Important Safety Information

AFINITOR is contraindicated in patients with clinically significant hypersensitivity to everolimus or to other rapamycin derivatives. There have been reports of noninfectious pneumonitis (including...

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Indication

AFINITOR® (everolimus) Tablets is indicated for the treatment of adults with progressive, well-differentiated, nonfunctional neuroendocrine tumors (NET) of gastrointestinal (GI) or lung origin with unresectable, locally advanced, or metastatic disease.

Limitation of Use: AFINITOR is not indicated for the treatment of patients with functional carcinoid tumors.

Disease Information

GI NET

Watch an animated video to learn more about advanced, progressive, well-differentiated, nonfunctional GI NET.

PROGRESSIVE, NONFUNCTIONAL GI NET: SYMPTOMATOLOGY AND CLINICAL PRESENTATION

Overview

  • GI NET accounts for approximately half of all NET diagnoses1
    • Vague symptoms lead to diagnostic challenges2
    • By the time diagnosis occurs, most patients have metastatic disease3

Nonfunctional GI NET: Asymptomatic or nonspecific symptoms

  • Most nonfunctional GI NET are asymptomatic or clinically silent4
    • Hormone secretion may occur at the subclinical level, preventing identification of a distinct hormonal syndrome3
  • When present, symptoms are generally related to increased tumor mass and/or metastasis and are of nonspecific nature3

Nonfunctional GI NET: diagnostic challenges

  • Patients remain asymptomatic for long periods of time4
  • When patients do exhibit symptoms, they vary widely due to numerous sites of GI tumor origin and diverse patterns of metastatic spread2

At diagnosis, most patients with nonfunctional GI NET already have progressive disease3

  • 50% of patients have regional or distant metastases3

GI NET Locations

Lung NET

Watch an animated video to learn more about advanced, progressive, well-differentiated, nonfunctional lung NET.

PROGRESSIVE, NONFUNCTIONAL LUNG NET: SYMPTOMATOLOGY AND CLINICAL PRESENTATION

Overview

  • Lung NET accounts for about one-quarter of all NET diagnoses1
    • Nonspecific symptoms create diagnostic challenges6
    • Many patients present with metastatic disease7

Nonfunctional lung NET: asymptomatic or nonspecific symptoms

  • When present, symptoms are generally related to tumor bulk and are of nonspecific nature6
  • Tumors in the central bronchi are more likely than those in the peripheral lung to exhibit symptoms6

Nonfunctional lung NET: diagnostic challenges

  • Patients remain asymptomatic for long periods of time6
  • Distinguishing histology between lung NET subtypes can be difficult6

Patients with well-differentiated lung NET often present with regional lymph node and distant metastases6

  • Up to 60% have regional lymph node metastases
  • Up to 20% have distant metastases

Well-Differentiated Lung Net Types

Progression

ASSESSING GI AND LUNG NET PROGRESSION

Is your patient’s disease more advanced than you think? In this brochure, discover how to recognize the first signs of disease progression in NET so you can influence patient care and outcomes.

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References: 1. Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017:E1-E8. Published April 27, 2017. doi:10.1001/jamaoncol.2017.0589. 2. Toth-Fejel S, Pommier RF. Relationships among delay of diagnosis, extent of disease, and survival in patients with abdominal carcinoid tumors. Am J Surg. 2004;187(5):575-579. 3. Öberg KE. Gastrointestinal neuroendocrine tumors. Ann Oncol. 2010;21(suppl 7);vii72-vii80. 4. American Society of Clinical Oncology. Carcinoid tumor. Cancer.net. http://www.cancer.net/cancer-types/carcinoid-tumor/view-all. Accessed June 20, 2018. 5. Gastrointestinal carcinoid tumors treatment–for health professionals (PDQ®). National Cancer Institute website. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq. Updated February 7, 2018. Accessed June 20, 2018. 6. Wolin EM. Challenges in the diagnosis and management of well-differentiated neuroendocrine tumors of the lung (typical and atypical carcinoid): current status and future considerations. Oncologist. 2015;20(10):1123-1131. 7. Rekhtman N. Neuroendocrine tumors of the lung: an update. Arch Pathol Lab Med. 2010;134(11):1628-1638.

Important Safety Information

AFINITOR® (everolimus) Tablets is contraindicated in patients with clinically significant hypersensitivity to everolimus or to other rapamycin derivatives.

Noninfectious Pneumonitis: Noninfectious pneumonitis was reported in up to 19% of patients treated with AFINITOR; some cases were reported with pulmonary hypertension (including pulmonary arterial hypertension) as a secondary event. The incidence of grade 3 and 4 noninfectious pneumonitis was up to 4% and up to 0.2%, respectively. Fatal outcomes have been observed. Monitor for clinical symptoms or radiological changes. Consider opportunistic infections such as Pneumocystis jiroveci pneumonia (PJP) in the differential diagnosis. For grade 2 to 4 noninfectious pneumonitis, withhold or permanently discontinue AFINITOR based on severity. Corticosteroids may be indicated until clinical symptoms resolve. Administer prophylaxis for PJP when concomitant use of corticosteroids or other immunosuppressive agents is required. The development of pneumonitis has been reported even at a reduced dose.

