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ORSERDU Elacestrant 345 mg Tablet, Film Coated, 30-count — NDC 72187-0102-03 package photo
Label image from the product's FDA listing (DailyMed) — may show a different pack size or an older label revision.

ORSERDU Elacestrant 345 mg Tablet, Film Coated, 30-count — NDC 72187-0102-3 (Billing 72187-0102-03)

by Stemline Therapeutics, Inc. · 30 TABLET, FILM COATED in 1 BOTTLE

This is a package of 30 tablets of ORSERDU Elacestrant 345 mg Tablet, Film Coated from Stemline Therapeutics, Inc., marketed since Jan 2023 and currently FDA-listed. It is this product's only package size.

NDC 72187-0102-03
🏷️ FDA NDC (as labeled) 72187-0102-3 billing pads the package segment with a zero
Rx only Brand On market Non-controlled ⇄ Compare with another NDC
🗂️ FDA directory synced Oct 1, 2026 · this listing last changed Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

Identity & classification

Regulatory identifiers FDA, NLM and CMS codes for this package

FDA NDC (as labeled) 72187-0102-3
Product NDC 72187-0102
11-digit billing NDC 72187010203
NCPDP billing unit EA — each (per item)
RxCUI 2628478, 2628484, 2628487, 2628489
UNII FM6A2627A8
UPC 0372187010135, 0372187010234
Application # NDA217639
SPL Set ID aa66ae5c-2bd2-4444-8178-b55651e054ef
Established class (EPC) Estrogen Receptor Antagonist
Mechanism of action Estrogen Receptor Antagonists; P-Glycoprotein Inhibitors; Breast Cancer Resistance Protein Inhibitors
DEA schedule Non-controlled
Marketing category NDA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2023-01-27
Route ORAL
Dosage form TABLET, FILM COATED
Substance ELACESTRANT

Drug-database identifiers Medi-Span GPI and First Databank GCN / HICL / AHFS classification

GPI-14 21403720100340
GCN Seq No 084359
GCN 53629
HICL code 048658
Ingredient (HICL) Elacestrant Hcl
HIC1 code V
Therapeutic class — broad (HIC1) Neoplasms
HIC2 code V1
Therapeutic class — intermediate (HIC2) Antineoplastic Drugs
HIC3 code V1T
Therapeutic class — specific (HIC3) Selective Estrogen Receptor Modulators (Serms)
AHFS code 10:00.00.00
AHFS class Antineoplastic Agents
FDB label name ORSERDU 345 MG TABLET
FDB brand name Orserdu
Legend status F — Federal legend — prescription drug or device
Quick answers
  • GSN (GCN sequence number): 084359
  • GCN: 53629
  • GPI-14 (Medi-Span): 21403720100340
  • HICL (First Databank): 048658
  • AHFS class code: 10:00.00.00
  • RxCUI (RxNorm): 2628478
Why two NDCs? The FDA registers this code as 72187-0102-3 — a 5-4-1 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the package segment → 72187-0102-03. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

RxNorm drug class

This medicine belongs to the Estrogen Receptor Antagonist class.

Pharmacologic class Estrogen Receptor Antagonist
Drug family (ATC) Anti-estrogens
How it works Estrogen Receptor Antagonists, P-Glycoprotein Inhibitors, Breast Cancer Resistance Protein Inhibitors
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

Clinical

Label name ORSERDU 345 MG TABLET Ingredient Elacestrant Hcl
📖 What it is MedlinePlus · NLM

Elacestrant is used to treat certain types of hormone receptor-positive breast cancer (breast cancer that depends on hormones such as estrogen to grow) in adults who have had disease progression following treatment with at least one other hormone therapies. Elacestrant is in a class of medications called estrogen receptor antagonists. It works by stopping growth of cancer cells, dependent on estrogen, by blocking the ability of estrogen to bind.

Read the full MedlinePlus article ↗
📗 Our plain-language guide HelloPharmacist
  • Orserdu is an oral targeted therapy for a specific type of advanced breast cancer — one that tests positive for estrogen receptors (ER-positive), negative for HER2, and has a mutat...
  • What exactly is Orserdu, and why did my doctor choose it for me?
  • Yes — always take Orserdu with food. Food helps reduce nausea and vomiting, and it also helps your body absorb the medication better. Try to take it at the same time every day. If...
  • Do I have to take it with food? What if I forget?
📖 Read our full Elacestrant guide →
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer eachPer package
Retail pharmacies payNADAC · weekly Not in the retail survey — common for institutional, discontinued, or low-volume packs.
Medicaid paysCMS SDUD · 12 mo $829.28 $24,878.54 / 30 tablets
Medicare drug plans payPart D · Q2 2026 $885.96 $26,578.77 / 30 tablets
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

Packaging — all sizes for this product

Package NDCDescription Marketing startMarketing endStatus
72187-0102-03 You're viewing this Main listing 30 TABLET, FILM COATED in 1 BOTTLE 2023-01-27 — Active

Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Orserdu 345 mgthis 72187-0102-03 Stemline 30 tablets — — FDA listed —
About this product: this is the brand-name version. We did not find an FDA-approved generic match for this exact strength, form and route.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & generic status

🏛️
2023
First FDA approval
Jan 2023
📍
2026
Currently FDA-listed
3 years listed
🛡️
2038
Latest patent/protection listed
not a guaranteed launch date
🔒No FDA-approved generic found

We did not find an FDA-approved generic match for this exact strength, form and route. Patent/protection dates below may affect future generic timing.

🛡️ Latest patent/protection date listed: FDA patent/protection data lists protections through Jan 2038. This may affect when a full generic version becomes widely available, but it is not a guaranteed launch date.
📅 FDA approved Jan 27, 2023 RLD RS ⏳ ~11.3 yr to latest listed protection

Why the date isn’t exact: Generic timing can change because patents may be challenged, settled, licensed, added, removed, or worked around with a narrower label — and FDA approval does not always mean a pharmacy can get the generic today.

