Fluoroestradiol F-18
Identification
- Name
- Fluoroestradiol F-18
- Accession Number
- DB15690
- Description
Fluoroestradiol F-18 is an imaging agent used with positron emission tomography (PET) to detect estrogen receptor-positive breast cancer lesions.4 The ability to image ER-positive tumors in vivo is advantageous in that, while helping to visualize tumor progression/regression, it may also be used to assess for heterogeneity in ER expression across metastases (i.e. to identify sites that no longer express ER) without the need for multiple biopsies.2
Fluoroestradiol F-18 was first granted FDA approval in May 2020, and will be developed by PETNET Solutions, Inc. and Zionexa USA under the brand name Cerianna.5 It is expected to be available in late 2020/early 2021.5
- Type
- Small Molecule
- Groups
- Approved
- Structure
- Weight
- Average: 289.381
Monoisotopic: 289.170742648 - Chemical Formula
- C18H23FO2
- Synonyms
- (18F)FES
- 16-alpha-(18-Fluoro)-17betaestradiol
- 16-alpha-(18F)Fluoro-17beta-estradiol
- 16alpha-(18F)Fluoro-17beta-estradiol
- F-18 16 alpha-Fluoroestradiol
- F-18 Fes
- Fes F-18
Pharmacology
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- Indication
Fluoroestradiol F-18 is a radioactive diagnostic agent indicated for use with positron emission tomography (PET) imaging for the detection of estrogen receptor-positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer.4
- Associated Conditions
- Contraindications & Blackbox Warnings
- Contraindications & Blackbox WarningsWith our commercial data, access important information on dangerous risks, contraindications, and adverse effects.Our Blackbox Warnings cover Risks, Contraindications, and Adverse Effects
- Pharmacodynamics
Fluoroestradiol F-18 is an analog of estradiol that emits small amounts of radioactivity, allowing it to be detected using PET. Following intravenous administration, it accumulates in cancerous tissues expressing estrogen receptors, thus allowing for visualization of these lesions.4 Fluoroestradiol has a relatively short duration of action - at 2 hours post-injection circulating levels are <5% those at peak concentration.
The uptake of fluoroestradiol F-18 is not specific to breast cancer cells and make occur in any tumor cell expressing estrogen receptors, including those arising from the uterus or ovaries.4
- Mechanism of action
Estrogen receptor (ER)-positive breast cancers are a subset of breast cancers in which the cancerous tissue expresses estrogen receptors - these receptors provide a useful target for imaging and treatment agents. Fluoroestradiol F-18 is a fluorinated analog of estradiol that binds to estrogen receptors, allowing for PET imaging of lesions.4
Following exposure in an ER-positive breast cancer cell line (MCF-7), it was found that fluoroestradiol F-18 bound with a Kd of 0.13 ± 0.02 nM, a Bmax of 1901 ± 89 fmol/mg, and a IC50 = 0.085 nM.4
Target Actions Organism UEstrogen receptor alpha binderHumans UEstrogen receptor beta binderHumans - Absorption
- Not Available
- Volume of distribution
As fluoroestradiol and its metabolites undergo enterohepatic circulation,2 it is found primarily distributed within the hepatobiliary system.4 It also distributes to the intestines, heart wall, blood, kidney, uterus, and bladder.4
- Protein binding
Following intravenous administration, approximately 95% of fluoroestradiol F-18 is protein-bound4 to both albumin and sex hormone-binding globulin.2
- Metabolism
Fluoroestradiol F-18 is highly extracted and metabolized by the liver - at 2 hours post-administration, only 10% of the total activity is attributable to unmetabolized parent drug.2 The majority of generated metabolites are products of glucuronide or sulfate conjugation.3
- Route of elimination
Elimination is primarily via urinary and biliary excretion.4 Unbound metabolites comprising mainly glucuronide and sulfate conjugates are secreted in the bile, reabsorbed via enterohepatic circulation, and then renally excreted.2
- Half-life
- Not Available
- Clearance
Fluoroestradiol F-18 is rapidly cleared from the blood by the liver.2
- Adverse Effects
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- Toxicity
- Not Available
- Affected organisms
- Humans and other mammals
- Pathways
- Not Available
- Pharmacogenomic Effects/ADRs
- Not Available
Interactions
- Drug Interactions
- This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction Integrate drug-drug
interactions in your softwareBazedoxifene Bazedoxifene may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Clomifene Clomifene may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Fulvestrant Fulvestrant may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Lasofoxifene Lasofoxifene may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Ospemifene Ospemifene may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Raloxifene Raloxifene may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Tamoxifen Tamoxifen may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Toremifene Toremifene may decrease effectiveness of Fluoroestradiol F-18 as a diagnostic agent. Improve patient outcomesBuild effective decision support tools with the industry’s most comprehensive drug-drug interaction checker.Learn more - Food Interactions
- No interactions found.
