Everolimus

Everolimus is a targeted cancer drug that blocks cancer growth, its also known by its brand name Afinitor.

You might have everolimus if you have advanced:

• breast cancer that is hormone receptor positive 
• neuroendocrine tumour (NET) of the stomach, bowel, lung or pancreas
• kidney cancer

How everolimus works

Everolimus is a type of cancer growth blocker. It works by reducing the blood supply to the cancer and slowing down the growth of the cancer. 

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. You can take it with or without food. 

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

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

Taking your tablets or capsules

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have everolimus

You usually take everolimus every day for as long as it is working. 

Tests

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

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 
• your side effects aren’t getting any better
• your side effects are getting worse

Early treatment can help manage side effects better. 

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

A change in blood sugar levels

You have regular blood and urine tests to check this. If you have diabetes you may need to check your blood sugar levels more often than usual. 

Sore mouth and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

Swollen hands and feet

Swelling of hands and feet is due to fluid build up. This is called oedema. Let your doctor or nurse know if you have any swelling.

Raised cholesterol levels

Cholesterol is a fatty substance which helps cells in the body to work normally. When the cholesterol level is too high it could have an effect on your heart. You usually have blood tests to check your cholesterol levels.

Nose bleeds

This might be due to a drop in the number of platelets in your blood. Platelets help the blood to clot. So if you have too few platelets you can bleed more easily.

To try and stop a nose bleed hold your nose tightly just above your nostrils and lean forwards slightly. Do this for about 10 to 15 minutes. You can still breathe through your mouth. Contact your advice line if you keep getting nose bleeds or it doesn't stop.    

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

• a drop in the level of platelets which can cause bruising and bleeding
• lack of fluid in your body (dehydration)
• difficulty sleeping
• high blood pressure
• indigestion
• difficulty swallowing
• pain in your tummy (abdomen)
• soreness, redness and peeling on palms and soles of feet
• aching or painful joints
• irregular periods, or more rarely, your periods may stop completely
• low levels of potassium, calcium or phosphate in your blood
• brittle or broken nails
• hair thinning
• liver changes picked up on blood tests
• changes to the way your kidneys work, which could be severe - tell your doctor if you're not passing much urine, have back pain or feel confused
• swelling of your eyelids

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

• an allergic reaction
• damage to the heart causing it not to work properly - you might feel breathless or your hands and feet may swell
• coughing up blood (haemoptysis)
• chest pain
• wounds taking longer to heal
• hot flushes
• sore or sticky eyes
• a blood clot in the deep veins of your body (deep vein thrombosis, DVT) that could possibly travel to your lungs (pulmonary embolism). This could be life threatening if not treated quickly

Symptoms of a blood clot includes:

• pain, redness and swelling around the area where the clot is and may feel warm to touch
• breathlessness
• pain in your chest or upper back – dial 999 if you have chest pain
• coughing up blood

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Grapefruit and grapefruit juice

You should not eat grapefruit or drink grapefruit juice when you are taking this drug because it can react with the drug.

Lactose intolerance

This drug contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

Pregnancy and contraception 

This treatment might harm a baby developing in the womb. It is important for women not to become pregnant while you are having treatment and for 8 weeks afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

Don’t breastfeed during this treatment and for 2 weeks after your last dose, because the drug may come through into your breast milk.

Hepatitis B

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. This drug can make hepatitis infection active again. So you should let your doctor know if you have had hepatitis in the past.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

• have other vaccines, but they might not give you as much protection as usual
• have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.