More than 75% of breast cancers are estrogen receptor
alpha (ERα)
positive (ER+), and resistance to current hormone therapies occurs
in one-third of ER+ patients. Tumor resistance is still ERα-dependent,
but mutations usually confer constitutive activation to the hormone
receptor, rendering ERα modulator drugs such as tamoxifen and
aromatase inhibitors ineffective. Fulvestrant is a potent selective
estrogen receptor degrader (SERD), which degrades the ERα receptor
in drug-resistant tumors and has been approved for the treatment of
hormone-receptor-positive metastatic breast cancer following antiestrogen
therapy. However, fulvestrant shows poor pharmacokinetic properties
in human, low solubility, weak permeation, and high metabolism, limiting
its administration to inconvenient intramuscular injections. This
Drug Annotation describes the identification and optimization of a
new series of potent orally available SERDs, which led to the discovery
of 6-(2,4-dichlorophenyl)-5-[4-[(3S)-1-(3-fluoropropyl)pyrrolidin-3-yl]oxyphenyl]-8,9-dihydro-7H-benzo[7]annulene-2-carboxylic acid (43d),
showing promising antitumor activity in breast cancer mice xenograft
models and whose properties warranted clinical evaluation.