Everolimus (AFINITOR)

Breast cancer, advanced or metastatic

Neuroendocrine tumours, advanced or metastatic

Renal cell carcinoma , advanced or metastatic

Breast cancer, advanced or metastatic

• Dose – Oral: 10 mg once daily continuously until disease progression or unacceptable toxicity
• Given in combination with exemestane

Neuroendocrine tumours, advanced or metastatic

• Dose – Oral: 10 mg once daily continuously until disease progression or unacceptable toxicity

Renal cell carcinoma , advanced or metastatic

• Dose – Oral: 10 mg once daily continuously until disease progression or unacceptable toxicity

Available as 2.5 mg, 5 mg, and 10 mg tablets. Tablets contain lactose. Tablets should NOT be crushed or broken. Store at room temperature and protect from light and moisture.

Mechanistic Target of Rapamycin (mTOR) Inhibitor

Take on an empty stomach or after a light fat-free meal

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 6 hours of the missed dose. If it is over 6 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Anemia, Diarrhea, Stomatitis, Fatigue, Infections, Asthenia, Cough.

Less Common: Neutropenia, Congestive heart failure, Hypersensitivity reactions, Pneumonitis (non-infectious), Impaired wound healing,

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, sodium, potassium, creatinine, BUN, glucose, calcium, phosphorus, ALT, LDH, total bilirubin, alkaline phosphatase, total cholesterol, triglycerides, appropriate radiographic evaluations including Chest X- ray, O2 saturation.

During treatment: CBC & differential, platelets, creatinine, bilirubin, ALT, alkaline phosphatase, sodium, potassium, random glucose.

• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Stomatitis is a common toxicity with everolimus. Using a dexamethasone (0.5 mg/5 mL) alcohol-free oral mouthwash (10 mL swish and spit 4 times/day) when initiating treatment reduces the incidence and severity of stomatitis (avoid food or drink within 1 hour after dexamethasone).
• Everolimus has immunosuppressant properties and may increase the risk of severe or fatal bacterial, protozoal or viral infections.
• Impaired wound healing is associated with this drug, drug may need to be held and restarted if patient requires surgery, discuss with team.
• Vaccines may be less effective due to diminished immune response. Live vaccines and close contact with individuals who have received live vaccines should be avoided to reduce the risk of infection from the vaccine.

BC Cancer. BC Cancer Drug Manual. Everolimus. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Everolimus_monograph.pdf. Updated January 1, 2024. Accessed January 22, 2024.

Lexicomp. Everolimus Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/1700399?cesid=3EsnD4mtCfP&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Deverolimus%26t%3Dname%26acs%3Dtrue%26acq%3Deverolimus. Updated January 24, 2024. Accessed January 30, 2024.

Cancer Care Ontario. Everolimus Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44036. Updated June 2019. Accessed January 22, 2024.

Novartis Pharmaceuticals Canada Inc. AFINITOR® Product Monograph. Dorval, Quebec. Updated July 3, 2023.