Everolimus is also known as Afinitor®. It can be used to treat kidney cancer that has spread and advanced pancreatic neuroendocrine cancer (pNET). It may also be used with a hormonal drug called exemestane to treat some women with breast cancer that has spread.
Everolimus may be used to treat other types of cancer as part of clinical research trials.
You'll see your cancer doctor and specialist nurse regularly while you’re having everolimus. This information may help you discuss any questions about your treatment and its side effects with them.
Everolimus is a treatment that interferes with the way a protein called mTOR works. The protein mTOR (also called enzyme kinase) makes cells divide and grow, and it’s often overactive in cancer cells. Everolimus may also be called a kinase inhibitor.
How does everolimus work?
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Everolimus blocks (inhibits) the mTOR protein. This may help to stop the cancer growing or slow down its growth. It can also stop the cancer cells making new blood vessels. This may help shrink the cancer.
When is everolimus used?
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Although everolimus is licensed in the UK to treat these cancers, it may not be widely available on the NHS. Some people may receive it as part of a clinical trial.
If a drug hasn’t been approved for funding on the NHS, it may still be available in certain situations.
We have more information about what you can do if a treatment isn’t available.
How is everolimus taken?
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Everolimus is taken as a tablet once a day. Take it at the same time every day. Swallow the tablet whole with a glass of water - don’t crush or chew it. You can take it with or without food.
Always take everolimus exactly as directed by your doctor, nurse or pharmacist. If you forget to take a tablet, just take your next one as scheduled. Don’t take two doses at the same time. Don’t stop taking it without talking to your cancer doctor.
Don’t drink grapefruit juice or eat grapefruit while you’re taking everolimus.
Possible side effects of everolimus
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These side effects won't affect everyone taking everolimus. Always let your cancer doctor or specialist nurse know about any side effects you have. They can prescribe drugs to reduce side effects and give you advice on how to cope with them.
We explain the most common side effects but haven't included the rare ones that are unlikely to affect you. If you notice any effects that aren't here, let your doctor or nurse know. Most side effects gradually improve after treatment stops.
Risk of infection
Everolimus can reduce the number of white blood cells, which help fight infection. If the number of your white blood cells is low you’ll be more prone to infections. A low white blood cell count is called neutropenia.
Contact the hospital immediately on the 24-hour contact number you’ve been given and speak to a nurse or doctor if:
you develop a high temperature, which may be over 37.5°C (99.5F) or over 38°C (100.4F) depending on the hospital’s policy - follow the advice you’ve been given by your cancer doctor, nurse or pharmacist
you suddenly feel unwell, even with a normal temperature
you feel shivery and shaky
you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection) or diarrhoea.
You’ll have blood tests during your treatment to check your white blood cell count. Occasionally your treatment may need to be delayed, or the dose may need to be reduced, if the number of your white blood cells is low.
Everolimus can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired or short of breath. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if your red blood cell count becomes too low.
Bruising or bleeding
Everolimus can reduce the number of platelets in your blood. Platelets help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Sore mouth and ulcers
During treatment, your mouth may become sore or dry, or you may notice small ulcers. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help reduce the risk of this happening. Tell your specialist nurse or doctor if you have any of these problems. They can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Feeling tired is a common side effect of everolimus. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate machinery or drive.
You might find that you feel short of breath or have a pain in your chest if you take a deep breath. If you have these symptoms or a high temperature or dry cough, it can be a sign of an inflammation in your lungs. This is called pneumonitis.
Very rarely, people can have chest pain with sudden shortness of breath or coughing up of blood. These can be a sign of a clot in the lung.
If you have any breathing or lung problems, contact your hospital straight away. Use the 24-hour contact number you’ve been given and speak to a specialist nurse or doctor.
Your skin may become dry or flaky during your treatment. Some people also find they get an acne-like rash. These side effects are usually mild but may make you feel uncomfortable or self-conscious. Speak to your doctor or nurse if you have any of these skin changes. They can advise you about creams or lotions, or prescribe medicines to relieve itching.
Loss of appetite
Some people lose their appetite while they’re taking everolimus. If you have a poor appetite, try to eat small amounts as often as possible. Keep snacks, such as nuts or dried fruit, handy to eat whenever you can. If this continues to be a problem, the dietitian at your hospital can give you advice about how to boost your appetite and maintain your weight.
You may notice that food tastes different. You could try using seasoning, spices and herbs to flavour your food. Some people find cold food tastes better than hot food. Most people find that their taste returns to normal after treatment finishes.
Feeling sick or being sick
Feeling sick is a common side effect but it’s usually easy to control. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or help with this. If the sickness isn't controlled, tell your cancer doctor or nurse. They can prescribe other anti-sickness drugs that should work better for you.
