Details
Stereochemistry | ACHIRAL |
Molecular Formula | C17H11N5 |
Molecular Weight | 285.3027 |
Optical Activity | NONE |
Defined Stereocenters | 0 / 0 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
N#CC1=CC=C(C=C1)C(N2C=NC=N2)C3=CC=C(C=C3)C#N
InChI
InChIKey=HPJKCIUCZWXJDR-UHFFFAOYSA-N
InChI=1S/C17H11N5/c18-9-13-1-5-15(6-2-13)17(22-12-20-11-21-22)16-7-3-14(10-19)4-8-16/h1-8,11-12,17H
DescriptionCurator's Comment: description was created based on several sources, including
https://www.ncbi.nlm.nih.gov/pubmed/?term=17912632
Curator's Comment: description was created based on several sources, including
https://www.ncbi.nlm.nih.gov/pubmed/?term=17912632
Letrozole (trade name Femara), a nonsteroidal aromatase inhibitor. Femara is indicated for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer. Also is indicated for the extended adjuvant treatment of early breast cancer in postmenopausal women, who have received 5 years of adjuvant tamoxifen therapy. Femara has to be used for first-line treatment of postmenopausal women with hormone receptor positive or unknown, locally advanced or metastatic breast cancer and for the treatment of advanced breast cancer in postmenopausal women with disease progression following antiestrogen therapy. Treatment of breast cancer thought to be hormonally responsive (i.e., estrogen and/or progesterone receptor positive or receptor unknown) has included a variety of efforts to decrease estrogen levels (ovariectomy, adrenalectomy, hypophysectomy) or inhibit estrogen effects (antiestrogens and progestational agents). These interventions lead to decreased tumor mass or delayed progression of tumor growth in some women. In postmenopausal women, estrogens are mainly derived from the action of the aromatase enzyme, which converts adrenal androgens (primarily androstenedione and testosterone) to estrone and estradiol. The suppression of estrogen biosynthesis in peripheral tissues and in the cancer tissue itself can therefore be achieved by specifically inhibiting the aromatase enzyme. Letrozole inhibits the conversion of androgens to estrogens. Letrozole selectively inhibits gonadal steroidogenesis but has no significant effect on adrenal mineralocorticoid or glucocorticoid synthesis. Letrozole inhibits the aromatase enzyme by competitively binding to the heme of the cytochrome P450 subunit of the enzyme, resulting in a reduction of estrogen biosynthesis in all tissues. Treatment of women with letrozole significantly lowers serum estrone, estradiol and estrone sulfate and has not been shown to significantly affect adrenal corticosteroid synthesis, aldosterone synthesis, or synthesis of thyroid hormones. Letrozole is rapidly and completely absorbed from the gastrointestinal tract and absorption is not affected by food. Metabolism to a pharmacologically inactive carbinol metabolite (4,4'¬ methanol-bisbenzonitrile) and renal excretion of the glucuronide conjugate of this metabolite is the major pathway of letrozole clearance. In human microsomes with specific CYP isozyme activity, CYP3A4 metabolized letrozole to the carbinol metabolite while CYP2A6 formed both this metabolite and its ketone analog. In human liver microsomes, letrozole strongly inhibited CYP2A6 and moderately inhibited CYP2C19. The most common side effects are sweating, hot flashes, arthralgia (joint pain), and fatigue
CNS Activity
Originator
Sources: https://www.ncbi.nlm.nih.gov/pubmed/?term=17912632
Curator's Comment: # Novartis
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: CHEMBL1978 Sources: https://www.ncbi.nlm.nih.gov/pubmed/15026471 |
7.27 nM [IC50] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Primary | FEMARA Approved Use1.1 Adjuvant Treatment of Early Breast Cancer Letrozole tablets are indicated for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer. 1.2 Extended Adjuvant Treatment of Early Breast Cancer Letrozole tablets are indicated for the extended adjuvant treatment of early breast cancer in postmenopausal women, who have received 5 years of adjuvant tamoxifen therapy. The effectiveness of letrozole tablets in extended adjuvant treatment of early breast cancer is based on an analysis of disease-free survival in patients treated with letrozole tablets for a median of 60 months [see Clinical Studies (14.2, 14.3) Launch Date1997 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
128 nM |
2.5 mg single, oral dose: 2.5 mg route of administration: Oral experiment type: SINGLE co-administered: |
LETROZOLE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: UNKNOWN |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
