Everolimus (Afinitor) | Cancer Research UK
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What everolimus is

Everolimus is pronounced e-ve-ro-li-mus. It’s brand name is Afinitor. It is a biological therapy treatment for 

  • Advanced breast cancer if you have been through the menopause (post menopausal). You take it with the hormone therapy drug exemestane
  • Advanced kidney cancer that has come back either during or after treatment.
  • Neuroendocrine tumours of the pancreas that can't be removed with surgery or have spread (metastatic disease)

Researchers are also looking at everolimus as a treatment for head and neck cancer and cancer of the food pipe (oesophageal cancer).

 

How everolimus works

It is a type of treatment called a signal transduction inhibitor. Signal transduction inhibitors stop some of the signals within cells that make them grow and divide. Everolimus stops a particular protein called mTOR from working properly. mTOR controls other proteins that trigger cancer cells to grow. So everolimus helps to stop the cancer growing or may slow it down.

 

How you have everolimus

You take everolimus as a tablet once a day. You should take it at the same time each day and swallow it whole with a glass of water. Don't chew or crush the tablet. You can take it with or without food. But do the same thing each day, so have it every day with food or every day without food.

You usually continue taking everolimus for as long as it works. It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

If you miss a dose, don't take an extra dose but take the next prescribed dose at the usual time.

If you have accidentally taken too much everolimus, see a doctor or go to a hospital straight away.

 

Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

 

About side effects

We've listed the side effects associated with everolimus. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)

The side effects may be different if you are having everolimus with other medicines.

Tell your doctor, nurse or pharmacist straight away if any of the side effects get severe.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • A change in blood sugar levels. Your nurse will check the levels regularly. If you are diabetic, talk to your diabetes doctor or nurse about the best way to control your diabetes
  • A sore mouth (stomatitis) occurs in more than 4 out of 10 people (44%). Your nurse will give you mouthwashes to use. Avoid mouthwashes containing alcohol, peroxide, iodine or thyme as these can make the soreness worse
  • Feeling weak affects 3 out of 10 people (30%)
  • Tiredness (fatigue) and weakness during and after treatment – this happens in 3 out of 10 people (30%)
  • Some kind of skin reaction affects 1 to 3 out of 10 people (10 to 30%) – you may have a rash or itchy or dry skin. Or you may have red, peeling skin on the palms of your hands and soles of your feet.
  • Loss of appetite happens in 1 in 4 people (25%)
  • Feeling or being sick happens in about 2 out of every 10 people (20%). It is usually well controlled with anti sickness medicines
  • Headaches
  • Taste changes
  • Diarrhoea – drink plenty of fluids. If your diarrhoea is severe or continues you could get dehydrated so let your doctor or nurse know
  • Inflammation of the lungs (pneumonitis) – let your doctor know if you have breathlessness, a high temperature and chills, extreme tiredness, a dry cough, or pain in your lungs when you take a deep breath
  • Fluid build up – your ankles, hands or other parts of the body may be swollen and you may put on weight
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
  • Weight loss
  • High levels of fats called cholesterol in the blood
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Kidney changes – you will have regular blood tests to check how well your kidneys are working and will have fluids to flush the drugs through. Let your nurse know if you pass less urine than usual
  • Liver changes – you are unlikely to notice any symptoms and your liver function will almost certainly go back to normal when you finish treatment. You will have regular blood tests to check how well your liver is working
  • Sore, red eyes or dry eyes – steroid eye drops can help
  • Difficulty sleeping
  • An allergic reaction to the drug. Let your doctor or nurse know straight away if you suddenly feel breathless, have difficulty swallowing, or have a severe itchy rash, chest pain, or swelling of the lips, tongue or throat
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
  • Joint pain – mild painkillers can help
  • Heartburn or indigestion (dyspepsia)
  • Difficulty swallowing – let your doctor or nurse know straight away if you have this
  • Abdominal (tummy) pain
  • Joint pains – your doctor or nurse can give you painkillers to help
  • Low levels of potassium in your blood (hypokalaemia) – let your doctor or nurse know if you have cramping in your arm or leg muscles, tingling or numbness, palpitations (feeling your heart beat irregularly), or if you feel faint
  • Low levels of calcium in the blood – tell your doctor or nurse if you have painful muscle spasm and cramps, muscle twitching, or numbness or tingling in your feet and hands or around your mouth
  • Nail changes – your nails may become brittle and break easily
  • Hair thinning
  • Sticky eyes with itching, redness and swelling – your nurse can give you eye drops to help
 

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Heart problems that cause chest pain, swollen ankles, breathlessness and a fast heart rate – tell your doctor or nurse if you have any of these symptoms
  • A type of anaemia called pure red cell aplasia
  • Blood clots in the leg – let your doctor or nurse know if you have swelling, pain or redness in your leg or if the area feels warm
  • Blood clots in the lung – let your doctor or nurse know if you have breathlessness, chest pain or coughing up blood
  • Hot flushes
  • Severe liver changes leading to yellowing of the skin and whites of the eyes (jaundice). Let your doctor or nurse know straight away if you have these signs
 

Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together. If you are taking other medicines at the same time as everolimus your doctor may need to change the dose.

Grapefruit and grapefruit juice

Avoid grapefruit and grapefruit juice while you are taking everolimus because they can make it work less well.

Lactose intolerance

Everolimus tablets contain lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don't breastfeed during this treatment because the drug may come through in the breast milk.

Slow wound healing

Everolimus can slow wound healing. If you need to have an operation you may need to stop taking it for a while beforehand. They will let you know when you can start taking it again.

Hepatitis and everolimus

Hepatitis means inflammation (swelling) of the liver. It can be due to a viral infection or because the liver comes into contact with harmful substances such as alcohol. Everolimus can make hepatitis infection active again. So you should let your doctor know if you have had hepatitis in the past.

 

Immunisations and everolimus

You shouldn't have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about everolimus

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at yellowcard.mhra.gov.uk.

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Updated: 4 December 2015