Everolimus is also known as Afinitor®. It is a targeted therapy drug that is used to treat some advanced types of cancers.
Everolimus (Afinitor®) is a targeted therapy drug. It is used to treat some types of cancers that have spread (advanced). These types of cancer include:
- a type of kidney cancer called renal cell carcinoma
- neuroendocrine cancers of the pancreas, lung or digestive system.
Targeted therapies target something in or around the cancer cell that is helping it to grow and survive. Everolimus is a type of targeted therapy called a cancer growth inhibitor. This works by blocking signals that tell cancer cells to grow and divide. It also blocks signals that help cancer cells develop a blood supply, so it is an angiogenesis inhibitor as well.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You have everolimus as a tablet, which you can take at home. It may be given on its own, or with other cancer drugs.
During treatment you see a cancer doctor, a specialist nurse and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
You are given everolimus as an outpatient. The specialist nurse or pharmacist gives you the tablets to take home. You may be given tablets of different strengths. Always take them exactly as explained. This is important to make sure they work as well as possible for you. Everolimus can reduce the number of blood cells in your blood. It may also affect your blood sugar and cholesterol levels, and your kidneys and liver. You have regular blood tests before and during treatment. This is to check for any changes and make sure that your blood test results are at a safe level to continue treatment.
Your nurse, pharmacist or doctor will talk to you about your test results and ask you how you have been feeling. Sometimes your treatment may be delayed for a short time until side effects improve. You may also have your next dose of treatment reduced.
You keep taking everolimus for as long as it is working for you and side effects can be managed. It is important that you do not stop taking it without talking to your doctor.
Taking everolimus tablets
Everolimus tablets must be swallowed whole with a glass of water. They should not be chewed, broken or crushed. You can take them with or without food, but do the same thing each day. Take them at the same time every day.
Do not eat grapefruit or drink grapefruit juice while you are having this treatment. This can change how effective the drug is.
Other things to remember about your tablets:
- If you forget to take the tablets, do not take the missed dose. Instead, take the next dose as usual. Do not take a double dose to make up for the tablets you did not take. Let your doctor or nurse know.
- If you are sick just after taking the tablets, contact the hospital. Do not take another dose.
- Keep the tablets in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- Other people should avoid direct contact with everolimus tablets.
- It is important to get a new prescription before you run out of tablets and make sure you have plenty for holidays.
- If your treatment is stopped, return any unused tablets to the pharmacist.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
You will have regular blood tests during treatment. If needed, your doctor may reduce or delay your treatment for a short time, until your cell count increases.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco and foods that irritate your mouth and throat.
Skin and nail changes
This treatment may affect your skin. It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.
This treatment can also affect your nails. Always tell your doctor or nurse about any changes to your skin or nails. They can give you advice and may prescribe creams or medicines to help.
Tell your doctor straight away if you have a severe rash.
Tiredness and sleeping problems
Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
Everolimus can also cause problems with sleeping (insomnia). If you are having difficulty sleeping, tell your doctor.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
Your doctor will give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.
Changes to your taste
Loss of appetite or weight loss
Some people lose their appetite while they are 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 you are finding it difficult to eat or you are losing weight, ask to see the dietitian at your hospital. They can give you advice on how to boost your appetite and maintain your weight. Our information on the building-up diet has useful tips.
This treatment can cause an inflammation in the lungs, called pneumonitis. This can cause:
- a high temperature
- a dry cough
- pain in your chest when you breathe in.
If you have any of these symptoms, contact your hospital straight away using the 24-hour contact number you have been given.
Pneumonitis can be mild and may not always need treatment. But if it is more severe your doctor may treat it with drugs that reduce inflammation (steroids).
Raised blood sugar levels
This treatment may raise your blood sugar levels. You will have regular blood tests to check this. Symptoms of raised blood sugar include:
- feeling thirsty
- needing to pass urine (pee) more often
- feeling tired.
If you have these symptoms while having this treatment, tell your doctor or nurse.
If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this.
Everolimus can increase the amounts of cholesterol (fats or lipids) in your blood. Your doctor will take blood tests during your treatment to check for this.
Build-up of fluid
Some people get swelling around their eyes, or in their hands, ankles or feet, because of fluid build-up. This often improves by itself but tell your doctor if you have swelling anywhere on your body. They may give you drugs to help.
This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.
High blood pressure
Everolimus can cause high blood pressure in some people. You will have your blood pressure checked regularly. Some people may need to take tablets to control their blood pressure.
If you already have high blood pressure and are on treatment to control it, you will have regular blood pressure checks. Talk to your doctor if you have any concerns.
Indigestion and abdominal pain
Some people have indigestion or acid reflux (acid coming up from the stomach into the gullet) and pain in the tummy area (abdominal pain) when taking everolimus. Tell your doctor if this affects you. They can give you medicines to help.
Rarely, some people have an allergic reaction to everolimus. Contact the hospital straight away if you develop:
- red, warm and itchy bumps on the skin (like nettle rash)
- swelling of the lips, tongue or throat
- breathlessness, wheezing, a cough or sudden difficulty breathing
- a tight chest or chest pain.
If you do have a reaction, it can be treated quickly.
Effects on the kidneys and liver
Everolimus can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before starting everolimus to check how well your kidneys and liver are working.
If you pass less urine or stop passing urine, contact your doctor straight away.
Effects on the heart
This treatment can affect how the heart works.
If you have any of these symptoms during or after treatment, contact your doctor straight away on the 24-hour number the hospital has given you:
- swelling in your feet or legs
- a persistent cough
- a fast heart rate.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
Sore and red palms of hands and soles of feet
You may get sore and red palms of hands and soles of feet. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.
Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:
- keep your hands and feet cool
- moisturise your hands and feet regularly
- avoid tight-fitting socks, shoes and gloves.
Wounds may take longer to heal while you are having treatment with everolimus. If you have any surgery planned, you may need to stop treatment for a few weeks before and after the operation. Your doctor will give you more advice.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.
Hepatitis B reactivation
If you have had a liver infection called hepatitis B, everolimus can make it active again. Let your doctor or nurse know if you have had hepatitis in the past or are worried about this.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Do not take the herbal remedy St John’s Wort while you are having everolimus. This is because it can make everolimus less effective.
Some other medicines can affect how this treatment works and may be harmful to take when you are having everolimus. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Everolimus tablets contain lactose. If you are intolerant to lactose, let your doctor know.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Changes to periods
If you have a period, these may become irregular or stop while you are having this treatment. This may be temporary, but it can sometimes be permanent. Your menopause may start sooner than it would have done. Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.