This site is intended for healthcare professionals outside the US.

In advanced, progressive, well-differentiated nonfunctional GI and lung NET

Most adverse events were manageable and consistent with the known side effect profile of AFINITOR1

The most common drug-related adverse events (>20%)1

  • Stomatitis* (63%)
  • Diarrhea (31%)
  • Fatigue (31%)
  • Infections (29%)
  • Rash (27%)
  • Peripheral edema (26%)

The most common grade 3 or 4 drug-related adverse events (>5%)1

  • Stomatitis* (9%)
  • Diarrhea (7%)
  • Infections (7%)

Patient population of the RADIANT-4 study by primary site of tumor originDrug-related adverse events occurring in ≥10% of patients in the RADIANT-4 study

Presented are drug-related adverse events reported in ≥10% of patients (safety set).

 

Discontinuation, dose adjustment, and interruption rates in RADIANT-4

  • The majority of patients remained on AFINITOR2
    • 20.3% of patients treated with AFINITOR discontinued therapy due to drug-related adverse events vs 4.1% with placebo2
  • 14% of patients with advanced, progressive, well-differentiated nonfunctional GI or lung NET had their dose of AFINITOR adjusted because of adverse events vs 2% with placebo2
  • 61.4% of patients with advanced, progressive, well-differentiated nonfunctional GI or lung NET had their dose of AFINITOR interrupted because of drug-related adverse events vs 15.3% with placebo2

The safety and tolerability of AFINITOR in RADIANT-4 are consistent with the previous experience of AFINITOR in the advanced, progressive pancreatic NET setting. Most AFINITOR-related adverse events were manageable through dose modification or interruption1

*Includes stomatitis, aphthous stomatitis, mouth ulceration, and tongue ulceration.
Includes all infections.
Includes pneumonitis, interstitial lung disease, lung infiltration, and pulmonary fibrosis.
Abbreviations:
GI, gastrointestinal; NET, neuroendocrine tumor(s); RADIANT, RAD001 in Advanced Neuroendocrine Tumors.
References:
  1. Yao JC, Fazio N, Singh S, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Lancet. 2016;387(10022):968-977.
  2. Data on file. Novartis Pharma AG.

Safety Information

AFINITOR®

Important note: Before prescribing, consult full prescribing information.

Presentation: Tablets containing 2.5 mg, 5 mg or 10 mg of everolimus.

Indications: Afinitor is indicated for the treatment of hormone receptor-positive, HER2/neu negative advanced breast cancer, in combination with exemestane, in postmenopausal women without symptomatic visceral disease after recurrence or progression following a nonsteroidal aromatase inhibitor. ♦Afinitor is indicated for the treatment of unresectable or metastatic, well- or moderately-differentiated neuroendocrine tumours of pancreatic origin in adults with progressive disease. ♦Afinitor is indicated for the treatment of advanced renal cell carcinoma, whose disease has progressed on or after treatment with VEGF-targeted therapy. ♦Afinitor is indicated for the treatment of unresectable or metastatic, well-differentiated (Grade 1 or Grade 2) non-functional neuroendocrine tumours of gastrointestinal or lung origin in adults with progressive disease.

Dosage: AFINITOR 10 mg dose once daily. ♦The daily dose should be taken orally at the same time every day, either consistently with or consistently without food. ♦Dose modification: Dose interruption (with or without dose reduction) or discontinuation may be required due to adverse drug reactions (ADRs), use of moderate CYP3A4/PgP inhibitors or strong CYP3A4 inducers, hepatic status (Child-Pugh). ♦Children: Not recommended for use in children or adolescents. ♦Patients with hepatic impairment: Recommended dose is 7.5 mg daily in patients with mild hepatic impairment (Child-Pugh A); 5 mg daily in patients with moderate hepatic impairment (Child-Pugh B); not recommended in patients with severe hepatic impairment (Child-Pugh C), unless benefit outweighs the risk. In the latter case, a dose of 2.5 mg daily must not be exceeded.  Dose adjustments should be made if a patient’s hepatic (Child-Pugh) status changes during treatment.