Patents & exclusivity — FDA Orange Book
US 11819480 — method of use (U-3523)
US 11819480 — method of use (U-3523)
US 10420734 — method of use (U-3524)
US 10420734 — method of use (U-3524)
US 7612114 — drug substance (U-3523)
US 7612114 — drug substance (U-3523)
US 10745343 — method of use (U-3523)
US 10745343 — method of use (U-3523)
US 10071066 — method of use (U-3524)
US 10071066 — method of use (U-3524)
US 11779552 — method of use (U-3524)
US 11779552 — method of use (U-3524)
US 10385008 — drug substance
US 10385008 — drug substance
Exclusivity NCE
Exclusivity NCE
2023 2025 2027 2029 2031 2033 2035 2037
Today
LOE
Substance patent Formulation patent Method-of-use patent Exclusivity Pediatric +6mo
🏛️FDA exclusivity
FDA-granted marketing protection. It’s separate from patents and may be shorter than patent protection.
🧪Product / substance patents
Patents covering the active ingredient, product, formulation, or related drug features.
🎯Method-of-use patents
Patents covering specific approved uses. These can sometimes be carved out with a “skinny label,” but not always.
🛈 What do these terms mean?
Patent
Legal protection listed in the Orange Book that may delay generic approval or launch. Issued by the U.S. Patent & Trademark Office.
Substance patent
Covers the active drug molecule itself — the hardest to design around. A generic generally can’t launch until it expires.
Formulation (product) patent
Covers a specific formulation or dosage form. A generic can sometimes work around it with a different formulation.
Method-of-use patent
A patent covering one specific approved use of the drug — not necessarily the whole molecule. A generic can sometimes launch with a “skinny label” that carves out the protected use and keeps the others.
Skinny label
A generic label that omits a still-patented use when the FDA allows it — letting a generic reach the market for the unprotected uses.
Exclusivity
FDA-granted marketing protection, separate from patents — e.g. 5-yr new chemical entity, 7-yr orphan drug, or a +6-month pediatric extension.
Paragraph IV
A generic applicant’s formal challenge to a listed patent. It can potentially lead to earlier generic entry, but often involves litigation or a settlement.
RLD / RS
Reference Listed Drug — the brand product the FDA uses as the reference for generic applications. Reference Standard — the product the FDA expects generics to compare against in bioequivalence testing.
TE / AB rating
FDA therapeutic-equivalence rating. An AB rating generally means the FDA considers a generic therapeutically equivalent to — and substitutable for — the brand.
LOE (loss of exclusivity)
The latest patent or exclusivity currently listed — the loss-of-exclusivity / latest-listed-protection date shown on this page. Paragraph-IV challenges and settlements can move the real date earlier; FDA approval and a manufacturer’s decision to market can move it later.

Built from the FDA Orange Book. The bars above are scaled to each protection’s expiry; the red LOE marker is the last one to lapse.

Listed patents (14)
PatentTypeUse codeExpires
US 11819480 ↗ Method of use U-3523 Feb 28, 2037
US 11819480 ↗ Method of use U-3523 Feb 28, 2037
US 10420734 ↗ Method of use U-3524 Oct 3, 2036
US 10420734 ↗ Method of use U-3524 Oct 3, 2036
US 7612114 ↗ Drug substance U-3523 Aug 18, 2026
US 7612114 ↗ Drug substance U-3523 Aug 18, 2026
US 10745343 ↗ Method of use U-3523 Jan 5, 2038
US 10745343 ↗ Method of use U-3523 Jan 5, 2038
US 10071066 ↗ Method of use U-3524 Oct 10, 2034
US 10071066 ↗ Method of use U-3524 Oct 10, 2034
US 11779552 ↗ Method of use U-3524 Oct 10, 2034
US 11779552 ↗ Method of use U-3524 Oct 10, 2034
US 10385008 ↗ Drug substance — Jan 5, 2038
US 10385008 ↗ Drug substance — Jan 5, 2038
FDA exclusivity
CodeWhat it grantsExpires
NCENew Chemical Entity (5-year)Jan 27, 2028
NCENew Chemical Entity (5-year)Jan 27, 2028
Common questions
Is there a generic version of ORSERDU 345 MG TABLET?
No FDA-approved generic equivalent is currently listed in the FDA Orange Book for ORSERDU 345 MG TABLET. Based on the patents and exclusivity currently listed, the Orange Book estimate is that full-label generic entry may be delayed until Jan 2038 — an estimate, not a guaranteed launch date.
The FDA approved a generic — why can’t I get it at my pharmacy yet?
FDA approval and pharmacy availability are two different things. The FDA can approve a generic years before it actually reaches pharmacies, because the brand company may still hold patents or have a settlement that delays the launch. A manufacturer also has to choose to make and sell it, and have supply ready. So a drug can be “FDA-approved generic exists” and still be brand-only at the counter today.
Why do different websites show different generic release dates?
Generic availability is not based on one single date. Some sources use the first exclusivity expiration, some use the last product patent, and others use the latest method-of-use patent. Patent challenges, settlements, licenses, and label carve-outs can also change the real-world launch date. This page shows the underlying Orange Book dates so you can see why estimates may differ.
What does “FDA listed” mean?
It means the product appears in the FDA’s official NDC directory. That’s a good sign a product exists and is intended for the U.S. market, but on its own it does not confirm a pharmacy can fill it today. Where we have recent retail pricing data (NADAC) for a product, we label it “Availability likely” instead.
What does a patent or protection date mean here?
It’s the latest date currently listed in the FDA Orange Book for a patent or exclusivity on the brand product. It can affect when a full generic version becomes widely available — but it is not a guaranteed generic launch date. Generics sometimes arrive earlier (through a settlement or patent challenge) or later (a manufacturer still has to make and sell one).
What does “current Orange Book estimate” mean?
It means we are using the latest patent and exclusivity dates currently listed in the FDA Orange Book. It is not a guaranteed launch date.
Can a generic come out before the last patent expires?
Sometimes. A generic company may challenge a patent, settle with the brand manufacturer, receive a license, or obtain approval with a narrower label that avoids a patented use. In other cases, the last listed protection may delay full-label generic competition.
Can a generic come out after the listed dates?
Yes. Even after patents or exclusivity expire, a generic still needs FDA approval and a manufacturer must choose to market it. Supply, litigation, business decisions, or regulatory issues can delay actual availability.
What is the difference between patents and exclusivity?
Patents are legal protections usually issued by the U.S. Patent and Trademark Office. FDA exclusivity is marketing protection granted by the FDA. They are separate, and either one can affect generic timing.
Why are there multiple patent dates?
One drug can have several patents covering different things: the active ingredient, a formulation, a manufacturing process, or a specific approved use. That is why a page may show several expiration dates instead of one simple generic date.
Built from FDA Orange Book patent and exclusivity data. Dates are refreshed from public FDA data when available; the marker is max(latest patent expiry, latest exclusivity expiry). Paragraph-IV settlements and first-filer 180-day exclusivity can shift the real date; a method-of-use patent may allow an earlier skinny-label generic for non-protected indications. Generic launch timing is an estimate, not a guarantee.
Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

What it looks like

Color Blue
ShapeOval
ImprintMH
Size19 mm
ScoringNot scored
One label can cover several strengths, so colors may be combined — always confirm a loose pill against the dispensed prescription label or a pharmacist.
Where does this data come from?
Physical description (imprint, shape, color, scoring, coating) from this product’s FDA Structured Product Labeling (SPL), mirrored from DailyMed / openFDA.

Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

A current SPL was checked, but it does not contain a structured or narrative inactive-ingredient list for this product. This does not mean the product has no inactive ingredients.
Where does this data come from?
Source: official FDA Structured Product Labeling (SPL) via DailyMed and the openFDA label index. Structured IACT rows and label-wide narrative are kept separate; availability and product-level specificity depend on the submitted label.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

Manufacturer & labeler

LabelerStemline Therapeutics, Inc.
Application holderSTEMLINE THERAPEUTICS INC
FDA applicationNDA217639 (NDA)
Labeler code72187
First marketedJan 2023
Product typeHuman Prescription Drug
Portfolio3 products on file
The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

Full prescribing information FDA SPL

The complete FDA label for this product — the official prescribing information, verbatim, section by section. Very long sections are excerpted here and marked; the full text is on DailyMed (linked in the sources below). Jump with a chip, search within the label, or expand everything.
🎯 Indications and Usage 104 words ▾

1 INDICATIONS AND USAGE ORSERDU is indicated for the treatment of postmenopausal women or adult men with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)‑negative, ESR1 -mutated advanced or metastatic breast cancer, as detected by an FDA-authorized test [see Dosage and Administration ( 2.1 )] , with disease progression following at least one line of endocrine therapy. ORSERDU is an estrogen receptor antagonist indicated for: treatment of postmenopausal women or adult men, with ER-positive, HER2-negative, ESR1 -mutated advanced or metastatic breast cancer, as detected by an FDA-authorized test, with disease progression following at least one line of endocrine therapy ( 1 )

⏱️ Dosage and Administration ~2 min read ▾

2 DOSAGE AND ADMINISTRATION Select patients for treatment with ORSERDU based on the presence of ESR1 mutations. ( 2.1 ) The recommended dosage of ORSERDU is one 345 mg tablet taken orally, once daily, with food ( 2.2 ) Dose interruption, reduction, or permanent discontinuation may be required due to adverse reactions. ( 2.3 )

2.1Patient Selection Select patients for treatment of ER-positive, HER2-negative advanced or metastatic breast cancer with ORSERDU based on the presence of ESR1 mutation(s) in plasma specimen using an FDA-authorized test [see Indications and Usage ( 1 ) and Clinical Studies ( 14 )] . Information on FDA-authorized tests for detection of ESR1 mutations in breast cancer is available at: http://www.fda.gov/CompanionDiagnostics.

2.2Recommended Dosage The recommended dosage of ORSERDU is 345 mg taken orally with food once daily until disease progression or unacceptable toxicity occurs. Take ORSERDU at approximately the same time each day. Take with food to reduce nausea and vomiting [see Adverse Reactions ( 6.1 )] .

Swallow ORSERDU tablet(s) whole. Do not chew, crush, or split prior to swallowing. Do not take any ORSERDU tablets that are broken, cracked, or that look damaged.

If a dose is missed for more than 6 hours or vomiting occurs, skip the dose and take the next dose the following day at its regularly scheduled time.

2.3Dosage Modifications for Adverse Reactions The recommended dose reduction levels for adverse reactions are listed in Table 1 : Table 1: ORSERDU Dose Reduction Levels for Adverse Reactions 1 If further dose reduction below 172 mg once daily is required, permanently discontinue ORSERDU. Dose Reduction Dosage Number and Strength of Tablets First-dose reduction 258 mg once daily Three 86 mg tablets Second-dose reduction 172 mg once daily 1 Two 86 mg tablets Recommended dosage modifications of ORSERDU for adverse reactions are provided in Table 2 [see Adverse Reactions ( 6.1 )] .

Table 2: ORSERDU Dosage Modification Guidelines for Adverse Reactions Severity Dosage Modification Grade 1 Continue ORSERDU at current dose level. Grade 2 Consider interruption of ORSERDU until recovery to Grade ≤ 1 or baseline. Then resume ORSERDU at the same dose level.

Grade 3 Interrupt ORSERDU until recovery to Grade ≤ 1 or baseline. Then resume ORSERDU at the next lower dose level. If the Grade 3 toxicity recurs, interrupt ORSERDU until recovery to Grade ≤ 1 or baseline.

Then resume ORSERDU reduced by another dose level. Grade 4 Interrupt ORSERDU until recovery to Grade ≤ 1 or baseline. Then resume ORSERDU reduced by one dose level.

If a Grade 4 or intolerable adverse reaction recurs, permanently discontinue ORSERDU.

2.4Dosage Modifications for CYP3A4 Inducers and Inhibitors Avoid concomitant use of ORSERDU with strong or moderate CYP3A4 inducers and inhibitors [see Drug Interactions ( 7.1 )] .

2.5Recommended Dosage in Patients with Hepatic Impairment Avoid use of ORSERDU in patients with severe hepatic impairment (Child-Pugh C). Reduce the ORSERDU dosage to 258 mg once daily for patients with moderate hepatic impairment (Child-Pugh B). No dosage adjustment is recommended for patients with mild hepatic impairment (Child-Pugh A) [see Clinical Pharmacology ( 12.3 )] .