4.26 μM × h |
2.5 mg single, oral dose: 2.5 mg route of administration: Oral experiment type: SINGLE co-administered: |
LETROZOLE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: UNKNOWN |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
41.9 h |
2.5 mg single, oral dose: 2.5 mg route of administration: Oral experiment type: SINGLE co-administered: |
LETROZOLE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
30 mg 1 times / day single, oral Highest studied dose Dose: 30 mg, 1 times / day Route: oral Route: single Dose: 30 mg, 1 times / day Sources: |
healthy, Mean age 28.4 years n = 3 Health Status: healthy Age Group: Mean age 28.4 years Sex: M Population Size: 3 Sources: |
|
2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
unhealthy, Mean age 63.6 years n = 174 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 63.6 years Sex: F Population Size: 174 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
Other AEs: Bilirubin abnormal, Aspartate aminotransferase abnormal... Other AEs: Bilirubin abnormal (grade 3, 5%) Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10Aspartate aminotransferase abnormal (grade 3, 3%) ALT increased (grade 3, 3%) Gamma-glutamyltransferase increased (grade 3, 6%) |
2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
unhealthy, Mean age 66 years n = 185 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 66 years Sex: F Population Size: 185 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
Disc. AE: Hypercalcemia, Cerebrovascular accident... Other AEs: Bilirubin abnormal, Aspartate aminotransferase abnormal... AEs leading to discontinuation/dose reduction: Hypercalcemia Other AEs:Cerebrovascular accident Bilirubin abnormal (grade 3, 3%) Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40Aspartate aminotransferase abnormal (grade 3, 4%) ALT increased (grade 3, 1%) Gamma-glutamyltransferase increased (grade 3, 9%) |
10 mg 1 times / day multiple, oral Highest studied dose Dose: 10 mg, 1 times / day Route: oral Route: multiple Dose: 10 mg, 1 times / day Sources: |
unhealthy, Mean age 71.6 years n = 12 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 71.6 years Sex: F Population Size: 12 Sources: |
|
62.5 mg 1 times / day single, oral Studied dose Dose: 62.5 mg, 1 times / day Route: oral Route: single Dose: 62.5 mg, 1 times / day Sources: |
unknown n = 1 Health Status: unknown Population Size: 1 Sources: |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
ALT increased | grade 3, 3% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
unhealthy, Mean age 63.6 years n = 174 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 63.6 years Sex: F Population Size: 174 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
Aspartate aminotransferase abnormal | grade 3, 3% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
unhealthy, Mean age 63.6 years n = 174 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 63.6 years Sex: F Population Size: 174 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
Bilirubin abnormal | grade 3, 5% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
unhealthy, Mean age 63.6 years n = 174 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 63.6 years Sex: F Population Size: 174 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
Gamma-glutamyltransferase increased | grade 3, 6% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
unhealthy, Mean age 63.6 years n = 174 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 63.6 years Sex: F Population Size: 174 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P4.PDF - p.10 |
Cerebrovascular accident | Disc. AE | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
unhealthy, Mean age 66 years n = 185 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 66 years Sex: F Population Size: 185 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
Hypercalcemia | Disc. AE | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
unhealthy, Mean age 66 years n = 185 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 66 years Sex: F Population Size: 185 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
ALT increased | grade 3, 1% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
unhealthy, Mean age 66 years n = 185 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 66 years Sex: F Population Size: 185 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
Bilirubin abnormal | grade 3, 3% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
unhealthy, Mean age 66 years n = 185 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 66 years Sex: F Population Size: 185 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
