You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Temsirolimus is a type of treatment called an mTOR inhibitor. mTOR is a protein inside cells that makes them divide and grow, and it is often overactive in cancer cells.
How temsirolimus works
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Temsirolimus works by blocking (inhibiting) the mTOR protein, which may help to stop the cancer growing or slow down its growth.
Temsirolimus can also stop the cancer cells from making new blood vessels. This reduces their supply of oxygen and nutrients, so that the tumour shrinks or stops growing. Drugs that interfere with blood vessel growth in this way are called angiogenesis inhibitors or anti-angiogenics.
When temsirolimus is used
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Temsirolimus is licensed and can be prescribed in the UK to treat people with some types of kidney cancer that has spread (advanced cancer). It's also licensed and can be prescribed in the UK to treat people with mantle cell lymphoma that has come back after chemotherapy or that hasn't responded to chemotherapy.
The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. NICE and the SMC do not recommend the use of temsirolimus for kidney cancer or for mantle cell lymphoma.
As a result, temsirolimus may not be widely available on the NHS, although you may be given it as part of a clinical trial. We have more information on what to do if a treatment isn't available.
After being diluted temsirolimus is a clear, light-yellow fluid.
Temsirolimus is given as a drip into a vein (intravenous infusion) once a week. Each infusion usually takes 30-60 minutes.
Temsirolimus is usually given once a week. The number of doses you have will depend on how well it is working and how many side effects you get. Your doctor or specialist nurse will discuss this with you.
Temsirolimus may cause an allergic reaction, so you'll be given an antihistamine drug before the infusion to reduce the risk of a reaction. If you do have a reaction, the infusion can be stopped and restarted once you feel better.
Each person’s reaction to cancer treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having this treatment. We've outlined the most common side effects, but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
Side effects of temsirolimus fall into two groups:
side effects that may occur during the infusion or for up to about 24 hours afterwards (infusion-related reactions)
side effects that may occur days or weeks later.
If reactions occur they are usually mild, but very occasionally they can be more severe. Reactions are most likely to happen with the first or second infusion, although they may occur with later infusions. If you have a reaction, this can usually be treated by stopping the drip until you feel better.
You'll be monitored closely during the infusion, but tell your nurse or doctor if you feel unwell or have any of the following symptoms:
flu-like symptoms such as feeling flushed, having a fever, chills, or dizziness
red, warm and itchy bumps on the skin (like nettle rash)
a feeling of swelling in the lips, tongue or throat
breathlessness, wheezing, a cough or sudden difficulty in breathing
pain in your back or stomach
a tight chest or chest pain.
Sometimes an infusion-related reaction can happen a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Other side effects
Lowered resistance to infection (neutropenia)
Temsirolimus can reduce the number of white blood cells, which help to fight infection. White cells are produced by the bone marrow. If the number of your white cells is low you will be more prone to infections. A low white cell count is called neutropenia. Your blood cell numbers (blood count) will be monitored while you're having treatment.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even if your temperature is normal.
Anaemia (low number of red blood cells)
Temsirolimus can reduce the number of red blood cells, which carry oxygen around the body. A low red cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Increased bruising and bleeding
Temsirolimus can reduce the production of platelets, which 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. You can have a platelet transfusion if your platelet count is low.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems: they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Loss of appetite
Some people lose their appetite while they’re having temsirolimus. A dietitian or specialist nurse at your hospital can give advice about how to boost your appetite, cope with eating difficulties and maintain your weight.
Tiredness (fatigue) and feeling weak
You may feel tired during and after your treatment. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise (such as short walks), which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
A rash, redness and dry itchy skin is quite common. These effects are usually mild. Speak to your doctor or nurse if you have any of these symptoms. They can advise you about creams or lotions to use, or prescribe medicines to relieve itching.
Feeling sick (nausea) or being sick (vomiting)
Mild nausea is quite common but is usually easy to control. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn't controlled, or if it continues tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some people have swelling in their ankles or sometimes in their face caused by fluid retention. This is not harmful but can be uncomfortable. Let your doctor know if you are affected.
Raised blood sugar
Temsirolimus may cause a temporary increase in the level of sugar in your blood. Your blood sugar levels will be checked by regular blood tests. Some signs of a raised blood sugar level are 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 are diabetic you may need to check your blood sugars more regularly and you may have to adjust your insulin or oral therapy, but you should let your doctor or nurse know first.
Temsirolimus increases the risk of getting a blood clot. If you become breathless or develop redness, swelling or pain in one of your limbs (especially in your lower leg) tell your doctor straight away.
Changes to your blood cholesterol
Samples of your blood may be taken from time to time to monitor this.
Some people having temsirolimus may become breathless. This is more likely if you already have lung problems. Let your doctor know if you notice you’re becoming more breathless.
Muscle and joint pain
You may notice that you have pain in your muscles, joints and back. Let your doctor know if you get these side effects, as they can prescribe painkillers.
Temsirolimus can cause diarrhoea. This can usually be easily controlled with medicine, but you should tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Temsirolimus can cause sleeplessness (insomnia) in some people. If this is a problem discuss it with your doctor or specialist nurse.
Let your doctor know if you develop any pain in your tummy (abdomen). It can usually be controlled with mild painkillers.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
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Other medicines Some medicines can interact with temsirolimus and may make it less effective. Tell your doctor about any medicines you're taking, including non-prescribed drugs such as complementary therapies and herbal drugs. Avoid taking St John’s wort, eating grapefruit or drinking grapefruit juice while having temsirolimus.
It's not advisable to become pregnant or father a child while having temsirolimus, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether biological therapies can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that temsirolimus may be present in breast milk so women are advised not to breastfeed during this treatment and for a few months afterwards.
It's not known what effects temsirolimus may have on your ability to have children in the future. If you have concerns about this it's important to discuss them with your doctor before beginning treatment.
You should avoid having live vaccines during treatment and for at least 12 months afterwards. Live vaccines include BCG, yellow fever, measles, mumps, rubella, liquid typhoid, poliomyelitis liquid and MMR.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having treatment with temsirolimus. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This section has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). Torisel (temsirolimus) Summary of Product Characteristics. (accessed 21 September 2010).
TA178 Renal cell carcinoma. August 2009. National Institute for Health and Clinical Excellence (NICE).
Scottish Medicines Consortium (SMC). 617/10 Relapsed or refractory mantle cell lymphoma. (accessed 12 April 2010).
With thanks to Dr James Larkin, Consultant Oncologist, and the people affected by cancer who reviewed this edition.