). Regorafenib should therefore be regarded as PBT substance, according to the ECHA guidance criteria, and as such the current PEC/PNEC ratio may underestimate the potential for long-term risks to aquatic organisms."


  1. European Medicines Agency. European public assessment reports (EPAR).
  2. Fass.se för vårdpersonal