Temsirolimus (Torisel®) is a targeted therapy drug. It is used to treat kidney (renal) cancer that has spread, and mantle cell lymphoma that has come back after treatment.
Temsirolimus (Torisel®) is a targeted therapy drug. It is used to treat some types of kidney (renal) cancer that has spread. Cancer that has spread is sometimes called advanced cancer. Temsirolimus may also be used to treat mantle cell lymphoma that has come back after chemotherapy treatment, or that has not responded to chemotherapy. It may sometimes be used to treat other cancers.
Temsirolimus is a type of treatment called an mTOR inhibitor. This is also known as a cancer growth inhibitor. mTOR is a protein that makes some cancer cells grow. Cancer growth inhibitors block (inhibit) signals that tell cancer cells to develop or divide. Temsirolimus blocks the mTOR protein to help stop or slow the growth of the cancer. It can also stop the cancer cells making new blood vessels. This may help shrink the cancer.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You will be given temsirolimus as an outpatient or during a stay in hospital.
During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor or nurse or pharmacist in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have treatment.
You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your targeted therapy. Your nurse will tell you when your treatment is likely to be ready.
Temsirolimus is given as a drip into a vein (intravenous infusion). Your nurse gives you anti-sickness drugs before you start treatment. You will also be given a drug to help prevent you having an allergic reaction (anti-histamine).
Your course of treatment
You usually have temsirolimus once a week. Each infusion takes 30 to 60 minutes. The number of doses you have will depend on how well it is working. It will also depend on any side effects you have. Your nurse, pharmacist or doctor will discuss your treatment plan with you.
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.
Some people may have side effects while they are being given the treatment or shortly after they have it:
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.
Pain along the vein
You may get pain at the place where the injection is given or along the vein. If you feel pain, tell your nurse or doctor straight away so that they can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.
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.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
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.
Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. 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.
Sometimes, temsirolimus can cause sleeplessness (insomnia). If you are finding it difficult to sleep, talk to your doctor or specialist nurse.
This treatment may affect your skin. It can cause a rash, which may 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.
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. Any changes to your skin are usually temporary and improve when treatment finishes.
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.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
You may feel sick in the first few days after 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.
Helpful hints to improve taste
- Season food or add spices and herbs to add flavour when cooking.
- Use strong, flavoured sauces or gravies to make food tastier.
- Eat sharp-tasting fresh fruit and juices or try sugar-free sweets to leave a pleasant taste in your mouth.
- Try cold foods as they may have a stronger taste than hot foods.
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.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
- a fever (high temperature)
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
Some people develop swelling around the eyes, ankles or other areas of their body because of a build-up of fluid. This is not 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 goes away by itself. Let your doctor know if you put on a lot of weight very quickly. This can be a sign that you have fluid build-up.
Abdominal (tummy) pain
Let your doctor know if this happens to you. It can usually be controlled with painkillers.
Temsirolimus can cause a hole (perforation) in the small bowel, but this is uncommon. Contact your doctor immediately if you have severe pain in the tummy or signs of bleeding.
It is also very important to let them know if you:
- are bleeding from the back passage
- have black stools
- are vomiting up blood
- have vomit that looks like coffee grounds.
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. Signs of a raised blood sugar level are:
- feeling thirsty
- needing to pass urine more often
- 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. Talk to your doctor or nurse about how to manage this. You may have to adjust your insulin or tablet dose.
Increase in cholesterol levels in your blood
Temsirolimus can increase cholesterol levels in the blood. You may have blood tests to check your cholesterol levels before, during and after treatment with temsirolimus.
Muscle or joint pain
You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor so they can give you give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Your eyes feel sore, red and itchy (conjunctivitis) with this treatment. Your doctor may prescribe eye drops to help prevent this. It is important to use these as instructed.
Effects on the nervous system
This treatment can affect the nervous system. Tell your doctor or nurse straight away if you notice any of the following symptoms:
- feeling anxious or restless
- problems sleeping
- mood changes
- feeling dizzy or unsteady
- pins and needles or tingling in your arms and legs.
It is important not to drive or operate machinery if you notice these effects.
Effects on the heart
This treatment can affect your heart. You may have tests to see how well your heart is working. Contact a doctor straight away if you:
- feel breathless or dizzy
- feel breathless when you lie down
- have pain or tightness in your chest.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If the treatment is causing heart problems, your doctor can change the type of treatment you are having.
Slow wound healing
While you are being treated with temsirolimus, it may take longer for any wounds to heal. This is because this treatment can affect the healing process. Your doctor or nurse will check your wound regularly. If you notice any leaking from the wound, swelling or redness in the area, tell your doctor or nurse straight away.
If you have any surgery planned, you may need to stop having temsirolimus before the operation and not start it again for a few weeks after. Talk to your doctor if you have surgery planned.
This treatment contains alcohol. If this is a problem for you, tell your doctor, nurse or pharmacist. Your blood alcohol level may be above the legal limit after you have the treatment. It is best not to drive or operate machinery for a few hours after having this treatment, even if you feel okay.
Food and drink
You should not have grapefruit or grapefruit juice with temsirolimus. It may increase the amount of temsirolimus in your blood.
This treatment can increase the chances of a blood clot. A clot can cause:
- pain, redness and swelling in a leg or arm
- chest pain.
Contact your doctor straight away if you have any of these symptoms. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can affect how this treatment works or be harmful when you are having it. 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.
If you have sex in the first few days after having treatment, you need to use a condom. This is to protect your partner in case there is any of the drug in semen or vaginal fluids.
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.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
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 cancer treatment.
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.