Everolimus (Afinitor®) is a targeted therapy drug. It is used to treat some types of cancer in the breast, kidney, lung, pancreas and digestive tract.
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 cancer of the pancreas, lung or digestive system.
Everolimus is also used, along with a hormonal therapy drug called exemestane, to treat secondary breast cancer (advanced).
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Everolimus comes as tablets, which you can take at home. It may be given on its own, or along with other cancer drugs. The nurse or pharmacist will give 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.
During treatment you will see a cancer doctor, specialist nurse and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information. You keep taking everolimus for as long as your doctor tells 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, opened 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.
If you forget to take the tablets, you should take the missed dose as soon as possible within the same day. If a full day has gone by, let your doctor or nurse know. Do not take a double dose.
Other things to remember about your tablets:
- Keep them 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.
- If you are sick just after taking the tablets, contact the hospital. Do not take another dose.
- 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.
If you are also having treatment with other cancer drugs, you may 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.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth 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.
This treatment may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. You may have a rash, which may be itchy. Always tell your doctor or nurse about any skin changes or if they get worse. They can give you advice and may prescribe creams or medicines to help.
Tell your doctor straightaway if you have a severe rash.
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 called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have 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.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may reduce or delay your treatment for a short time.
Feeling tired (fatigue) 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.
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 (31/2 pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
You may feel sick during this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. 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 and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
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.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them 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. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
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).
Blood sugar levels
Some people have an increase in their blood sugar when taking everolimus. You will have regular blood tests to check this. If your blood sugar is too high, you may feel thirsty, need to pass urine more often and feel hungry. Tell your doctor or nurse if you have any of these symptoms.
If you have diabetes, 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.
Everolimus can increase the amounts of cholesterol (fats or lipids) in your blood. Your doctor will check the level with a simple blood test during your treatment.
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. Your doctor may give you drugs to help reduce the swelling.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Increased blood pressure
This treatment can cause high blood pressure. You will have your blood pressure checked regularly. If you have headaches, nosebleeds or feel dizzy, let your doctor know. They can prescribe tablets to control high blood pressure.
If you have high blood pressure before you start treatment, your doctor will monitor you closely during treatment.
Back pain or joint pain
Some people have back pain or joint pain while having treatment. Your doctor can prescribe painkillers to help.
Everolimus can affect sleep in some people. If you are having difficulty sleeping, tell your doctor.
Some people have indigestion or acid reflux (acid comes up from the stomach into the gullet) when taking everolimus. Tell your doctor if this affects you. They can prescribe treatment 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
- tight chest or chest pain.
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.
Reduced levels of calcium, phosphate and potassium
Everolimus can sometimes affect the levels of these in your blood. You will have regular blood tests and your doctor may prescribe you supplements to take if the levels are too low.
Effects on the heart
If you become breathless, develop a cough or notice swelling in your arms or legs (caused by a build-up of fluid) contact a doctor immediately.
Changes to your hands and feet
You may develop redness on the palms of your hands and soles of your feet. Sometimes the hands and feet become sore or swollen. Tell your doctor if your hands or feet are affected. They may give you creams that can help. Keep your hands and feet cool, and avoid hot water and tight shoes. Wear gloves to protect your hands when doing housework or gardening.
Slow healing wounds
Wounds may take longer to heal while you are having treatment with everolimus. If you have any surgery planned, you may need to stop taking everolimus before the operation and not start taking it again for a few weeks afterwards. Your doctor will give you more advice.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect 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.
Hepatitis B reactivation
If you have had hepatitis B (a liver infection) 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:
- pain, redness or swelling in a leg or arm
- chest pain.
If you have any of these symptoms, contact a doctor straight away.
A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Food and medicines
During treatment with everolimus you should avoid grapefruit and grapefruit juice. You should also not use the herbal remedy St John’s Wort. This is because they can make everolimus less effective. Some other medicines can be harmful to take when you are having everolimus. This includes those that you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, supplements, complementary therapies and herbal drugs.
Everolimus tablets contain lactose. If you are intolerant to lactose, let your doctor know.
Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.
Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.
If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Driving and using machines
If you feel dizzy or drowsy, or if tiredness affects your concentration, do not drive or operate machinery.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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 this treatment.