Products
- Comprehensive & structured drug product infoFrom application numbers to product codes, connect different identifiers through our commercial datasets.Easily connect various identifiers back to our datasets
- Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Cerianna Injection 100 mCi/1mL Intravenous Zionexa US Corporation 2020-05-20 Not applicable US
Categories
- Drug Categories
- Classification
- Not classified
Chemical Identifiers
- UNII
- T32277KB09
- CAS number
- 94153-53-4
- InChI Key
- KDLLNMRYZGUVMA-ZYMZXAKXSA-N
- InChI
- InChI=1S/C18H23FO2/c1-18-7-6-13-12-5-3-11(20)8-10(12)2-4-14(13)15(18)9-16(19)17(18)21/h3,5,8,13-17,20-21H,2,4,6-7,9H2,1H3/t13-,14-,15+,16-,17+,18+/m1/s1/i19-1
- IUPAC Name
- (1R,2R,3aS,3bR,9bS,11aS)-2-(¹⁸F)fluoro-11a-methyl-1H,2H,3H,3aH,3bH,4H,5H,9bH,10H,11H,11aH-cyclopenta[a]phenanthrene-1,7-diol
- SMILES
- [H][C@@]12C[C@@H]([18F])[C@H](O)[C@@]1(C)CC[C@]1([H])C3=C(CC[C@@]21[H])C=C(O)C=C3
References
- Synthesis Reference
Kiesewetter DO, Kilbourn MR, Landvatter SW, Heiman DF, Katzenellenbogen JA, Welch MJ: Preparation of four fluorine- 18-labeled estrogens and their selective uptakes in target tissues of immature rats. J Nucl Med. 1984 Nov;25(11):1212-21.
- General References
- Liu Y, Ma H, Yao J: ERalpha, A Key Target for Cancer Therapy: A Review. Onco Targets Ther. 2020 Mar 11;13:2183-2191. doi: 10.2147/OTT.S236532. eCollection 2020. [PubMed:32210584]
- Liao GJ, Clark AS, Schubert EK, Mankoff DA: 18F-Fluoroestradiol PET: Current Status and Potential Future Clinical Applications. J Nucl Med. 2016 Aug;57(8):1269-75. doi: 10.2967/jnumed.116.175596. Epub 2016 Jun 15. [PubMed:27307345]
- Mankoff DA, Tewson TJ, Eary JF: Analysis of blood clearance and labeled metabolites for the estrogen receptor tracer [F-18]-16 alpha-fluoroestradiol (FES). Nucl Med Biol. 1997 May;24(4):341-8. doi: 10.1016/s0969-8051(97)00002-4. [PubMed:9257333]
- FDA Approved Drug Products: Cerianna (fluoroestradiol F 18) for intravenous injection [Link]
- Applied Radiology News Release: PETNET, Zionexa Announce FDA Approval of Cerianna (Fluoroestradiol F 18) [Link]
- External Links
- ChemSpider
- 9045262
- 2372221
- ZINC
- ZINC000100657549
- Wikipedia
- Fluoroestradiol_F-18
- FDA label
- Download (169 KB)
Clinical Trials
- Clinical Trials
Phase Status Purpose Conditions Count 2 Not Yet Recruiting Diagnostic Estrogen Receptor Positive / Primary or Recurrent Breast Carcinoma / Stage IV Breast Cancer AJCC v6 and v7 1 2 Recruiting Diagnostic Breast Cancer / Ductal Carcinoma in Situ - Category 1 2 Recruiting Diagnostic HER2/Neu Negative / Progesterone Receptor Negative / Progesterone Receptor Positive / Stage IV Breast Cancer AJCC v6 and v7 1 1, 2 Enrolling by Invitation Diagnostic Endometriosis 1 0 Terminated Diagnostic Deep Fibromatosis/Desmoid Tumor / Familial Adenomatous Polyposis (FAP) 1 Not Available Active Not Recruiting Diagnostic Estrogen Receptor Positive / Recurrent Breast Carcinoma / Stage IV Breast Cancer AJCC v6 and v7 1
Pharmacoeconomics
- Manufacturers
- Not Available
- Packagers
- Not Available
- Dosage Forms
Form Route Strength Injection Intravenous 100 mCi/1mL - Prices
- Not Available
- Patents
- Not Available
Properties
- State
- Solid
- Experimental Properties
- Not Available