Aspartate aminotransferase abnormal | grade 3, 4% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
unhealthy, Mean age 66 years n = 185 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 66 years Sex: F Population Size: 185 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
Gamma-glutamyltransferase increased | grade 3, 9% | 2.5 mg 1 times / day multiple, oral Recommended Dose: 2.5 mg, 1 times / day Route: oral Route: multiple Dose: 2.5 mg, 1 times / day Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
unhealthy, Mean age 66 years n = 185 Health Status: unhealthy Condition: breast cancer Age Group: Mean age 66 years Sex: F Population Size: 185 Sources: Page: 20726_FEMARA%202.5MG_MEDR_P5.PDF - p.40 |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
yes [Ki 0.12 uM] | ||||
yes [Ki 8.5 uM] | ||||
Sources: https://pubmed.ncbi.nlm.nih.gov/19198839/ Page: - |
yes | |||
Sources: https://pubmed.ncbi.nlm.nih.gov/19198839/ Page: - |
yes |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Page: - |
no | |||
Page: - |
no | |||
Page: - |
no | |||
Page: - |
no | |||
Page: - |
no | |||
Page: - |
no | |||
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no | |||
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no | |||
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no | |||
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no | |||
yes | yes (co-administration study) Comment: The effect of a 400 mg b.i.d treatment with cimetidine for 7 days on the letrozole pharmacokinetics after a single 2.5-mg dose was investigated in 16 healthy subjects [Protocol 004], A slight but statistically significant decrease in systemic exposure and an increase in Cmax were observed when letrozole was administered together with cimetidine (table below). Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/97/20726_FEMARA%202.5MG_BIOPHARMR.PDF#page=4 Page: 4.0 |
|||
yes | yes (co-administration study) Comment: The effect of a 400 mg b.i.d treatment with cimetidine for 7 days on the letrozole pharmacokinetics after a single 2.5-mg dose was investigated in 16 healthy subjects [Protocol 004], A slight but statistically significant decrease in systemic exposure and an increase in Cmax were observed when letrozole was administered together with cimetidine (table below). Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/97/20726_FEMARA%202.5MG_BIOPHARMR.PDF#page=4 Page: 4.0 |
PubMed
Title | Date | PubMed |
---|---|---|
Aromatase inhibitors. | 2001 |
|
Treatment of delayed male puberty: efficacy of aromatase inhibition. | 2001 |
|
Aromatase and aromatase inhibitors. | 2001 |
|
Third-generation aromatase inhibitors in the treatment of advanced breast cancer. | 2001 |
|
[Neoadjuvant use of the aromatase inhibitor letrozole in uterine cancer: endocrine and clinical effects]. | 2001 |
|
Promising results for Arimidex and Femara. | 2001 Dec |
|
Are differences in the available aromatase inhibitors and inactivators significant? | 2001 Dec |
|
The role of tamoxifen and aromatase inhibitors/inactivators in postmenopausal patients. | 2001 Dec |
|
17alpha-methyl testosterone is a competitive inhibitor of aromatase activity in Jar choriocarcinoma cells and macrophage-like THP-1 cells in culture. | 2001 Dec |
|
Where do selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) now fit into breast cancer treatment algorithms? | 2001 Dec |
|
Adjuvant trials of aromatase inhibitors: determining the future landscape of adjuvant endocrine therapy. | 2001 Dec |
|
A summary of second-line randomized studies of aromatase inhibitors. | 2001 Dec |
|
Biological and clinical effects of aromatase inhibitors in neoadjuvant therapy. | 2001 Dec |
|
Local endocrine effects of aromatase inhibitors within the breast. | 2001 Dec |
|
Comparative clinical pharmacology and pharmacokinetic interactions of aromatase inhibitors. | 2001 Dec |
|
Aromatase and COX-2 expression in human breast cancers. | 2001 Dec |
|
Aromatase overexpression transgenic mice model: cell type specific expression and use of letrozole to abrogate mammary hyperplasia without affecting normal physiology. | 2001 Dec |
|
High dehydroepiandrosterone-sulfate predicts breast cancer progression during new aromatase inhibitor therapy and stimulates breast cancer cell growth in tissue culture: a renewed role for adrenalectomy. | 2001 Dec |
|
False shortening of time to progression in letrozole 2.5-mg dose? | 2001 Dec 1 |
|
Letrozole in second-line therapy of advanced breast cancer: more questions than answers. | 2001 Dec 1 |
|
New breast cancer drug. | 2001 Dec 24 |
