Elacestrant

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Elacestrant
Clinical data
Pronunciation/ˌɛləˈsɛstrənt/
EL-ə-SES-trənt
Trade namesOrserdu
Other namesRAD-1901; ER-306323
License data
Routes of
administration		By mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability~10%[1]
Protein binding>99%[1]
MetabolismLiver (major: CYP3A4, minor: CYP2A6, CYP2C9)[1]
Elimination half-life30–50 hours[1]
ExcretionFeces (82%), urine (7.5%)[1]
Identifiers
  • (6R)-6-{2-[Ethyl({4-[2-(ethylamino)ethyl]phenyl}methyl)amino]-4-methoxyphenyl}-5,6,7,8-tetrahydronaphthalen-2-ol
JSmol)
  • CCNCCC1=CC=C(C=C1)CN(CC)C2=C(C=CC(=C2)OC)C3CCC4=C(C3)C=CC(=C4)O
  • InChI=1S/C30H38N2O2/c1-4-31-17-16-22-6-8-23(9-7-22)21-32(5-2)30-20-28(34-3)14-15-29(30)26-11-10-25-19-27(33)13-12-24(25)18-26/h6-9,12-15,19-20,26,31,33H,4-5,10-11,16-18,21H2,1-3H3/t26-/m1/s1
  • Key:SIFNOOUKXBRGGB-AREMUKBSSA-N

Elacestrant, sold under the brand name Orserdu, is an

by mouth.[1][4]

Elacestrant is an

upset stomach.[2]

Elacestrant was approved for medical use in the United States in January 2023,[1][2][5][6] and in the European Union in September 2023.[3][7]

Medical uses

Elacestrant is

endocrine therapy.[2][4]

Pharmacology

Pharmacodynamics

Elacestrant is an

endogenous estrogens like estradiol.[1] It is specifically an antagonist of the estrogen receptor alpha (ERα).[1] Elacestrant is also a selective estrogen receptor degrader (SERD), in that it induces degradation of the ERα.[1][8]

Pharmacokinetics

The

elimination half-life of elacestrant is 30 to 50 hours.[1] It is excreted 82% in feces and 7.5% in urine.[1]

History

Efficacy was evaluated in EMERALD (NCT03778931), a randomized, open-label, active-controlled, multicenter trial that enrolled 478 postmenopausal women and men with ER-positive, HER2-negative advanced or metastatic breast cancer of which 228 participants had ESR1 mutations.[2] Participants were required to have disease progression on one or two prior lines of endocrine therapy, including one line containing a CDK4/6 inhibitor.[2] Eligible participants could have received up to one prior line of chemotherapy in the advanced or metastatic setting.[2] Participants were randomized (1:1) to receive elacestrant 345 mg orally once daily (n=239) or investigator’s choice of endocrine therapy (n=239), which included fulvestrant (n=166) or an aromatase inhibitor (n=73).[2] Randomization was stratified by ESR1 mutation status (detected vs. not detected), prior treatment with fulvestrant (yes vs. no), and visceral metastasis (yes vs. no).[2] ESR1 mutational status was determined by blood circulating tumor deoxyribonucleic acid (ctDNA) using the Guardant360 CDx assay and was limited to ESR1 missense mutations in the ligand binding domain.[2]

The FDA granted the application for elacestrant priority review and fast track designations.[2]

Research

It is a

blood-brain-barrier into the central nervous system, where it can target breast cancer metastases in the brain,[10][11] and is orally bioavailable and does not require intramuscular injection.[10][11]

References

  1. ^ a b c d e f g h i j k l m n o p q r "Orserdu- elacestrant tablet, film coated". DailyMed. 8 February 2023. Archived from the original on 11 February 2023. Retrieved 11 February 2023.
  2. ^ a b c d e f g h i j k "FDA approves elacestrant for ER-positive, HER2-negative, ESR1-mutated advanced or metastatic breast cancer". U.S. Food and Drug Administration (FDA). 27 January 2023. Archived from the original on 2 February 2023. Retrieved 1 February 2023. Public Domain This article incorporates text from this source, which is in the public domain.
  3. ^ a b "Orserdu Product information". Union Register of medicinal products. 18 September 2023. Retrieved 1 October 2023.
  4. ^ a b c d "Orserdu EPAR". European Medicines Agency (EMA). 9 October 2023. Retrieved 9 October 2023.
  5. ^ https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2023/217639Orig1s000ltr.pdf Archived 2023-02-02 at the Wayback Machine Public Domain This article incorporates text from this source, which is in the public domain.
  6. ^ "Stemline Therapeutics Inc., a wholly owned subsidiary of Menarini Group, Receives Approval from U.S. FDA for Orserdu (elacestrant) as the First and Only Treatment Specifically Indicated for Patients with ESR1 Mutations in ER+, HER2- Advanced or Metastatic Breast Cancer". Radius (Press release). 31 January 2023. Archived from the original on 2 February 2023. Retrieved 1 February 2023.
  7. ^ "EC approves Menarini Group's Orserdu for advanced or metastatic breast cancer". PMLive. 21 September 2023. Retrieved 22 September 2023.
  8. PMID 35923930
    .
  9. ^ Clinical trial number NCT03778931 for "Phase 3 Trial of Elacestrant vs. Standard of Care for the Treatment of Patients With ER+/HER2- Advanced Breast Cancer" at ClinicalTrials.gov
  10. ^
    PMID 26162914
    .
  11. ^
    PMID 26164151
    .
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