Infections: 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, candidiasis, or PJP; and viral infections, including reactivation of hepatitis B virus, have occurred. Some of these infections have been severe (eg, sepsis, septic shock, or resulting in multisystem organ failure) or fatal. The incidence of grade 3 and 4 infections was up to 10% and up to 3%, respectively. Complete treatment of preexisting invasive fungal infections prior to starting treatment. Monitor for signs and symptoms of infection. Withhold or permanently discontinue AFINITOR based on severity of infection. Administer prophylaxis for PJP when concomitant use of corticosteroids or other immunosuppressive agents is required.

Severe Hypersensitivity Reactions: Hypersensitivity reactions to AFINITOR have been observed and include anaphylaxis, dyspnea, flushing, chest pain, and angioedema (eg, swelling of the airways or tongue, with or without respiratory impairment). The incidence of grade 3 hypersensitivity reactions was up to 1%. Permanently discontinue AFINITOR for the development of clinically significant hypersensitivity.

Angioedema With Concomitant Use of Angiotensin-Converting Enzyme (ACE) Inhibitors: Patients taking concomitant ACE inhibitor with AFINITOR may be at increased risk for angioedema (eg, swelling of the airways or tongue, with or without respiratory impairment). In a pooled analysis of randomized double-blind oncology clinical trials, the incidence of angioedema in patients taking AFINITOR with an ACE inhibitor was 6.8% compared to 1.3% in the control arm with an ACE inhibitor. Permanently discontinue AFINITOR for angioedema.

Stomatitis: Stomatitis, including mouth ulcers and oral mucositis, has 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. Stomatitis most often occurs within the first 8 weeks of treatment. When starting AFINITOR, initiating dexamethasone alcohol-free oral solution as a swish and spit mouthwash reduces the incidence and severity of stomatitis. If stomatitis does occur, mouthwashes and/or other topical treatments are recommended, but alcohol-, hydrogen peroxide-, iodine-, or thyme-containing products should be avoided. Antifungal agents should not be used unless fungal infection has been diagnosed.

Renal Failure: Cases of renal failure (including acute renal failure), some with a fatal outcome, have occurred in patients taking AFINITOR. Elevations of serum creatinine and proteinuria have been reported in patients taking AFINITOR. The incidence of grade 3 and 4 elevations of serum creatinine was up to 2% and up to 1%, respectively. The incidence of grade 3 and 4 proteinuria was up to 1% and up to 0.5%, respectively. Monitor renal function prior to starting AFINITOR and annually thereafter. Monitor renal function at least every 6 months in patients who have additional risk factors for renal failure.

Impaired Wound Healing: AFINITOR 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.

Metabolic Disorders: Hyperglycemia, hypercholesterolemia, and hypertriglyceridemia have been reported in patients taking AFINITOR at an incidence up to 75%, 86%, and 73%, respectively. The incidence of these grade 3 and 4 laboratory abnormalities was up to 15% and up to 0.4%, respectively. In nondiabetic patients, monitor fasting serum glucose prior to starting AFINITOR and annually thereafter. In diabetic patients, monitor fasting serum glucose more frequently as clinically indicated. Monitor lipid profile prior to starting AFINITOR and annually thereafter. When possible, achieve optimal glucose and lipid control prior to starting AFINITOR. For grade 3 to 4 metabolic events, withhold or permanently discontinue AFINITOR based on severity.

Myelosuppression: Anemia, lymphopenia, neutropenia, and thrombocytopenia have been reported in patients taking AFINITOR. The incidence of these grade 3 and 4 laboratory abnormalities was up to 16% and up to 2%, respectively. Monitor complete blood count prior to starting AFINITOR every 6 months for the first year of treatment and annually thereafter. Withhold or permanently discontinue AFINITOR based on severity.

Risk of Infection or Reduced Immune Response With Vaccinations: The safety of immunization with live vaccines during AFINITOR therapy has not been studied. Due to the potential increased risk of infection, avoid the use of live vaccines and close contact with individuals who have received live vaccines during treatment with AFINITOR.

Embryo-Fetal Toxicity: Fetal harm can occur if AFINITOR is administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. Advise female patients of reproductive potential to avoid becoming pregnant and to use effective contraception during treatment with AFINITOR and for 8 weeks after the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with AFINITOR and for 4 weeks after the last dose.

Adverse Reactions: The most common adverse reactions (incidence ≥30%) were stomatitis (63%), infections (58%), diarrhea (41%), peripheral edema (39%), fatigue (37%), and rash (30%). The most common grade 3/4 adverse reactions (incidence ≥5%) were infections (11%), stomatitis (9%), diarrhea (9%), and fatigue (5%). 

Laboratory Abnormalities: The most common laboratory abnormalities (incidence ≥50%, all grades) were anemia (81%), hypercholesterolemia (71%), lymphopenia (66%), increased aspartate transaminase (57%), and hyperglycemia (55%). The most common grade 3/4 laboratory abnormalities (incidence ≥5%) were lymphopenia (16%), hyperglycemia (6%), hypokalemia (6%), increased alanine transaminase (5%), and anemia (5%).

Please see full Prescribing Information.

 

Indication

AFINITOR is indicated for the treatment of adults with progressive, well-differentiated, nonfunctional neuroendocrine tumors (NET) of gastrointestinal (GI) or lung origin with unresectable, locally advanced, or metastatic disease.

Limitation of Use: AFINITOR is not indicated for the treatment of patients with functional carcinoid tumors.