Blood sugar levels
Everolimus may cause a temporary increase in the level of sugar in your blood. Your doctor will take regular blood tests to check this. Signs of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling hungry. If you get any of these symptoms, let your doctor or nurse know.
If you’re diabetic, you may find that your blood sugar levels are higher than usual. Talk to your doctor or nurse so that you know how to manage this. You may need to adjust your insulin or tablet dose.
Some people find that everolimus causes headaches. Taking simple painkillers can usually relieve this. Let your doctor or nurse know if the headaches continue.
Everolimus can cause diarrhoea. This can usually be easily controlled with medicine. However, if it's severe or continues for more than 24 hours, contact the hospital on the number you’ve been given. It's important to drink plenty of fluids if you have diarrhoea.
Changes to your blood cholesterol
Everolimus may cause the levels of cholesterol in your blood to increase. Your doctor or nurse will take blood samples regularly to monitor this.
Less common side effects of everolimus
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Sometimes everolimus can have an effect on how well your kidneys work. Your doctor will check your blood regularly to monitor this.
Some people notice swelling around the eyes and ankles because of fluid retention. This isn’t harmful, but it can be upsetting and uncomfortable. Diuretics (drugs that make you pass more urine) can help get rid of some of the fluid, but it often settles down by itself. Let your doctor know if you put on a lot of weight very quickly. This can be a sign that you’re retaining fluid.
Everolimus may cause changes in the way your liver works. This should return to normal when the treatment finishes. You're very unlikely to notice any problems but your doctor will take regular blood samples to check that your liver is working properly. Let your doctor know if you develop pain in your right side.
Some people develop sore, red eyes (conjunctivitis) or dry eyes. Your doctor can prescribe eye drops to help with this. Let your doctor know if you notice any changes to your eyes.
Some people find that they have trouble sleeping while taking everolimus. Using relaxation techniques, CDs or podcasts may help. If you still have trouble sleeping, talk to your doctor about taking sleeping tablets.
Additional information about everolimus
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Some medicines, including those you can buy in a shop or chemist, can be harmful when you’re taking everolimus.
Tell your doctor about any medicines you’re taking, including over-the-counter drugs, complementary therapies and herbal drugs. Avoid taking St. John’s Wort while taking everolimus.
You should speak to your doctor before getting any live vaccines during and after your treatment. Your immune system may be weak and vaccines may be harmful.
Fertility and contraception
Your ability to become pregnant or father a child may be affected by this drug. It's important to discuss fertility with your doctor before starting treatment.
We don’t know enough about the effects of everolimus on a developing baby. So it isn’t advisable to become pregnant or father a child while taking this drug.
Protecting your partner
Doctors don’t know whether everolimus is present in semen or vaginal fluids. They usually advise that you use a barrier form of contraception to protect your partner while taking everolimus.
There’s a possible risk that everolimus may be present in breast milk. Women are advised not to breastfeed while taking it and for a few months afterwards.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Explain you are taking chemotherapy tablets that no one should stop or restart without advice from your cancer doctor. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
It’s important to know whom you should contact if you have any problems or need advice when you’re at home.
Some cancer centres provide a 24-hour number that you can call anytime, day or night. Or, you may be given a hospital number to contact during the day and other contact numbers for the evening, night and weekend.
Make sure you keep these in a safe place. If you’re not sure who to contact, ask your specialist cancer doctor or nurse.
Other things to remember about everolimus tablets:
Always tell any doctors treating you for non-cancerous conditions that you’re taking tablets that shouldn’t be stopped or restarted without advice from your cancer doctor.
Keep the tablets in the original packaging, in a safe place at room temperature (away from heat and direct sunlight) and out of reach of children.
If your doctor decides to stop the treatment, return any tablets you have left to the pharmacist. Don't flush them down the toilet or throw them away.
This information has been written by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by our medical editor, Dr Tim Iveson, Macmillan Consultant Medical Oncologist.
This section has been compiled using information from a number of reliable sources, including:
British National Formulary. British Medical Association and Royal Pharmaceutical Society of Great Britain. 64th edition. 2012.
electronic Medicines Compendium (eMC). Accessed February 2013.
National Institute for Health and Care Excellence (NICE). Everolimus for the second-line treatment of advanced renal cell carcinoma. April 2011.
Scottish Medicines Consortium (SMC). 595/10 - everolimus (Afinitior®). March 2010.
Scottish Medicines Consortium (SMC). 777/12 - everolimus (Afinitior®). April 2012.
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
With thanks to: Christine Clarke, Macmillan Lead Pharmacist; Dr James Larkin, Consultant Oncologist; Diane Mackie, Clinical Nurse Specialist; Dr Samra Turajlic, Clinical Research Fellow; and the people affected by cancer who reviewed this information.
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