Everolimus (RCC)

How it works

It inhibits the mammalian target of rapamycin (mTOR) kinase, disrupting tumour-cell proliferation, metabolism, and angiogenesis.

Prescribing in practice

• Non-infectious pneumonitis is a characteristic and potentially serious effect, so new or worsening respiratory symptoms must be investigated promptly and treatment interrupted if significant.
• It causes immunosuppression with increased infection risk, plus stomatitis, hyperglycaemia, and hyperlipidaemia that require monitoring and management.
• Exposure is markedly altered by CYP3A4 and P-glycoprotein inhibitors and inducers, so review interactions carefully against the SPC.

Monitoring

Monitor full blood count, renal and liver function, fasting glucose and lipids, and watch for pneumonitis and infection during treatment.

Counselling the patient

• Report new cough, breathlessness, or fever without delay.
• Mouth ulcers are common; maintain good oral hygiene and report severe soreness.
• Avoid grapefruit and tell clinicians about all other medicines you take.

Evidence & guidelines

Licensed in advanced renal cell carcinoma on the basis of a randomised trial showing prolonged progression-free survival after VEGF-targeted therapy.