|Systematic (IUPAC) name|
|Licence data||US FDA:|
|Pregnancy cat.||D (US)|
|Legal status||℞ Prescription only|
|ATC code||L01 L04|
|Mol. mass||958.224 g/mol|
|(what is this?)|
It is currently used as an immunosuppressant to prevent rejection of organ transplants and treatment of renal cell cancer and other tumours. Much research has also been conducted on everolimus and other mTOR inhibitors for use in a number of cancers.
It is marketed by Novartis under the tradenames Zortress (USA) and Certican (Europe and other countries) in transplantation medicine, and Afinitor in oncology. Everolimus also available with Biocon with the brand name of Evertor.
Approvals and indications
Everolimus is approved for various conditions:
- Advanced kidney cancer (approved in March 2009)
- Prevention of organ rejection after renal transplant(April 2010)
- Subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis (TS) in patients who are not suitable for surgical intervention (October 2010)
- Progressive or metastatic pancreatic neuroendocrine tumors not surgically removable (May 2011)
- Breast cancer in post-menopausal women with advanced hormone-receptor positive, HER2-negative type cancer, in conjunction with exemestane (July 2012)
- Prevention of organ rejection after liver transplant(Feb 2013)
As of October 2010[update], Phase III trials are under way in gastric cancer, hepatocellular carcinoma and lymphoma. The use of everolimus in refractory chronic graft-versus-host disease has been reported in 2012.
Interim phase III trial results in 2011 showed that adding Afinitor (everolimus) to exemestane therapy against advanced breast cancer can significantly improve progression-free survival compared with exemestane therapy alone. However, everolimus increases mortality in cancer patients.
In a similar fashion to other mTOR inhibitors its effect is solely on the mTORC1 protein and not on the mTORC2 protein. This can lead to a hyper-activation of the kinase AKT via inhibition on the mTORC1 negative feedback loop while not inhibiting the mTORC2 positive feedback to AKT. This AKT elevation can lead to longer survival in some cell types.?
Role in heart transplantation
Everolimus may have a role in heart transplantation as it has been shown to reduce chronic allograft vasculopathy in such transplants. It also may have a similar role to sirolimus in kidney and other transplants.
Because hypercholesterolemia and hypertriglyceridemia have been reported, monitoring of blood lipid level is recommended.
Use in vascular stents
Everolimus is used in drug-eluting coronary stents as an immunosuppressant to prevent restenosis. Abbott Vascular produces an everolimus-eluting stent called the Xience V. It utilizes the Multi-Link Vision cobalt chromium stent platform and Novartis' everolimus. The product is also currently in use in the United States and as an investigational device in Japan. A similar version called the PROMUS Everolimus-Eluting Coronary Stent System is produced by Boston Scientific and it is currently available in the United States and most major European and Asia-Pacific markets.
- R.N Formica Jra, K.M Lorberb, A.L Friedmanb, M.J Biaa, F Lakkisa, J.D Smitha, M.I Lorber (March 2004). "The evolving experience using everolimus in clinical transplantation". Elsevier 36 (2): S495–S499.
- "Afinitor approved in US as first treatment for patients with advanced kidney cancer after failure of either sunitinib or sorafenib" (Press release). Novartis. 2009-03-30. Retrieved April 6, 2009.
- "Novartis receives US FDA approval for Zortress (everolimus) to prevent organ rejection in adult kidney transplant recipients" (Press release). Novartis. 2010-04-22. Retrieved April 26, 2010.
- "Novartis’ Afinitor Cleared by FDA for Treating SEGA Tumors in Tuberous Sclerosis". 1 Nov 2010.
- "US FDA approves Novartis drug Afinitor for breast cancer". 20 Jul 2012.
- Lutz M, Kapp M, Grigoleit GU, Stuhler G, Einsele H, Mielke S (April 2012). "Salvage therapy with everolimus improves quality of life in patients with refractory chronic graft-versus-host disease". Bone Marrow Transplant 47 (S1): S410–S411.
- "Positive Trial Data Leads Novartis to Plan Breast Cancer Filing for Afinitor by Year End". 2011.
- Fatal AEs Higher with mTOR Drugs in Cancer. Med Page Today
- Eisen HJ, Tuzcu EM, Dorent R, et al. (August 2003). "Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients". N. Engl. J. Med. 349 (9): 847–58. doi:10.1056/NEJMoa022171. PMID 12944570.
- Sedrani R, Cottens S, Kallen J, Schuler W (August 1998). "Chemical modification of rapamycin: the discovery of SDZ RAD". Transplant. Proc. 30 (5): 2192–4. doi:10.1016/S0041-1345(98)00587-9. PMID 9723437.