Contraindications: Hypersensitivity to the active substance, to other rapamycin derivatives or to any of the excipients.

Warnings/Precautions: ♦Non-infectious pneumonitis: Cases have been described in patients taking AFINITOR, some of these have been severe and on rare occasions, a fatal outcome was observed. A diagnosis of non-infectious pneumonitis should be considered in patients presenting with non-specific respiratory signs and symptoms such as hypoxia, pleural effusion, cough or dyspnoea, and in whom infectious, neoplastic, and other non-medicinal causes have been excluded. Opportunistic infections such as pneumocystis jirovecii (carinii) pneumonia (PJP, PCP) should be ruled out in the differential diagnosis of non-infectious pneumonitis. In some cases, management of pneumonitis may require interruption or discontinuation of treatment. The use of corticosteroids may be indicated. For patients who require use of corticosteroids for treatment of non-infectious pneumonitis, prophylaxis for pneumocystis jirovecii (carinii) pneumonia (PJP, PCP) may be considered. AFINITOR may be reinitiated at a lower dose. ♦Infections: AFINITOR is immunosuppressive. Localized and systemic bacterial, fungal, viral, or protozoal infections (e.g. pneumonia, aspergillosis, candidiasis, or pneumocystis jirovecii (carinii) pneumonia (PJP, PCP) and hepatitis B reactivation) have been described in patients taking AFINITOR; some of these have been severe and occasionally fatal. Pre-existing infections should be resolved prior to starting treatment with AFINITOR. Be vigilant for symptoms or signs of infection during treatment with AFINITOR. In case of emergent infections, institute appropriate treatment promptly and consider interruption or discontinuation of AFINITOR. If a diagnosis of invasive systemic fungal infection is made, discontinue AFINITOR and treat with appropriate antifungal therapy. Prophylaxis for PJP/PCP should be considered when concomitant use of corticosteroids or other immunosuppressive agents are required. ♦Hypersensitivity reactions: Have been observed with everolimus. ♦Angioedema: Patients taking concomitant ACE inhibitor therapy may be at increased risk for angioedema (e.g. swelling of the airways or tongue, with or without respiratory impairment). ♦Oral ulceration: Mouth ulcers, stomatitis, and oral mucositis have been seen in patients treated with AFINITOR. Management of these adverse reactions may require dose temporary interruption, dose reduction or discontinuation. Topical treatments are recommended, but alcohol-, hydrogen peroxide, iodine-, or thyme containing mouthwashes should be avoided. AFINITOR may be reinitiated at the same dose or at a lower dose. ♦Renal failure: Cases of renal failure (including acute renal failure), some fatal, have been observed in patients treated with AFINITOR. Renal function of patients should be monitored particularly where patients have additional risk factors that may further impair their renal function. ♦Laboratory tests and monitoring: Renal function, blood glucose, blood lipids, and complete blood counts are recommended prior to initiation of and periodically during treatment. ♦Functional carcinoid tumours: The safety and efficacy of Afinitor in patients with functional carcinoid tumours have not been established. ♦Prognostic factors in neuroendocrine tumors of gastrointestinal or lung origin: In patients with non-functional gastrointestinal or lung neuroendocrine tumours and good prognostic baseline factors, e.g. ileum as primary tumour origin and normal chromogranin A values or without bone involvement, an individual benefit-risk assessment should be performed prior to the start of AFINITOR therapy. A limited evidence of PFS benefit was reported in the subgroup of patients with ileum as primary tumour origin. ♦Hepatic Impairment: Not recommended in patients with severe hepatic impairment (Child-Pugh C) unless the potential benefit outweighs the risk. ♦Vaccination: Avoid use of live vaccines and close contact with people who have received live vaccines. ♦Lactose: Patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product. ♦Wound healing complications: Impaired wound healing is a class effect of rapamycin derivatives, including AFINITOR. Caution should be exercised with use of AFINITOR in peri-surgical period. ♦Pregnancy: AFINITOR is not recommended during pregnancy and in women of childbearing potential not using contraception. Male patients taking AFINITOR should not be prohibited from attempting to father children. ♦Women of childbearing potential: Use highly effective contraception methods while receiving AFINITOR and for up to 8 weeks after ending treatment. ♦Breast-feeding: Women taking AFINITOR should not breast-feed. ♦Fertility: Male and female fertility may be compromised by treatment with AFINITOR. Menstrual irregularities, secondary amenorrhea, and associated luteinizing hormone (LH) / follicle stimulating hormone (FSH) imbalance have been observed in female patients receiving AFINITOR.

