OncoLink

Everolimus (Afinitor®)

OncoLink
Last Modified: January 19, 2012

Pronounced: e-ver-OH-li-mus
Classification: mTOR Inhibitor

About Everolimus

Everolimus is a type of targeted therapy. This means it works by targeting something specific to the cancer cells, therefore decreasing side effects caused by unwanted damage to the healthy cells. Everolimus is a kinase inhibitor that inhibits mTor kinase, an enzyme required for cell growth and survival. By blocking this enzyme, the drug prevents cell division and, in turn, tumor growth. The medication can also interrupt angiogenesis, the development of blood vessels to supply the tumor with nutrients, which they need to grow.

How to Take Everolimus

Everolimus is taken orally (through the mouth) in pill form. The drug comes in 2.5mg, 5 mg and 10 mg oral tablets. Specific dosage is based on the person. The tablets should be swallowed whole with a glass of water. Do not crush or chew the tablets. Take your dose around the same time every day. Do not drink grapefruit juice or eat grapefruit while on this medication, as this can cause the amount of everolimus in your blood to be too high.

Possible Side Effects of Everolimus

There are a number of things you can do to manage the side effects of Everolimus. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Mouth Ulcers (Sores)

Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.

  • Brush with a soft-bristle toothbrush or cotton swab twice a day.
  • Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily.
  • If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
  • Avoid smoking and chewing tobacco, drinking alcoholic beverages and citrus juices.

Read the mouth ulcer tip sheet for more information.

Lung or Breathing Problems

Everolimus can cause pneumonitis, an inflammation of the lung tissue that is not caused by infection. You should notify your healthcare team right away if you notice worsening cough, shortness of breath or difficulty breathing or wheezing. If your healthcare provider suspects pneumonitis, he or she may decide to lower your dose or treat your symptoms with a steroid medication.

Infection Risk

Everolimus can suppress your immune system, putting you at higher risk of getting an infection. You should wash your hands frequently, and avoid large crowds and people who are sick or have colds. You should let your healthcare team know right away if you have a fever (temperature greater than 100.4), sore throat or cold, or a sore that doesn't heal. You should not receive or be around anyone who has had a "live" vaccine. Live vaccines include: nasal flu vaccine (not the type given by injection), chicken pox (Varicella), MMR, oral polio, BCG and typhoid. If you are not certain if a vaccine is live, check with your healthcare team.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Decrease in Appetite

Visit OncoLink's section on Nutrition for tips on dealing with this side effect. Ask your nurse about nutritional counseling services.

  • Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
  • If you are not eating enough, nutritional supplements may help.
  • You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months.
  • Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell.
  • Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can also add flavor to vegetables.

Muscle or Joint Pain/Aches and Headache

Your doctor or nurse can recommend medication and other strategies to relive pain. Also view OncoLink's page on pain management.

Other Side Effects

Other less common side effects include dry skin, rash and fever.

This drug can affect your reproductive system, resulting in the menstrual cycle or sperm production becoming irregular or stopping permanently. Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected. You may want to consider sperm banking or egg harvesting if you may wish to have a child in the future. Discuss these options with your oncology team. See OncoLink's section on sexuality for helpful tips for dealing with these side effects.