Afinitor (everolimus) vs Xeloda ()

Afinitor (everolimus) is an mTOR inhibitor primarily used in various types of cancers, such as advanced renal cell carcinoma, certain breast cancers, and neuroendocrine tumors, and is also indicated for non-cancerous conditions like tuberous sclerosis complex. Xeloda (capecitabine) is an orally-administered chemotherapeutic agent that is a prodrug of 5-fluorouracil (5-FU) and is commonly used to treat metastatic breast cancer and colorectal cancer. The choice between Afinitor and Xeloda would depend on the specific type and stage of cancer, the patient's overall health, previous treatments, and potential side effects, and thus should be made in consultation with an oncologist who can tailor the treatment to the patient's individual needs.

Difference between Afinitor and Xeloda

Metric	Afinitor (everolimus)	Xeloda (capecitabine)
Generic name	Everolimus	Capecitabine
Indications	Advanced hormone receptor-positive, HER2-negative breast cancer, advanced neuroendocrine tumors, renal cell carcinoma, subependymal giant cell astrocytoma (SEGA), tuberous sclerosis complex (TSC)-associated renal angiomyolipoma, and TSC-associated partial-onset seizures	Metastatic colorectal cancer, metastatic breast cancer, gastric cancer, gastroesophageal junction cancer, and adjuvant treatment in stage III colon cancer
Mechanism of action	mTOR inhibitor, which inhibits the mammalian target of rapamycin (mTOR) pathway, a key signaling pathway that regulates cell growth, proliferation, and survival	Prodrug that is enzymatically converted to 5-fluorouracil (5-FU) in the body, which then inhibits thymidylate synthase and incorporates into RNA and DNA to interfere with cancer cell growth and division
Brand names	Afinitor, Afinitor Disperz, Zortress	Xeloda
Administrative route	Oral	Oral
Side effects	Mouth ulcers, infections, rash, fatigue, diarrhea, edema, abdominal pain, nausea, fever, headache, cough, decreased appetite, dyspnea, and elevated blood glucose and lipids	Diarrhea, hand-foot syndrome, nausea, vomiting, abdominal pain, fatigue, decreased appetite, and increased bilirubin levels
Contraindications	Hypersensitivity to everolimus or other rapamycin derivatives, patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption	Hypersensitivity to capecitabine or fluorouracil, patients with severe renal impairment, and patients with dihydropyrimidine dehydrogenase (DPD) deficiency
Drug class	mTOR inhibitor, immunosuppressant	Antimetabolite, fluoropyrimidine
Manufacturer	Novartis Pharmaceuticals	Roche (Genentech)

Efficacy

Efficacy of Afinitor (Everolimus) in Breast Cancer

Afinitor (everolimus) is an mTOR inhibitor that has been studied for its efficacy in treating hormone receptor-positive, HER2-negative breast cancer. It is specifically used in postmenopausal women with advanced breast cancer. Clinical trials have demonstrated that when everolimus is combined with exemestane, a hormonal therapy, it can significantly extend progression-free survival compared to exemestane alone. This combination has been shown to be beneficial for patients who have previously received treatment with an aromatase inhibitor.

The BOLERO-2 clinical trial was a pivotal study that highlighted the efficacy of Afinitor in this setting. The trial showed that the addition of everolimus to exemestane therapy resulted in a median progression-free survival of 7.8 months compared to 3.2 months with placebo plus exemestane. This marked improvement in delaying disease progression has made Afinitor a valuable option for patients with advanced hormone receptor-positive breast cancer.

Efficacy of Xeloda (Capecitabine) in Breast Cancer

Xeloda (capecitabine) is an oral chemotherapeutic agent that is a prodrug of 5-fluorouracil (5-FU), which has shown efficacy in the treatment of metastatic breast cancer, particularly in patients who have failed anthracycline and taxane therapy. Capecitabine is metabolized to 5-FU in the tumor tissue, where it inhibits DNA synthesis and hampers cell division, leading to cancer cell death. In metastatic breast cancer, Xeloda has been used as monotherapy or in combination with other agents such as docetaxel.

Several studies have indicated that Xeloda is effective in improving response rates and overall survival in metastatic breast cancer patients. For instance, when used in combination with docetaxel, Xeloda has been shown to significantly improve the time to disease progression and overall survival compared to docetaxel alone. The efficacy of Xeloda as a single agent has also been established, with response rates in the range of 20-30% in patients previously treated with anthracycline and taxane.

Regulatory Agency Approvals

Afinitor

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Pharmaceuticals and Medical Devices Agency (PMDA), Japan
Therapeutic Goods Administration (TGA), Australia

Xeloda

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

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