Interactions: Avoid concurrent treatment with strong CYP3A4 inhibitors or PgP inhibitors (e.g. ketoconazole, itraconazole, ritonavir, clarithromycin, telithromycin). ♦Caution with moderate CYP3A4 inhibitors or PgP inhibitors (e.g. erythromycin, verapamil, diltiazem, fluconazole, ciclosporin, amprenavir, fosamprenavir, aprepitant, imatinib, dronedarone). Consider a dose decrease of AFINITOR when co-administered with moderate inhibitors. ♦Avoid concurrent treatment with strong CYP3A4 inducers or PgP inducers (e.g. rifampicin, rifabutin, carbamazepine, phenobarbital, phenytoin, efavirenz, nevirapine, dexamethasone, St. John’s Wort (Hypericum perforatum)). Consider a dose increase of AFINITOR when co-administered with strong inducers. ♦Avoid grapefruit juice, grapefruit, star fruit, Seville oranges and other foods affecting CYP3A4 or PgP. ♦Caution when used in combination with orally administered CYP3A4 substrates with a narrow therapeutic index.

Adverse drug reactions: ♦Very common (≥10%): Infections, anemia, decreased appetite, hyperglycemia, hypercholesterolemia, dysgeusia, headache, pneumonitis, epistaxis, cough, stomatitis, diarrhea, nausea, rash, pruritus, fatigue, edema peripheral, asthenia, weight decreased. ♦Common (≥1 to <10%): Thrombocytopenia, neutropenia, leukopenia, lymphopenia, hypertriglyceridemia, hyperlipidemia, hypophosphatemia, diabetes mellitus, hypokalemia, dehydration, insomnia, hypertension, hemorrhage, dyspnea, vomiting, dry mouth, abdominal pain, oral pain, dyspepsia, dysphagia, dry skin, nail disorder, erythema, acne, hand-foot syndrome, arthralgia, renal failure, proteinuria, menstruation irregular, pyrexia, mucosal inflammation, alanine aminotransferase (ALT) increased, aspartate aminotransferase (AST) increased, blood creatinine increased. ♦Uncommon (≥0.1 to <1%): Pancytopenia, hypersensitivity, ageusia, congestive cardiac failure, deep vein thrombosis, hemoptysis, pulmonary embolism, increased daytime urination, acute renal failure, amenorrhea, non-cardiac chest pain, impaired wound healing. ♦Rare (<0.1%): Pure red cell aplasia, acute respiratory distress syndrome, angioedema. ♦In clinical trials and post-marketing reports, everolimus has been associated with serious cases of hepatitis B reactivation, including fatal outcome. Reactivation of infections is an expected event during periods of immunosuppression.  In clinical trials and post-marketing spontaneous reports, everolimus has been associated with renal failure events (including fatal outcome), proteinuria, and cases of amenorrhea (secondary amenorrhea and other menstrual irregularities). In clinical studies and post marketing spontaneous reports, everolimus has been associated with cases of pneumocystis jirovecii (carinii) pneumonia (PJP, PCP), some with fatal outcome. In clinical trials and post-marketing spontaneous reports, angioedema has been reported with and without concomitant use of ACE inhibitors.

Packs and prices: Country specific.

Legal classification: Country specific.