Everolimus can be used to treat kidney cancer that has spread and advanced pancreatic neuroendocrine cancer. It can also be used with a drug called exemestane to treat certain women with breast cancer that has spread.

Everolimus can also be used to treat other types of cancer as part of a clinical trial.

WHAT IS EVEROLIMUS?

Everolimus is a treatment that interferes with the way a protein called mTOR works. The mTOR protein (also called enzyme kinase) makes cells divide and grow, and is often overactive in cancer cells. Everolimus can also be called a kinase inhibitor.

HOW DOES EVEROLIMUS WORK?

Everolimus blocks the mTOR protein. This can help stop cancer from growing or slow its growth. It can also stop cancer cells from making new blood vessels. This may help reduce the size of the cancer.

HOW IS EVEROLIMUS TAKEN?

Everolimus is taken once a day in tablet form. Take it at the same time each day. Swallow the tablet whole with a glass of water – do not crush or chew it. Everolimus can be taken with or without food.

Always take everolimus exactly as your doctor, nurse or pharmacist has instructed you. If you forget to take a tablet, simply take the next one as scheduled. Do not take two doses at the same time. Do not stop taking the drug without consulting with your cancer doctor first.

Do not drink grapefruit juice or eat grapefruit while taking everolimus.

POSSIBLE SIDE EFFECTS OF EVEROLIMUS

These side effects will not affect everyone who takes everolimus. Always let your doctor or specialist nurse know about any side effects you have. They can prescribe drugs to help reduce the side effects, and they will give you advice on how to cope with them.

Here we outline the most common side effects, though we have left out the rarer ones that are unlikely to affect you. If you notice you develop any side effects that are not listed here, talk to your doctor or nurse. Most of the side effects improve gradually once the treatment has concluded.

RISK OF INFECTION

Everolimus can reduce your number of white blood cells, which help fight off infection. If your white blood cell count is low, you will be more prone to infection. A low number of white blood cells is called neutropenia.

Contact your hospital immediately if any of the following happens:

• your temperature goes above 38 degrees Celcius
• you suddenly feel unwell, even if your temperature is normal
• you feel shaky and weak
• you have any symptoms of infection, such as a cold, sore throat, cough, frequent urination, or diarrhea.

You will have blood tests done during your treatment to determine your white blood cell count. Occasionally, it may be necessary to delay the treatment or lower the dose you are given if you have a low white blood cell count.

ANEMIA

Everolimus can reduce the number of red blood cells, which transport oxygen throughout the body. A low number of red blood cells is called anemia. This may make you feel tired and short of breath. Tell your doctor or nurse if you have these symptoms. You may need a blood transfusion if the number of red blood cells in your blood is too low.

BRUISING AND BLEEDING

Everolimus may lower the number of platelets in your blood. Platelets help the blood to coagulate. Tell your doctor if you have any unexplained bleeding or bruising, such as nosebleeds, bleeding gums, blood spots, or skin rashes.

SORENESS OF THE MOUTH AND MOUTH ULCERS

During the treatment, your mouth may become sore or dry, and you may develop small mouth ulcers. Drinking lots of fluids and regularly brushing your teeth gently using a soft-bristled toothbrush can help lower the risk of this happening. Tell your specialist nurse or doctor if you have any of these problems. They can prescribe a mouthwash and drugs to prevent mouth infections.

TIREDNESS

Feeling tired is a common side effect of everolimus. It is important that you try to pace yourself and rest as much as you need to. Try to balance this with light exercise, such as taking short walks. If your tiredness leaves you feeling drowsy, do not operate machinery or drive.

LUNG PROBLEMS

You may have difficulty breathing or have chest pain when you breathe deeply. If you have these symptoms or a high temperature or a dry cough, it may be a sign you have inflammation in the lungs. This is called pneumonitis.

Rarely, people can have chest pain with a sudden feeling of breathlessness or cough up blood. These can be a sign of a blood clot in the lung.

If you have any respiratory or lung problems, get in touch with your hospital immediately.

SKIN REACTION

You skin may become dry or scaly during your treatment. Some people also develop a rash that looks like acne. These side effects are normally mild, though they can make you feel discomfort. Tell your doctor or nurse immediately if you notice any of these changes in your skin. They can recommend creams or lotions you can use; also, they can prescribe drugs to relieve the itchiness.