- Predicted Properties
Property Value Source Water Solubility 0.0345 mg/mL ALOGPS logP 3.33 ALOGPS logP 3.56 ChemAxon logS -3.9 ALOGPS pKa (Strongest Acidic) 10.33 ChemAxon pKa (Strongest Basic) -3.5 ChemAxon Physiological Charge 0 ChemAxon Hydrogen Acceptor Count 2 ChemAxon Hydrogen Donor Count 2 ChemAxon Polar Surface Area 40.46 Å2 ChemAxon Rotatable Bond Count 0 ChemAxon Refractivity 79.57 m3·mol-1 ChemAxon Polarizability 32.11 Å3 ChemAxon Number of Rings 4 ChemAxon Bioavailability 1 ChemAxon Rule of Five Yes ChemAxon Ghose Filter Yes ChemAxon Veber's Rule No ChemAxon MDDR-like Rule No ChemAxon - Predicted ADMET Features
- Not Available
Spectra
- Mass Spec (NIST)
- Not Available
- Spectra
- Not Available
Targets

- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Binder
- General Function
- Zinc ion binding
- Specific Function
- Nuclear hormone receptor. The steroid hormones and their receptors are involved in the regulation of eukaryotic gene expression and affect cellular proliferation and differentiation in target tissu...
- Gene Name
- ESR1
- Uniprot ID
- P03372
- Uniprot Name
- Estrogen receptor
- Molecular Weight
- 66215.45 Da
References
- FDA Approved Drug Products: Cerianna (fluoroestradiol F 18) for intravenous injection [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Binder
- General Function
- Zinc ion binding
- Specific Function
- Nuclear hormone receptor. Binds estrogens with an affinity similar to that of ESR1, and activates expression of reporter genes containing estrogen response elements (ERE) in an estrogen-dependent m...
- Gene Name
- ESR2
- Uniprot ID
- Q92731
- Uniprot Name
- Estrogen receptor beta
- Molecular Weight
- 59215.765 Da
References
- FDA Approved Drug Products: Cerianna (fluoroestradiol F 18) for intravenous injection [Link]
Carriers
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Binder
- General Function
- Androgen binding
- Specific Function
- Functions as an androgen transport protein, but may also be involved in receptor mediated processes. Each dimer binds one molecule of steroid. Specific for 5-alpha-dihydrotestosterone, testosterone...
- Gene Name
- SHBG
- Uniprot ID
- P04278
- Uniprot Name
- Sex hormone-binding globulin
- Molecular Weight
- 43778.755 Da
References
- Liao GJ, Clark AS, Schubert EK, Mankoff DA: 18F-Fluoroestradiol PET: Current Status and Potential Future Clinical Applications. J Nucl Med. 2016 Aug;57(8):1269-75. doi: 10.2967/jnumed.116.175596. Epub 2016 Jun 15. [PubMed:27307345]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Binder
- General Function
- Toxic substance binding
- Specific Function
- Serum albumin, the main protein of plasma, has a good binding capacity for water, Ca(2+), Na(+), K(+), fatty acids, hormones, bilirubin and drugs. Its main function is the regulation of the colloid...
- Gene Name
- ALB
- Uniprot ID
- P02768
- Uniprot Name
- Serum albumin
- Molecular Weight
- 69365.94 Da
References
- Liao GJ, Clark AS, Schubert EK, Mankoff DA: 18F-Fluoroestradiol PET: Current Status and Potential Future Clinical Applications. J Nucl Med. 2016 Aug;57(8):1269-75. doi: 10.2967/jnumed.116.175596. Epub 2016 Jun 15. [PubMed:27307345]
Drug created on May 29, 2020 13:45 / Updated on October 06, 2020 17:43