💊 Dosage Forms and Strengths 75 words ▾

3 DOSAGE FORMS AND STRENGTHS Tablets: Elacestrant 345 mg (equivalent to 400 mg elacestrant hydrochloride) and 86 mg (equivalent to 100 mg elacestrant hydrochloride): 345 mg: light blue, unscored, oval film-coated biconvex tablet, imprinted with “MH” on one side and plain on the other side. 86 mg: light blue, unscored, round film-coated biconvex tablet, imprinted with “ME” on one side and plain on the other side. Tablets: 345 mg and 86 mg ( 3 )

⛔ Contraindications 7 words ▾

4 CONTRAINDICATIONS None. None ( 4 )

⚠️ Warnings and Cautions ~1 min read ▾

5 WARNINGS AND PRECAUTIONS Dyslipidemia : ORSERDU may cause hypercholesterolemia and hypertriglyceridemia. Monitor lipid profile prior to starting treatment and periodically thereafter. ( 5.1 ) Embryo-Fetal Toxicity : ORSERDU can cause fetal harm. Advise of the potential risk to a fetus and to use effective contraception. ( 5.2 , 8.1 , 8.3 )

5.1Dyslipidemia Hypercholesterolemia and hypertriglyceridemia occurred in patients taking ORSERDU at an incidence of 30% and 27%, respectively. The incidence of Grade 3 and 4 hypercholesterolemia and hypertriglyceridemia were 0.9% and 2.2%, respectively [see Adverse Reactions ( 6.1 )] . Monitor lipid profile prior to starting and periodically while taking ORSERDU.

5.2Embryo-Fetal Toxicity Based on findings in animals and its mechanism of action, ORSERDU can cause fetal harm when administered to a pregnant woman. Administration of elacestrant to pregnant rats resulted in adverse developmental outcomes, including embryo-fetal mortality and structural abnormalities, at maternal exposures below the recommended dose based on area under the curve (AUC). Advise pregnant women and females of reproductive potential of the potential risk to a fetus.

Advise females of reproductive potential to use effective contraception during treatment with ORSERDU and for 1 week after the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with ORSERDU and for 1 week after the last dose [see Use in Specific Populations ( 8.1 , 8.3 ) and Clinical Pharmacology ( 12.1 )] .

🤒 Adverse Reactions ~3 min read ▾

6 ADVERSE REACTIONS The following clinically significant adverse reactions are described elsewhere in the labeling: Dyslipidemia [see Warnings and Precautions ( 5.1 )] The most common (>10%) adverse reactions, including laboratory abnormalities, of ORSERDU were musculoskeletal pain, nausea, increased cholesterol, increased AST, increased triglycerides, fatigue, decreased hemoglobin, vomiting, increased ALT, decreased sodium, increased creatinine, decreased appetite, diarrhea, headache, constipation, abdominal pain, hot flush, and dyspepsia.

( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Stemline Therapeutics, Inc. at 1-877-332-7961 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

6.1Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety of ORSERDU was evaluated in 467 patients with ER+/HER2- advanced breast cancer following CDK4/6 inhibitor therapy in EMERALD, a randomized, open-label, multicenter study [see Clinical Studies ( 14 )] . Patients received ORSERDU 345 mg orally once daily (n=237) or standard of care (SOC) consisting of fulvestrant or an aromatase inhibitor (n=230).

Among patients who received ORSERDU, 22% were exposed for 6 months or longer and 9% were exposed for greater than one year. Serious adverse reactions occurred in 12% of patients who received ORSERDU. Serious adverse reactions in >1% of patients who received ORSERDU were musculoskeletal pain (1.7%) and nausea (1.3%).

Fatal adverse reactions occurred in 1.7% of patients who received ORSERDU, including cardiac arrest, septic shock, diverticulitis, and unknown cause (one patient each). Permanent discontinuation of ORSERDU due to an adverse reaction occurred in 6% of patients. Adverse reactions which resulted in permanent discontinuation of ORSERDU in >1% of patients were musculoskeletal pain (1.7%) and nausea (1.3%).

Dosage interruptions of ORSERDU due to an adverse reaction occurred in 15% of patients. Adverse reactions which resulted in dosage interruption of ORSERDU in >1% of patients were nausea (3.4%), musculoskeletal pain (1.7%), and increased ALT (1.3%). Dosage reductions of ORSERDU due to an adverse reaction occurred in 3% of patients.

Adverse reactions which required dosage reductions of ORSERDU in >1% of patients were nausea (1.7%). The most common (≥10%) adverse reactions, including laboratory abnormalities, of ORSERDU were musculoskeletal pain, nausea, increased cholesterol, increased AST, increased triglycerides, fatigue, decreased hemoglobin, vomiting, increased ALT, decreased sodium, increased creatinine, decreased appetite, diarrhea, headache, constipation, abdominal pain, hot flush, and dyspepsia. Table 3 summarizes the adverse reactions in EMERALD.

Table 3: Adverse Reactions (>10%) in Patients with ER-positive, HER2-negative, Advanced or Metastatic Breast Cancer Who Received ORSERDU in EMERALD a a Adverse reactions were graded using NCI CTCAE version 5.0. b Includes other related terms c Only includes Grade 3 adverse reactions. Adverse Reaction ORSERDU (n=237) Fulvestrant or an Aromatase Inhibitor (n=230) All Grades (%) Grade 3 or 4 c (%) All Grades (%) Grade 3 or 4 c (%) Musculoskeletal and connective tissue disorders Musculoskeletal pain b 41 7 39 1 Gastrointestinal disorders Nausea 35 2.5 19

0.9Vomiting b 19 0.8 9 0 Diarrhea 13 0 10 1 Constipation 12 0 6 0 Abdominal pain b 11 1 10

0.9Dyspepsia 10 0 2.6 0 General disorders Fatigue b 26 2 27 1 Metabolism and nutrition disorders Decreased appetite 15 0.8 10

0.4Nervous system Headache 12 2 12 0 Vascular disorders Hot flush 11 0 8 0 Clinically relevant adverse reactions in < 10% of patients who received ORSERDU included rash, insomnia, dyspnea, cough, dizziness, stomatitis and gastroesophageal reflux disease. Table 4 summarizes the labo… [Excerpted — this section continues on DailyMed.]

🔄 Drug Interactions ~1 min read ▾

7 DRUG INTERACTIONS Strong and Moderate CYP3A4 Inducers : Avoid concomitant use. ( 7.1 ) Strong and Moderate CYP3A4 Inhibitors : Avoid concomitant use. ( 7.1 )

7.1Effect of Other Drugs on ORSERDU Strong and Moderate CYP3A4 Inhibitors Avoid concomitant use of strong or moderate CYP3A inhibitors with ORSERDU. Elacestrant is a CYP3A4 substrate. Concomitant use of a strong or moderate CYP3A4 inhibitor increase elacestrant exposure [see Clinical Pharmacology ( 12.3 )] , which may increase the risk of adverse reactions of ORSERDU.