|
Effect of age and single versus multiple dose pharmacokinetics of letrozole (Femara) in breast cancer patients. | 2001 Jul |
|
Huge response to letrozole in inoperable T4 breast cancer: a case report. | 2001 Jul-Aug |
|
Formestane, a steroidal aromatase inhibitor after failure of non-steroidal aromatase inhibitors (anastrozole and letrozole): is a clinical benefit still achievable? | 2001 Nov |
|
Preoperative treatment of postmenopausal breast cancer patients with letrozole: A randomized double-blind multicenter study. | 2001 Nov |
|
Pre-operative endocrine therapy for postmenopausal women: when and why? | 2001 Nov |
|
Defining the galaxy of gene expression in breast cancer. | 2002 |
|
Recent advances in breast cancer (the Twenty-fourth San Antonio Breast Cancer Symposium, December, 2001). | 2002 |
|
Tamoxifen resistant and refractory breast cancer: the value of aromatase inhibitors. | 2002 |
|
Antiaromatase agents: evolving role in adjuvant therapy. | 2002 Apr |
|
Short-term effects of anastrozole treatment on insulin-like growth factor system in postmenopausal advanced breast cancer patients. | 2002 Apr |
|
[CGS 20267 (Letrozole), a new aromatase inhibitor: early phase II study for postmenopausal women with advanced breast cancer]. | 2002 Apr |
|
Current status and future innovations of hormonal agents, chemotherapy and investigational agents in endometrial cancer. | 2002 Feb |
|
Superior efficacy of letrozole versus tamoxifen as first-line therapy. | 2002 Feb 1 |
|
Influence of letrozole and anastrozole on total body aromatization and plasma estrogen levels in postmenopausal breast cancer patients evaluated in a randomized, cross-over study. | 2002 Feb 1 |
|
Role of low levels of endogenous estrogen in regulation of bone resorption in late postmenopausal women. | 2002 Jan |
|
[Growth rate can be manipulated. Estrogen production in pubertal boys can be blocked by an aromatase inhibitor]. | 2002 Jan 17 |
|
[Aromatase inhibitors of the 3rd generation. What can the "pill against breast cancer" really do?]. | 2002 Jan 31 |
|
Reproductive changes in male rats treated perinatally with an aromatase inhibitor. | 2002 Jan-Feb |
|
Genetic or enzymatic disruption of aromatase inhibits the growth of ectopic uterine tissue. | 2002 Jul |
|
Human ejaculated spermatozoa contain active P450 aromatase. | 2002 Jul |
|
Effects of the aromatase inhibitor letrozole on normal breast epithelial cell proliferation and metabolic indices in postmenopausal women: a pilot study for breast cancer prevention. | 2002 Jul |
|
Exemestane: a potent irreversible aromatase inactivator and a promising advance in breast cancer treatment. | 2002 Jun |
|
Letrozole for the management of breast cancer. | 2002 Jun |
|
Approval summary: letrozole in the treatment of postmenopausal women with advanced breast cancer. | 2002 Mar |
|
The role of sex steroids in the regulation of insulin sensitivity and serum lipid concentrations during male puberty: a prospective study with a P450-aromatase inhibitor. | 2002 Mar |
|
Aromatase inhibitors in breast cancer. | 2002 Mar |
|
Detection of aromatase inhibitors in vitro using rat ovary microsomes. | 2002 Mar 24 |
|
Endocrine and clinical endpoints of exemestane as neoadjuvant therapy. | 2002 Mar-Apr |
|
Letrozole in the treatment of breast cancer. | 2002 May |
Patents
Sample Use Guides
The recommended dose of Femara (letrozole) is one 2.5 mg tablet administered once a day, without regard to meals.
Route of Administration:
Oral
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/12569569
After treatment of cells with letrozole (10 nM) for 24 and 48 h, significant inhibition of matrix metalloproteinases (MMP) levels was obtained. Furthermore, concurrent treatment of MCF-7, human epithelial breast cancer cells with 17-beta-estradiol in the presence of letrozole significantly suppressed the estradiol-induced stimulation of MMP levels. Letrozole is a potent in vitro inhibitor of cell proliferation and of type IV collagenases expressed by estrogen receptor (ER)-positive MCF-7 cells and may be of value for suppressing breast tumor growth and invasiveness.
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LIVERTOX |
NBK548381
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QL02BG04
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NCI_THESAURUS |
C2018
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m6772
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C1527
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Letrozole
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ACTIVE MOIETY
METABOLITE (PARENT)