This page tells you about the drug everolimus. There is information about
Everolimus is pronounced e-ve-ro-li-mus. It’s brand name is Afinitor. It is a biological therapy treatment for advanced kidney cancer that has come back either during or after treatment.
In some situations you may have it to treat
- Advanced breast cancer if you have been through the menopause (post menopausal). You take it with the hormone therapy drug exemestane
- Neuroendocrine tumours of the pancreas that cannot 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).
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.
You take everolimus as a tablet once a day. You should try to take it at the same time each day and swallow it whole with a glass of water. Do not chew or crush the tablet. You can take it with or 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. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. 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.
The side effects associated with everolimus are listed below. You can use the links to find out more about each side effect. If there is no link, go to our cancer drug side effects section or type the name of the side effect into the search box at the top of the page.
More than 10 in every 100 people have one or more of the side effects listed below.
A temporary drop in the number of blood cells made by the bone marrow, causing
- 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, sore throat, pain passing urine, or feel cold and shivery
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts before and during treatment to see how well your bone marrow is working.
Other common side effects include
- A sore mouth (stomatitis) in more than 4 out of 10 people (44%) – your nurse will give you mouthwashes to use but avoid mouthwashes containing alcohol, peroxide, iodine or thyme as these can make the soreness worse
- Feeling weak in 3 out of 10 people (30%)
- Tiredness (fatigue) and weakness during and after treatment – this happens in 3 out of 10 people (30%)
- Cough and shortness of breath in about 1 in 4 people (25%)
- Some kind of skin reaction in 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%) but is usually well controlled with anti sickness medicines
- 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
- Taking everolimus may affect your blood sugar levels so 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
- Fluid retention – your ankles 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 having this treatment. Talk to your doctor before starting treatment if having a baby is important to you
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
- A rise in the level of cholesterol in the blood – you will have blood tests to check the levels
- 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 or have chest pain or if you have swelling of the lips, tongue or throat
- Joint pain – mild painkillers can help
- Heartburn or indigestion (dyspepsia)
- Difficulty swallowing – let your doctor or nurse know straight away if you have this
Fewer than 1 in 100 people have these effects.
- Taste changes
- 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
- Hot flushes
You will not get all these side effects and those that you have may be mild. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
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.
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.
Everolimus may react with the following drugs
- Anti fungal medicines
- Some antibiotics
- Some HIV medicines
- Some drugs used to treat heart conditions or high blood pressure
- An anti cancer drug called imatinib (Glivec)
The following medicines may make everolimus work less well
- A tuberculosis (TB) drug called rifampicin
- St. John’s wort (Hypericum perforatum) – a herbal product used to treat depression and other conditions
- Some anti epileptic medicines
Grapefruit and grapefruit juice
Avoid grapefruit and grapefruit juice while you are taking everolimus because they can make it work less well.
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 have a harmful effect on a developing baby. It is important not to become pregnant or father a child during treatment. Talk to your doctor or nurse about contraception before starting treatment if there is any chance that you or your partner could become pregnant.
Breastfeeding is not advisable 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.
You should not 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.
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 www.mhra.gov.uk.
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