Strong and Moderate CYP3A4 Inducers Avoid concomitant use of strong or moderate CYP3A inducers with ORSERDU. Elacestrant is a CYP3A4 substrate. Concomitant use of a strong or moderate CYP3A4 inducer decreases elacestrant exposure [see Clinical Pharmacology ( 12.3 )] , which may decrease effectiveness of ORSERDU.

7.2Effect of ORSERDU on Other Drugs P-gp Substrates Reduce the dosage of P-gp substrates per their Prescribing Information when minimal concentration changes may lead to serious or life-threatening adverse reactions. Elacestrant is a P-gp inhibitor. Concomitant use of ORSERDU with a P-gp substrate increased the concentrations of P-gp substrate [see Clinical Pharmacology ( 12.3 )] , which may increase the adverse reactions associated with a P-gp substrate.

BCRP Substrates Reduce the dosage of BCRP substrates per their Prescribing Information when minimal concentration changes may lead to serious or life-threatening adverse reactions. Elacestrant is a BCRP inhibitor. Concomitant use of ORSERDU with a BCRP substrate increased the plasma concentrations of BCRP substrate [see Clinical Pharmacology ( 12.3 )] , which may increase the adverse reactions associated with a BCRP substrate.

👥 Use in Specific Populations ~3 min read ▾

8 USE IN SPECIFIC POPULATIONS Lactation : Advise not to breastfeed. ( 8.2 ) Hepatic Impairment : Avoid use in patients with severe hepatic impairment (Child-Pugh C). Reduce the dosage for patients with moderate hepatic impairment (Child-Pugh B). ( 2.5 , 8.6 )

8.1Pregnancy Risk Summary Based on findings in animals and its mechanism of action, ORSERDU can cause fetal harm when administered to a pregnant woman [see Clinical Pharmacology ( 12.1 )] . There are no available human data on ORSERDU use in pregnant women to inform the drug-associated risk. In an animal reproduction study, oral administration of elacestrant to pregnant rats during organogenesis caused embryo-fetal mortality and structural abnormalities at maternal exposures below the recommended dose based on AUC (see Data ) .

Advise pregnant women and females of reproductive potential of the potential risk to a fetus. The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2%-4% and 15%-20%, respectively.

Data Animal Data In an embryo-fetal development study in pregnant rats, administration of oral doses of elacestrant up to 30 mg/kg/day during the period of organogenesis resulted in maternal toxicity (reduced body weight gain, low food consumption, red vulvar discharge) and embryo-fetal mortality (increased resorptions, post-implantation loss, and reduced number of live fetuses) at ≥ 3 mg/kg/day (approximately 0.1 times the human AUC at the recommended dose). Additional adverse effects included reduced fetal weight and external malformations of the limbs (hyperflexion, malrotation) and head (domed, misshapen, flattened) with corresponding skeletal malformations of the skull at doses ≥ 10 mg/kg/day (approximately 0.5 times the human AUC at the recommended dose).

8.2Lactation Risk Summary There are no data on the presence of elacestrant in human milk, its effects on milk production, or the breastfed child. Because of the potential for serious adverse reactions in the breastfed child, advise lactating women to not breastfeed during treatment with ORSERDU and for 1 week after the last dose.

8.3Females and Males of Reproductive Potential ORSERDU can cause fetal harm when administered to a pregnant woman [see Use in Specific Populations ( 8.1 )] . Pregnancy Testing Verify the pregnancy status in females of reproductive potential prior to initiating ORSERDU treatment. Contraception Females Advise females of reproductive potential to use effective contraception during treatment with ORSERDU and for 1 week after the last dose.

Males Advise male patients with female partners of reproductive potential to use effective contraception during treatment with ORSERDU and for 1 week after the last dose. Infertility Based on findings from animal studies, ORSERDU may impair fertility in females and males of reproductive potential [see Nonclinical Toxicology ( 13.1 )] .

8.4Pediatric Use The safety and effectiveness of ORSERDU in pediatric patients have not been established.

8.5Geriatric Use Of 237 patients who received ORSERDU in the EMERALD trial, 43% were 65 years of age or older and 17% were 75 years of age or older. No overall differences in safety or effectiveness of ORSERDU were observed between patients 65 years or older of age compared to younger patients. There are an insufficient number of patients 75 years of age or older to assess whether there are differences in safety or effectiveness.

8.6Hepatic Impairment Avoid use of ORSERDU in patients with severe hepatic impairment (Child-Pugh C). Reduce the dose of ORSERDU in patients with moderate hepatic impairment (Child-Pugh B). No dosage adjustment is recommended for patients with mild hepatic impairment (Child-Pugh A) [see Dosage and Administration ( 2.5 ) and Clinical Pharmacology ( 12.3 )] .

🤰 Pregnancy ~1 min read ▾

8.1Pregnancy Risk Summary Based on findings in animals and its mechanism of action, ORSERDU can cause fetal harm when administered to a pregnant woman [see Clinical Pharmacology ( 12.1 )] . There are no available human data on ORSERDU use in pregnant women to inform the drug-associated risk. In an animal reproduction study, oral administration of elacestrant to pregnant rats during organogenesis caused embryo-fetal mortality and structural abnormalities at maternal exposures below the recommended dose based on AUC (see Data ) .

Advise pregnant women and females of reproductive potential of the potential risk to a fetus. The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2%-4% and 15%-20%, respectively.

Data Animal Data In an embryo-fetal development study in pregnant rats, administration of oral doses of elacestrant up to 30 mg/kg/day during the period of organogenesis resulted in maternal toxicity (reduced body weight gain, low food consumption, red vulvar discharge) and embryo-fetal mortality (increased resorptions, post-implantation loss, and reduced number of live fetuses) at ≥ 3 mg/kg/day (approximately 0.1 times the human AUC at the recommended dose). Additional adverse effects included reduced fetal weight and external malformations of the limbs (hyperflexion, malrotation) and head (domed, misshapen, flattened) with corresponding skeletal malformations of the skull at doses ≥ 10 mg/kg/day (approximately 0.5 times the human AUC at the recommended dose).

🧒 Pediatric Use 16 words ▾

8.4Pediatric Use The safety and effectiveness of ORSERDU in pediatric patients have not been established.

🧓 Geriatric Use 76 words ▾

8.5Geriatric Use Of 237 patients who received ORSERDU in the EMERALD trial, 43% were 65 years of age or older and 17% were 75 years of age or older. No overall differences in safety or effectiveness of ORSERDU were observed between patients 65 years or older of age compared to younger patients. There are an insufficient number of patients 75 years of age or older to assess whether there are differences in safety or effectiveness.

