Temsirolimus (Torisel™)

OncoLink
Last Modified: September 12, 2012

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Pronounced: TEM-sir-OH-li-mus
Classification: Kinase Inhibitor

About Temsirolimus

Temsirolimus is a kinase inhibitor that inhibits mTor kinase, an enzyme required for cell growth and survival. By blocking this enzyme, temsirolimus prevents cell division and may slow the growth of tumors. This medication may also slow the growth of blood vessels that feed the tumor.

How to Take Temsirolimus

Temsirolimus is given intravenously (through an IV into a vein), typically once a week. You will be given diphenhydramine prior to the infusion to decrease the chance of a reaction to the medication, which can include flushing, shortness of breath, and chest pain. Let your nurse know right away if you experience any problems during the infusion.

Patients should not eat grapefruit or drink grapefruit juice while receiving this drug, or between treatments, as this can affect the amount of medication in your body.

Possible Side Effects of Temsirolimus

There are a number of things you can do to manage the side effects of Temsirolimus. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Hyperglycemia

Temsirolimus can cause blood sugar to be elevated. Your blood sugar will be checked before and after treatment. Some people will require treatment for elevated blood sugar, including insulin or oral medications. Patients taking the drug should report excess thirst or urination to their healthcare team, which can be a sign of high blood sugar.

Infection Risk

Temsirolimus can suppress your immune system, putting you at higher risk of getting an infection. You should wash your hands frequently, and avoid large crowds and people who are sick or have colds. You should let your healthcare team know right away if you have a fever (temperature greater than 100.4), sore throat or cold, or a sore that doesn't heal. You should not receive or be around anyone who has had a "live" vaccine. Live vaccines include: nasal flu vaccine (not the type given by injection), chicken pox (Varicella), MMR, oral polio, BCG and typhoid. If you are not certain if a vaccine is live, check with your healthcare team.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

  • Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
  • Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
  • When working in your yard, wear protective clothing including long pants and gloves.
  • Do not handle pet waste.
  • Keep all cuts or scratches clean.
  • Shower or bath daily and perform frequent mouth care.
  • Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
  • Ask your doctor or nurse before scheduling dental appointments or procedures.
  • Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the count becomes too low, you may receive a transfusion of platelets.

  • Do not use a razor (an electric razor is fine).
  • Avoid contact sports and activities that can result in injury or bleeding.
  • Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
  • Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Read the thrombocytopenia tip sheet for more information.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Decrease in Appetite

Visit OncoLink's section on Nutrition for tips on dealing with this side effect. Ask your nurse about nutritional counseling services.

  • Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
  • If you are not eating enough, nutritional supplements may help.
  • You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months.
  • Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell.
  • Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can also add flavor to vegetables.

Mouth Ulcers (Sores)

Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.

  • Brush with a soft-bristle toothbrush or cotton swab twice a day.
  • Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily.
  • If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
  • Avoid smoking and chewing tobacco, drinking alcoholic beverages and citrus juices.

Read the mouth ulcer tip sheet for more information.

Increase in Cholesterol and Triglycerides

Patients receiving temsirolimus may develop increased cholesterol and triglyceride levels. Some people may require a lipid lowering medication to treat this increase.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected.

Other Side Effects

Temsirolimus can result in a serious problem called gastrointestinal perforation, which is the development of a hole in the stomach or small or large intestine. If you develop abdominal pain, nausea, vomiting, constipation or fever, you should notify your healthcare team immediately.

This medication can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, this medication should be used with caution before or after surgery. In addition, any surgical incision should be fully healed prior to starting treatment. If you notice that your surgical wound has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.

Some less common side effects that have been reported include: rash, weakness, and edema (swelling). A type of lung problem called interstitial lung disease can also occur. Let your healthcare team know if you develop any difficulty breathing or cough.


News
Biomarker Found to Predict Therapy Benefit in Renal Cancer

Aug 16, 2012 - Pretreatment serum lactate dehydrogenase is a predictive biomarker for the survival benefit derived from treatment with the TORC1 inhibitor temsirolimus in patients with renal cell carcinoma, according to a study published online Aug. 13 in the Journal of Clinical Oncology.



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