LOSS OF APPETITE

Some people lose their appetite while taking everolimus. If you find you have little appetite, try to eat in small portions as often as possible. Eat snacks like nuts and dried fruit whenever you can. If this problem continues, the hospital dietitian can give you advice on ways to increase your appetite and maintain your weight.

CHANGES IN TASTE

You may notice that food tastes different. You can try to use condiments, spices, and herbs to give flavor to your food. Some people find that cold foods taste better than hot ones. Most people discover that their sense of taste goes back to normal once the treatment is over.

NAUSEA OR VOMITING

Nausea is a common side effect, though it is normally mild and easily controllable. Your doctor can prescribe antiemetic drugs to prevent or lessen the effect of nausea or vomiting. If the nausea remains uncontrolled, tell your doctor or nurse. They can prescribe you other drugs that should work better.

HIGH BLOOD SUGAR LEVELS

Everolimus can cause a temporary rise in blood sugar. Your doctor will give you periodic blood tests to check on this. The signs of raised blood sugar include a feeling of thirstiness, a need to urinate more frequently, and feeling hungry. If you have any of these symptoms, tell your doctor or nurse.

If you have diabetes, you may find your blood sugar levels are higher than normal. Talk to your doctor or nurse about how to manage this. You may need for your insulin dose to be changed.

HEADACHES

Some people find that everolimus gives them headaches. This can be relieved by simply taking painkillers. Tell your doctor or nurse if your headaches do not go away.

DIARRHEA

Everolimus can cause diarrhea. Normally, this can be easily controlled with drugs. However, if the symptoms are severe or do not get better after 24 hours, get in touch with your hospital. It's important to drink lots of fluids if you have diarrhea.

CHANGE TO YOUR BLOOD CHOLESTEROL

Everolimus can cause your blood cholesterol to go up. Your doctor or nurse will give you periodic blood tests to monitor this.

LESS COMMON SIDE EFFECTS OF EVEROLIMUS

KIDNEY CHANGES

Sometimes, everolimus may affect the way the kidneys function. Your doctor will take periodic blood samples to monitor this.

BUILD-UP OF FLUID

Some people notice swelling around their eyes and in their ankles due to a build-up of fluid. This does no harm, though it can be bothersome and uncomfortable. Diuretics can help rid the body of fluids, though often these fluids are eliminated by themselves. Tell your doctor if you experience rapid weight gain. This may be a sign that you are retaining fluids.

CHANGES IN THE LIVER

Everolimus can change the way the liver functions. This should go back to normal once the treatment is over. It is very unlikely you will notice any problems, though your doctor will take periodic blood samples to check whether your liver is working properly. Tell your doctor if you develop pain in your right side.

EYE SORENESS

Some people develop eye soreness, redness or dryness of the eyes. Your doctor can prescribe eye drops to help this. Tell your doctor if you notice any changes in your eyes.

DIFFICULTY SLEEPING

Some people find they have trouble sleeping while they take everolimus. Relaxation techniques can help this. If you still have problems sleeping, talk to your doctor about taking sleeping pills.

ADDITIONAL INFORMATION ON EVEROLIMUS

OTHER MEDICINES

Some drugs, including those bought over the counter in a store or pharmacy, may be harmful to you while you are taking everolimus.

Tell your doctor if you are taking any medicines, including over-the-counter drugs, complementary therapies, and herbal remedies. Avoid taking the herbal remedy St. John's Wort.

LIVE VACCINES

You should talk to your doctor before taking any kind of live vaccine during and after the treatment. Your immune system may be weakened and vaccines could be harmful.

FERTILITY AND CONTRACEPTION

This drug may effect your ability to conceive. It is important that you talk to your doctor before beginning treatment.

We still do not know enough about the effects of everolimus on developing babies. Because of this, it is not recommendable to become pregnant or have babies while you are taking this drug.

Protecting your partner

Doctors do not know if everolimus is present in semen or vaginal fluid, which is why it is advisable to use a barrier contraceptive method to protect your partner while you are taking everolimus.

BREASTFEEDING

There is a possible risk of everolimus being present in breast milk. Women are recommended not to breastfeed during treatment and for a few months after it has concluded.

MEDICAL AND DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Explain to them that you are taking chemotherapy pills that no one should stop or restart if it is not done under the advice of a cancer doctor.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.