🧬 Clinical Pharmacology ~3 min read ▾

12 CLINICAL PHARMACOLOGY

12.1Mechanism of Action Elacestrant is an estrogen receptor antagonist that binds to estrogen receptor-alpha (ERα). In ER-positive (ER+) HER2-negative (HER2-) breast cancer cells, elacestrant inhibited 17β-estradiol mediated cell proliferation at concentrations inducing degradation of ERα protein mediated through proteasomal pathway. Elacestrant demonstrated in vitro and in vivo antitumor activity including in ER+ HER2- breast cancer models resistant to fulvestrant and cyclin-dependent kinase 4/6 inhibitors and those harboring estrogen receptor 1 gene ( ESR1 ) mutations.

12.2Pharmacodynamics Exposure-Response Relationships Elacestrant exposure-response relationships and the time course of pharmacodynamics have not been fully characterized. Cardiac Electrophysiology ORSERDU does not cause a mean increase in QTc interval > 20 msec at the approved recommended dose.

12.3Pharmacokinetics The steady-state mean (%CV) maximum concentration (Cmax) of elacestrant is 119 ng/mL (44%) and the area under the concentration-time curve (AUC) is 2,440 ng*h/mL (44%) after administration of the recommended dosage of 345 mg once daily. The C max and AUC of elacestrant increase more than proportionally over a dosage range from 43 mg to 862 mg once daily (0.125 to 2.5 times the approved recommended dosage). Steady state is reached by Day 6 and the mean accumulation ratio based on AUC is 2-fold.

Absorption The time to achieve peak plasma concentration (t max ) ranges from 1 to 4 hours. The elacestrant oral bioavailability is approximately 10%. Effect of Food Administration of ORSERDU 345 mg with a high-fat meal (800 to 1000 calories, 50% fat) increased Cmax by 42% and AUC by 22% compared to fasted administration.

Distribution The estimated apparent volume of distribution is 5,800 L. Plasma protein binding of elacestrant is >99% and independent of concentration. Elimination The elimination half-life of elacestrant is 30 to 50 hours.

The estimated mean (% CV) clearance of elacestrant is 186 L/hr (44%) and renal clearance is ≤

0.14L/hr. Metabolism Elacestrant is primarily metabolized by CYP3A4 and to a lesser extent by CYP2A6 and CYP2C9. Excretion Following a single radiolabeled oral dose of 345 mg, 82% was recovered in feces (34% unchanged) and 7.5% was recovered in urine (< 1% unchanged).

Specific Populations There were no clinically significant differences in the pharmacokinetics of elacestrant based on age (24 to 89 years), sex, and body weight (41 to 143 kg). Patients with Hepatic Impairment There were no clinically significant differences in the C max and AUC of elacestrant in subjects with mild hepatic impairment (Child-Pugh A). The AUC of elacestrant increased in subjects with moderate hepatic impairment (Child-Pugh B) by 83%.

Elacestrant has not been studied in subjects with severe hepatic impairment (Child-Pugh C). Drug Interaction Studies Clinical Studies There were no clinically significant differences in the pharmacokinetics of elacestrant when used concomitantly with cimetidine (weak CYP3A inhibitor), omeprazole (gastric acid-reducing agent), or warfarin (highly protein-bound drug). Table 5 describes the effect of other drugs on the pharmacokinetics of elacestrant and Table 6 describes the effect of elacestrant on the pharmacokinetics of other drugs.

Table 5: Effect of Other Drugs on Elacestrant a Predicted changes in C max and AUC of elacestrant. Concomitant Drug Elacestrant Dose Fold Increased or Percent Decrease of Elacestrant With Concomitant Drug C max AUC CYP3A Inhibitors Strong Inhibitor Itraconazole 172 mg once daily 4.4

5.3Moderate Inhibitor Fluconazole a 345 mg single dose 1.6

2.3CYP3A Inducers Strong Inducer Rifampin 345 mg single dose 73% 86% Moderate Inducer Efavirenz a 345 mg single dose 44-63% 55-73% Table 6: Effect of Elacestrant on Other Drugs Concomitant Drug Elacestrant Dose Fold Increase of Concomitant Drug With Elacestrant C max AUC Substrate of P-gp Digoxin 345 mg single dose 1.3

1.1Sub… [Excerpted — this section continues on DailyMed.]

🧬 Mechanism of Action 76 words ▾

12.1Mechanism of Action Elacestrant is an estrogen receptor antagonist that binds to estrogen receptor-alpha (ERα). In ER-positive (ER+) HER2-negative (HER2-) breast cancer cells, elacestrant inhibited 17β-estradiol mediated cell proliferation at concentrations inducing degradation of ERα protein mediated through proteasomal pathway. Elacestrant demonstrated in vitro and in vivo antitumor activity including in ER+ HER2- breast cancer models resistant to fulvestrant and cyclin-dependent kinase 4/6 inhibitors and those harboring estrogen receptor 1 gene ( ESR1 ) mutations.

📦 How Supplied / Storage and Handling 101 words ▾

16 HOW SUPPLIED/STORAGE AND HANDLING ORSERDU (elacestrant) film-coated tablets for oral use are supplied as follows: Tablet Strength Tablet Color and Shape Tablet Markings Pack Size NDC Code Elacestrant 345 mg (equivalent to 400 mg elacestrant hydrochloride) Light blue; Oval “MH” Bottle of 30 Tablets with Child Resistant Closure (CRC). NDC 72187-0102-3 Elacestrant 86 mg (equivalent to 100 mg elacestrant hydrochloride) Light blue; Round “ME” Bottle of 30 Tablets with Child Resistant Closure (CRC). NDC 72187-0101-3 Storage and Handling Store at 20°C to 25°C (68°F to 77°F).

Excursions permitted from 15°C to 30°C (59°F to 86°F). [see USP controlled room temperature].

📦 Storage and Handling 25 words ▾

Storage and Handling Store at 20°C to 25°C (68°F to 77°F). Excursions permitted from 15°C to 30°C (59°F to 86°F). [see USP controlled room temperature].

📋 Description 153 words ▾

11 DESCRIPTION Elacestrant hydrochloride is the salt form of elacestrant, an estrogen receptor antagonist, that has the chemical name: (6R)-6-(2-(N-(4-(2-(ethylamino)ethyl)benzyl)-N-ethylamino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol dihydrochloride. Elacestrant hydrochloride is the dihydrochloride salt and the molecular formula is C 30 H 38 N 2 O 2 .2HCL. The relative molecular mass is 531.56 g/mol.

