Temsirolimus

What is Temsirolimus

Temsirolimus, an ester analog of sirolimus, is an inhibitor of mammalian target of rapamycin (mTOR) and was the first FDA-approved mTOR antagonist for the treatment of renal cell cancer (RCC).

Treatment with temsirolimus significantly improved overall survival and progression-free survival compared with interferon alfa in patients with previously untreated advanced RCC (clear cell and non-clear cell histologies). Exposure to temsirolimus increases significantly with hepatic impairment.

Significant hypersensitivity / infusion-related reactions have been reported with temsirolimus administration; premedication with an antihistamine is recommended.

Additionally temsirolimus can cause significant immunosuppression. Live vaccines should be avoided, and patients should be closely monitored for infection.

Brand Name

Torisel

Indications

  • glioblastoma multiforme
  • malignant glioma
  • mantle cell lymphoma (MCL)
  • neuroblastoma
  • renal cell cancer
  • rhabdomyosarcoma

For the treatment of advanced renal cell cancer

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. anaphylactic shock
  4. anaphylactoid reactions
  5. anemia
  6. angioedema
  7. anorexia
  8. apnea
  9. arthralgia
  10. asthenia
  11. back pain
  12. chest pain (unspecified)
  13. chills
  14. cholecystitis
  15. cholelithiasis
  16. conjunctivitis
  17. constipation
  18. cough
  19. depression
  20. diabetes mellitus
  21. diarrhea
  22. dysgeusia
  23. dyspnea
  24. edema
  25. elevated hepatic enzymes
  26. epistaxis
  27. exfoliative dermatitis
  28. fever
  29. flushing
  30. GI bleeding
  31. GI perforation
  32. glossitis
  33. headache
  34. hyperbilirubinemia
  35. hypercholesterolemia
  36. hyperglycemia
  37. hyperlipidemia
  38. hypertension
  39. hypertriglyceridemia
  40. hypokalemia
  41. hypophosphatemia
  42. hypotension
  43. hypoxia
  44. immunosuppression
  45. impaired wound healing
  46. increased urinary frequency
  47. infection
  48. infusion-related reactions
  49. injection site reaction
  50. insomnia
  51. leukopenia
  52. lymphopenia
  53. maculopapular rash
  54. metabolic acidosis
  55. myalgia
  56. nausea
  57. nephrotic syndrome
  58. neutropenia
  59. oral ulceration
  60. pancreatitis
  61. pericardial effusion
  62. peripheral edema
  63. pharyngitis
  64. phlebitis
  65. pleural effusion
  66. pneumonitis
  67. proteinuria
  68. pruritus
  69. psychosis
  70. pulmonary embolism
  71. rash
  72. renal failure (unspecified)
  73. rhabdomyolysis
  74. rhinitis
  75. seizures
  76. Stevens-Johnson syndrome
  77. stomatitis
  78. thrombocytopenia
  79. thromboembolism
  80. thrombosis
  81. vomiting
  82. weight loss
  83. xerosis

Monitoring Parameters

  • blood glucose
  • CBC with differential
  • chest x-ray
  • LFTs
  • serum cholesterol
  • serum creatinine/BUN
  • serum triglycerides
  • urinalysis

Contraindications

  • anticoagulant therapy
  • brain tumor
  • breast-feeding
  • children
  • contraception requirements
  • coronary artery disease
  • corticosteroid therapy
  • diabetes mellitus
  • geriatric
  • GI perforation
  • hepatic disease
  • hypercholesterolemia
  • hyperlipidemia
  • hypertriglyceridemia
  • immunosuppression
  • infants
  • infection
  • male-mediated teratogenicity
  • neonates
  • pneumonitis
  • polysorbate 80 hypersensitivity
  • pregnancy
  • proteinuria
  • pulmonary disease
  • reproductive risk
  • surgery
  • vaccination

Interactions

  • Abacavir; Dolutegravir; Lamivudine
  • Afatinib
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Amiodarone
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Apalutamide
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atorvastatin
  • Atorvastatin; Ezetimibe
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Betrixaban
  • Bictegravir; Emtricitabine; Tenofovir Alafenamide
  • Brigatinib
  • Budesonide
  • Budesonide; Formoterol
  • Cabozantinib
  • Capmatinib
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Carvedilol
  • Ceritinib
  • Chloramphenicol
  • Clarithromycin
  • Clevidipine
  • Cobicistat
  • Cobimetinib
  • Colchicine
  • Colchicine; Probenecid
  • Conivaptan
  • Cyclosporine
  • Dabigatran
  • Daclatasvir
  • Dapagliflozin; Saxagliptin
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Dexamethasone
  • Dextromethorphan; Quinidine
  • Digoxin
  • Diltiazem
  • Dolutegravir
  • Dolutegravir; Lamivudine
  • Dolutegravir; Rilpivirine
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Doxorubicin
  • Dronedarone
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Edoxaban
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elexacaftor; tezacaftor; ivacaftor
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir alafenamide
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enzalutamide
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etravirine
  • Felodipine
  • Flibanserin
  • Fluticasone; Umeclidinium; Vilanterol
  • Fosamprenavir
  • Fosinopril
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fosphenytoin
  • Fostamatinib
  • Glecaprevir; Pibrentasvir
  • Glyburide
  • Glyburide; Metformin
  • grapefruit juice
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Ibrutinib
  • Idelalisib
  • Indinavir
  • Irinotecan
  • Irinotecan Liposomal
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isradipine
  • Istradefylline
  • Itraconazole
  • Ivacaftor
  • Ketoconazole
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lapatinib
  • Ledipasvir; Sofosbuvir
  • Lefamulin
  • Letermovir
  • Lisinopril
  • Live Vaccines
  • Lomitapide
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Maraviroc
  • Mefloquine
  • Mephobarbital
  • Metformin; Saxagliptin
  • Mifepristone
  • Mitomycin
  • Mitotane
  • Modafinil
  • Moexipril
  • Morphine
  • Morphine; Naltrexone
  • Naldemedine
  • Nefazodone
  • Nelfinavir
  • Neratinib
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Nisoldipine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Osimertinib
  • Palifermin
  • Penicillamine
  • Perindopril
  • Perindopril; Amlodipine
  • Phenobarbital
  • Phenytoin
  • Ponatinib
  • Posaconazole
  • Primidone
  • Propafenone
  • Quinapril
  • Quinidine
  • Quinine
  • Ramipril
  • Ranolazine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifaximin
  • Rimegepant
  • Riociguat
  • Risperidone
  • Ritonavir
  • Rolapitant
  • Romidepsin
  • Sapropterin
  • Saquinavir
  • Saxagliptin
  • Segesterone Acetate; Ethinyl Estradiol
  • Silodosin
  • Simeprevir
  • Sirolimus
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sorafenib
  • St. John’s Wort, Hypericum perforatum
  • Sunitinib
  • Talazoparib
  • Telithromycin
  • Tenofovir Alafenamide
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Tezacaftor; Ivacaftor
  • Ticagrelor
  • Tipranavir
  • Tolvaptan
  • Topotecan
  • Trandolapril
  • Trandolapril; Verapamil
  • Tuberculin Purified Protein Derivative, PPD
  • Tucatinib
  • Ubrogepant
  • Umeclidinium
  • Umeclidinium; Vilanterol
  • Vemurafenib
  • Venetoclax
  • Verapamil
  • Vinblastine
  • Vincristine
  • Vincristine Liposomal
  • Voriconazole
  • Zonisamide
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