After failure of first-line VEGFR-TKIs sunitinib or sorafenib in aRCC, look to
AFINITOR® (everolimus) Tablets is indicated for the treatment of adults with advanced renal cell carcinoma after failure of treatment with sunitinib or sorafenib.
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Important Safety Information
- There have been reports of noninfectious pneumonitis, infections, and renal failure (including acute renal failure) in patients taking AFINITOR, some with fatal outcomes
- Oral ulceration is the most frequently occurring adverse event and occurred in 44% to 78% of AFINITOR-treated patients across the clinical trial experience. Most of these events were grade 1/2. Grade 3/4 stomatitis was reported in 4% to 9% of patients
- Exercise caution with the use of AFINITOR in the perisurgical period, as everolimus delays wound healing and increases the occurrence of wound-related complications
- Elevations of serum creatinine, proteinuria, glucose, lipids, and triglycerides, and reductions of hemoglobin, lymphocytes, neutrophils, and platelets have also been reported; monitoring of laboratory tests is recommended
- The use of live vaccines and close contact with those who have received live vaccines should be avoided
- AFINITOR can cause fetal harm when administered to a pregnant woman
Please see additional Important Safety Information.
Please see full Prescribing Informationfor AFINITOR.
Abbreviations: aRCC, advanced renal cell carcinoma; PFS, progression-free survival; VEGFR-TKI, vascular endothelial growth factor receptor-tyrosine kinase inhibitor.
Important Safety Information
AFINITOR is contraindicated in patients with hypersensitivity to everolimus, to other rapamycin derivatives, or to any of the excipients.
- Noninfectious pneumonitis was reported in up to 19% of patients treated with AFINITOR. The incidence of Common Terminology Criteria (CTC) grade 3 and 4 noninfectious pneumonitis was up to 4.0% and up to 0.2%, respectively. Fatal outcomes have been observed
- If symptoms are moderate, consider interrupting therapy until symptoms improve
- The use of corticosteroids may be indicated
- For grade 3 cases, interrupt AFINITOR until resolution to grade ≤1. AFINITOR may be reintroduced at a daily dose approximately 50% lower than the dose previously administered, depending on the individual clinical circumstances. If toxicity recurs at grade 3, consider discontinuation of AFINITOR
- For grade 4 cases, discontinue AFINITOR. Corticosteroids may be indicated until symptoms resolve
- The development of pneumonitis has been reported even at a reduced dose
- AFINITOR has immunosuppressive properties and may predispose patients to bacterial, fungal, viral, or protozoal infections (including those with opportunistic pathogens)
- Localized and systemic infections, including pneumonia, mycobacterial infections, other bacterial infections, invasive fungal infections such as aspergillosis or candidiasis, and viral infections, including reactivation of hepatitis B virus, have occurred
- Some of these infections have been severe (eg, leading to sepsis, respiratory failure, or hepatic failure) or fatal
- Physicians and patients should be aware of the increased risk of infection with AFINITOR
- Treatment of preexisting invasive fungal infections should be completed prior to starting treatment with AFINITOR
- Be vigilant for signs and symptoms of infection and institute appropriate treatment promptly; interruption or discontinuation of AFINITOR should be considered
- Discontinue AFINITOR if invasive systemic fungal infection is diagnosed and institute appropriate antifungal treatment
- Mouth ulcers, stomatitis, and oral mucositis have occurred in patients treated with AFINITOR at an incidence ranging from 44% to 78% across the clinical trial experience. Grade 3/4 stomatitis was reported in 4% to 9% of patients
- In such cases, topical treatments are recommended, but alcohol-, hydrogen peroxide-, iodine-, or thyme-containing mouthwashes should be avoided
- Antifungal agents should not be used unless fungal infection has been diagnosed
- Cases of renal failure (including acute renal failure), some with a fatal outcome, have been observed in patients treated with AFINITOR
Impaired Wound Healing:
- Everolimus delays wound healing and increases the occurrence of wound-related complications like wound dehiscence, wound infection, incisional hernia, lymphocele, and seroma
- These wound-related complications may require surgical intervention. Exercise caution with the use of AFINITOR in the perisurgical period
Laboratory Tests and Monitoring:
- Elevations of serum creatinine and proteinuria have been reported. Renal function (including measurement of blood urea nitrogen, urinary protein, or serum creatinine) should be evaluated prior to treatment and periodically thereafter, particularly in patients who have additional risk factors that may further impair renal function
- Hyperglycemia, hyperlipidemia, and hypertriglyceridemia have been reported. Blood glucose and lipids should be evaluated prior to treatment and periodically thereafter. More frequent monitoring is recommended when AFINITOR is coadministered with other drugs that may induce hyperglycemia. Management with appropriate medical therapy is recommended. When possible, optimal glucose and lipid control should be achieved before starting a patient on AFINITOR
- Reductions in hemoglobin, lymphocytes, neutrophils, and platelets have been reported. Monitoring of complete blood count is recommended prior to treatment and periodically thereafter
- Avoid coadministration with strong CYP3A4/PgP inhibitors (eg, ketoconazole, itraconazole, clarithromycin, atazanavir, nefazodone, saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole)
- Use caution and reduce the AFINITOR dose to 2.5 mg daily if coadministration with a moderate CYP3A4/PgP inhibitor is required (eg, amprenavir, fosamprenavir, aprepitant, erythromycin, fluconazole, verapamil, diltiazem)
- Avoid coadministration with strong CYP3A4/PgP inducers (eg, phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital); however, if coadministration is required, consider doubling the daily dose of AFINITOR using increments of 5 mg or less
- Exposure to everolimus was increased in patients with hepatic impairment
- For patients with severe hepatic impairment (Child-Pugh class C), AFINITOR may be used at a reduced dose if the desired benefit outweighs the risk. For patients with mild (Child-Pugh class A) or moderate (Child-Pugh class B) hepatic impairment, a dose reduction is recommended
- The use of live vaccines and close contact with those who have received live vaccines should be avoided during treatment with AFINITOR
- Fetal harm can occur if AFINITOR is administered to a pregnant woman
- Advise female patients of reproductive potential to use highly effective contraception while using AFINITOR and for up to 8 weeks after ending treatment
- The most common adverse reactions (incidence ≥30%) were stomatitis (44%), infections (37%), asthenia (33%), fatigue (31%), cough (30%), and diarrhea (30%)
- The most common grade 3/4 adverse reactions (incidence ≥5%) were infections (10%), dyspnea (7%), stomatitis (5%), and fatigue (5%)
- The most common laboratory abnormalities (incidence ≥50%, all grades) were: decreased hemoglobin (92%) and lymphocytes (51%); and increased cholesterol (77%), triglycerides (73%), glucose (57%), and creatinine (50%)
- The most common grade 3/4 laboratory abnormalities (incidence ≥5%) were decreased hemoglobin (13%), lymphocytes (18%), and phosphate (6%), and increased glucose (16%)
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Please see full Prescribing Information for AFINITOR.