The chemical structure of elacestrant hydrochloride is shown below: Elacestrant hydrochloride is a white to off-white to grey solid and is freely soluble in 0.01N HCI. ORSERDU (elacestrant) 345 mg film-coated tablet contains 400 mg of elacestrant hydrochloride (approximately 345 mg of elacestrant free base). ORSERDU (elacestrant) 86 mg film-coated tablet contains 100 mg of elacestrant hydrochloride (approximately 86 mg of elacestrant free base).

Both tablet strengths contain the following inactive ingredients: colloidal silicon dioxide, crospovidone, magnesium stearate (non-bovine), microcrystalline cellulose, and silicified microcrystalline cellulose. The tablets also contain Opadry II Blue (polyvinyl alcohol, titanium dioxide, polyethylene glycol, FD&C Blue #1 and talc). Chemical Structure

💬 Information for Patients ~2 min read ▾

17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). Dyslipidemia Advise patients that hypercholesterolemia and hypertriglyceridemia may occur while taking ORSERDU. Inform patients that lipid profile monitoring will be performed prior to starting and periodically while taking ORSERDU [see Warnings and Precautions ( 5.1 ) and Adverse Reactions ( 6.1 )] .

Embryo-Fetal Toxicity Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females to inform their healthcare provider of a known or suspected pregnancy [see Warnings and Precautions ( 5.2 ) and Use in Specific Populations ( 8.1 )] . Advise females of reproductive potential to use effective contraception during treatment with ORSERDU and for 1 week after the last dose.

Advise male patients with female partners of reproductive potential to use effective contraception during treatment with ORSERDU and for 1 week after the last dose [see Use in Specific Populations ( 8.3 )] . Lactation Advise women not to breastfeed during treatment with ORSERDU and for 1 week after the last dose [see Use in Specific Populations ( 8.2 )] . Infertility Advise males and females of reproductive potential that ORSERDU may impair fertility [see Use in Specific Populations ( 8.3 )] .

Drug Interactions Advise patients to inform their healthcare providers of all concomitant medications, including prescription medicines, over-the-counter drugs, and herbal products [see Drug Interactions ( 7.1 , 7.2 )] . Other Common Adverse Reactions Advise patients that other adverse reactions with ORSERDU treatment may include musculoskeletal pain, nausea, fatigue, vomiting, decreased appetite, diarrhea, headache, constipation, abdominal pain, hot flush, and dyspepsia, [see Adverse Reactions ( 6.1 )] . Dosing Instructions Instruct patients to take ORSERDU at approximately the same time each day and to swallow the tablet(s) whole.

Tablets should not be chewed, crushed, or split prior to swallowing [see Dosage and Administration ( 2.2 )] . Advise patients to take ORSERDU with food to reduce nausea and vomiting [see Dosage and Administration ( 2.2 ) and Adverse Reactions ( 6.1 )] . Instruct patients that if a dose of ORSERDU is missed for more than 6 hours or vomiting occurs, skip the dose and take the next dose the following day at its regularly scheduled time [see Dosage and Administration ( 2.2 )] .

ORSERDU is a trademark of the Menarini Group. ©Stemline Therapeutics, Inc., a Menarini Group company Manufactured for: Stemline Therapeutics, Inc., New York, NY 10022

🧬 Pharmacokinetics ~3 min read ▾

12.3Pharmacokinetics The steady-state mean (%CV) maximum concentration (Cmax) of elacestrant is 119 ng/mL (44%) and the area under the concentration-time curve (AUC) is 2,440 ng*h/mL (44%) after administration of the recommended dosage of 345 mg once daily. The C max and AUC of elacestrant increase more than proportionally over a dosage range from 43 mg to 862 mg once daily (0.125 to 2.5 times the approved recommended dosage). Steady state is reached by Day 6 and the mean accumulation ratio based on AUC is 2-fold.

Absorption The time to achieve peak plasma concentration (t max ) ranges from 1 to 4 hours. The elacestrant oral bioavailability is approximately 10%. Effect of Food Administration of ORSERDU 345 mg with a high-fat meal (800 to 1000 calories, 50% fat) increased Cmax by 42% and AUC by 22% compared to fasted administration.

Distribution The estimated apparent volume of distribution is 5,800 L. Plasma protein binding of elacestrant is >99% and independent of concentration. Elimination The elimination half-life of elacestrant is 30 to 50 hours.

The estimated mean (% CV) clearance of elacestrant is 186 L/hr (44%) and renal clearance is ≤

0.14L/hr. Metabolism Elacestrant is primarily metabolized by CYP3A4 and to a lesser extent by CYP2A6 and CYP2C9. Excretion Following a single radiolabeled oral dose of 345 mg, 82% was recovered in feces (34% unchanged) and 7.5% was recovered in urine (< 1% unchanged).

Specific Populations There were no clinically significant differences in the pharmacokinetics of elacestrant based on age (24 to 89 years), sex, and body weight (41 to 143 kg). Patients with Hepatic Impairment There were no clinically significant differences in the C max and AUC of elacestrant in subjects with mild hepatic impairment (Child-Pugh A). The AUC of elacestrant increased in subjects with moderate hepatic impairment (Child-Pugh B) by 83%.

Elacestrant has not been studied in subjects with severe hepatic impairment (Child-Pugh C). Drug Interaction Studies Clinical Studies There were no clinically significant differences in the pharmacokinetics of elacestrant when used concomitantly with cimetidine (weak CYP3A inhibitor), omeprazole (gastric acid-reducing agent), or warfarin (highly protein-bound drug). Table 5 describes the effect of other drugs on the pharmacokinetics of elacestrant and Table 6 describes the effect of elacestrant on the pharmacokinetics of other drugs.

