Everolimus (Afinitor ®)

Everolimus is a targeted therapy drug used to treat cancers that have spread (advanced or metastatic cancer). It is used to treat:

  • a type of kidney cancer called renal cell carcinoma
  • neuroendocrine cancer of the pancreas, lung or digestive system.

It is also used with a hormonal therapy drug called exemestane to treat secondary breast cancer. It is best to read this information with our general information about the type of cancer you have. Everolimus is given as tablets. Your cancer doctor or nurse will tell you how often you will have it.

Like all targeted therapy drugs, everolimus can cause side effects. Some of the side effects can be serious, so It’s important to read the detailed information below. How targeted therapy affects people varies from person to person. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

How everolimus works

Everolimus works by blocking a protein called mTOR, which makes some cancer cells grow. This may help to stop or slow down the cancer that is growing. It can also stop the cancer cells making new blood vessels. This may help shrink the cancer.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


When everolimus is used

Everolimus is used to treat cancers that have spread (advanced or metastatic). It is used to treat:

Everolimus may only be available in some situations. Your cancer doctor can tell you if it is suitable for you. Some people may have it as part of a clinical trial. If a drug is not available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice. We have further information on what to do if a treatment is not available.


Taking everolimus tablets

You take everolimus as a tablet once a day. Take it at the same time every day. Swallow the tablet whole with a glass of water. Do not crush or chew it. You can take it with or without food. Avoid grapefruit juice and grapefruit during treatment with everolimus as it can affect how the drug works.

Always take everolimus exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you.

There are some important things to remember when taking your tablets:

  • If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
  • Keep tablets in the original package and away from heat and direct sunlight.
  • Keep them safe and out of reach of children.
  • Get a new prescription before you run out of tablets. Make sure you have enough for holidays.
  • If your treatment is stopped, return any unused tablets to the pharmacist.
  • If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. Do not take another dose without telling your doctor, nurse or pharmacist first.

Everolimus is a long-term treatment and you should carry on taking it for as long as your doctor tells you. You will have regular blood tests to check how well it is working for you.


Possible side effects

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 here, but you will not get them all. Always tell your doctor or nurse about any side effects you have.

If you have other cancer drugs along with this treatment, some side effects may be worse. You may also have side effects not listed here. We have more information about chemotherapy and radiotherapy.

If a side effect is more severe, your doctors may need to reduce the dose, or stop the treatment for a short time. Some people may have this treatment stopped completely.

Your doctor can give you drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you. Your nurse will give you advice about managing side effects. Most side effects start to improve after treatment has finished.

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.

More information

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.

Skin changes

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.

Feeling tired

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.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Sore mouth

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.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work 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 bad or have no taste. Try different foods to find out what tastes best to you. Your nurse can give you more advice.

Loss of appetite

This treatment can affect your appetite. Don’t worry if you don’t 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.

Indigestion

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.

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 shaky
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine a lot.

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.

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 blood cells. This is called a blood transfusion.

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 or nurse if you have any bruising or bleeding that you can’t explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Lung changes

Everolimus can cause an inflammation in the lungs, called pneumonitis. This can cause:

  • breathlessness
  • wheezing
  • 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.

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 settles down by itself. Your doctor may prescribe drugs to make you pass more urine (diuretics) to help get rid of some of the fluid.

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.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Back pain or joint pain

Some people have back pain or joint pain while having treatment. Your doctor can prescribe painkillers to help.

Difficulty sleeping

Everolimus can affect sleep in some people. If you are having difficulty sleeping, tell your doctor.


Less common and rare side effects

Allergic reaction

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.

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.

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.

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.

Changes to periods

Women taking everolimus may notice their periods become irregular. Rarely, periods may stop during treatment.

Sore and red hands and feet

Having sore and red palms of hands and soles of feet is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.

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.

Blood clots

This treatment can increase the chances of a blood clot. A clot can cause:

  • pain, redness and swelling in a leg or arm
  • breathlessness
  • 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.


Other 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.

Live vaccines

You should speak to your doctor before getting any live vaccines during and after your treatment. Your immune system may be weak, so vaccines may be less effective and could be harmful.

Examples of live vaccines are:

  • measles
  • mumps
  • rubella
  • polio (when taken by mouth)
  • BCG (Bacillus Calmette-Guérin)
  • yellow fever
  • varicella
  • TY21a typhoid vaccines
  • intranasal influenza (given into the nose).

Fertility

Doctors don’t yet know how this treatment may affect your fertility (the ability to become pregnant or father a child). If you are worried about this, talk to you doctor before treatment starts.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. 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.