Table 5: Effect of Other Drugs on Elacestrant a Predicted changes in C max and AUC of elacestrant. Concomitant Drug Elacestrant Dose Fold Increased or Percent Decrease of Elacestrant With Concomitant Drug C max AUC CYP3A Inhibitors Strong Inhibitor Itraconazole 172 mg once daily 4.4

5.3Moderate Inhibitor Fluconazole a 345 mg single dose 1.6

2.3CYP3A Inducers Strong Inducer Rifampin 345 mg single dose 73% 86% Moderate Inducer Efavirenz a 345 mg single dose 44-63% 55-73% Table 6: Effect of Elacestrant on Other Drugs Concomitant Drug Elacestrant Dose Fold Increase of Concomitant Drug With Elacestrant C max AUC Substrate of P-gp Digoxin 345 mg single dose 1.3

1.1Substrate of BCRP Rosuvastatin 345 mg single dose 1.5

1.2In Vitro Studies Cytochrome P450 (CYP) Enzymes: Elacestrant is not an inhibitor of CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, or CYP3A. Elacestrant is not an inducer of CYP1A2, CYP2A6, CYP2B6, CYP2C9, CYP2C19, or CYP3A. Transporter Systems: Elacestrant is a substrate for OATP2B1, and P-gp. Elacestrant is not an inhibitor of OAT1, OAT3, OCT2, MATE1, MATE2-K, OCT1, OATP1B1, OATP1B3 or OATP2B1.

🧬 Pharmacodynamics 38 words ▾

12.2Pharmacodynamics Exposure-Response Relationships Elacestrant exposure-response relationships and the time course of pharmacodynamics have not been fully characterized. Cardiac Electrophysiology ORSERDU does not cause a mean increase in QTc interval > 20 msec at the approved recommended dose.

🔬 Clinical Studies ~2 min read ▾

14 CLINICAL STUDIES The efficacy of ORSERDU was evaluated in EMERALD (NCT03778931), a randomized, open-label, active-controlled, multicenter trial that enrolled 478 postmenopausal women and men with ER+/HER2- advanced or metastatic breast cancer of which 228 patients had ESR1 mutations. Patients were required to have disease progression on one or two prior lines of endocrine therapy, including one line containing a CDK4/6 inhibitor. Eligible patients could have received up to one prior line of chemotherapy in the advanced or metastatic setting.

Patients were randomized (1:1) to receive ORSERDU 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; anastrozole, letrozole or exemestane). Randomization was stratified by ESR1 mutation status (detected vs not detected), prior treatment with fulvestrant (yes vs no), and visceral metastasis (yes vs no). 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 (between codons 310 to 547).

Patients were treated until disease progression or unacceptable toxicity. The major efficacy outcome was progression-free survival (PFS), assessed by a blinded imaging review committee (BIRC). An additional efficacy outcome measure was overall survival (OS).

A statistically significant difference in PFS was observed in the intention to treat (ITT) population and in the subgroup of patients with ESR1 mutations. An exploratory analysis of PFS in the 250 (52%) patients without ESR1 mutations showed a HR 0.86 (95% CI: 0.63, 1.19) indicating that the improvement in the ITT population was primarily attributed to the results seen in the ESR1 mutated population. Among the patients with ESR1 mutations (n=228), the median age was 63 years (range: 28-89); 100% were female; 72% were White, 5.7% Asian, 3.5% Black, 0.4% Other, 18.4% unknown/not reported; 8.8% were Hispanic/Latino; and baseline ECOG performance status was 0 (57%) or 1 (43%).

Most patients had visceral disease (71%); 62% had received 1 line of endocrine therapy and 39% had received 2 lines of endocrine therapy in the advanced or metastatic setting. All patients had received prior treatment with a CDK4/6 inhibitor, 24% had received prior fulvestrant, and 25% had received prior chemotherapy in the advanced or metastatic setting. Efficacy results are presented in Table 7 and Figure 1 for patients with ESR1 mutations.

Table 7: Efficacy Results for EMERALD (Patients with ESR1 Mutations) CI=confidence interval; ESR1 =estrogen receptor 1 a PFS results based on blinded imaging review committee. b Kaplan-Meier estimate; 95% CI based on the Brookmeyer-Crowley method using a linear transformation. c Cox proportional hazards model stratified by prior treatment with fulvestrant (yes vs no) and visceral metastasis (yes vs no). d Stratified log-rank test two-sided p-value. e NS – Not statistically significant. ORSERDU (N = 115) Fulvestrant or an Aromatase Inhibitor (N=113) Progression-free Survival (PFS) a Number of PFS Events, n (%) 62 (54) 78 (69) Median PFS months b (95% CI) 3.8 (2.2, 7.3) 1.9 (1.9, 2.1) Hazard ratio c (95% CI) 0.55 (0.39, 0.77) p-value d 0.0005 Overall Survival (OS) Number of OS Events, n (%) 61 (53) 60 (53) Hazard ratio c (95% CI) 0.90 (0.63, 1.30) p-value d NS e Figure 1: Kaplan-Meier Curve for PFS in EMERALD (Patients with ESR1 Mutations, BIRC Assessment) + Censored times Figure 1

🧪 Nonclinical Toxicology 153 words ▾

13 NONCLINICAL TOXICOLOGY

13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies have not been conducted with elacestrant. Elacestrant was not mutagenic in an in vitro bacterial reverse mutation (Ames) assay or clastogenic in either in vitro chromosome aberration assays or an in vivo rat bone marrow micronucleus assay. Fertility studies with elacestrant in animals have not been conducted.

In repeated-dose toxicity studies up to 26 weeks duration in rats and 39 weeks duration in cynomolgus monkeys, adverse reactions were observed in female reproductive organs including atrophy of the vagina, cervix, and uterus and follicular cysts in the ovary at doses ≥ 10 mg/kg/day in rats and cynomolgus monkeys (≥ 0.3 times the human AUC at the recommended dose). Decreased cellularity of Leydig cells and degeneration/atrophy of the seminiferous epithelium in the testis were observed in male rats at a dose of 50 mg/kg/day (approximately 2.6 times the human AUC at the recommended dose).

📄 Carcinogenesis, Mutagenesis, Impairment of Fertility 150 words ▾

13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies have not been conducted with elacestrant. Elacestrant was not mutagenic in an in vitro bacterial reverse mutation (Ames) assay or clastogenic in either in vitro chromosome aberration assays or an in vivo rat bone marrow micronucleus assay. Fertility studies with elacestrant in animals have not been conducted.

In repeated-dose toxicity studies up to 26 weeks duration in rats and 39 weeks duration in cynomolgus monkeys, adverse reactions were observed in female reproductive organs including atrophy of the vagina, cervix, and uterus and follicular cysts in the ovary at doses ≥ 10 mg/kg/day in rats and cynomolgus monkeys (≥ 0.3 times the human AUC at the recommended dose). Decreased cellularity of Leydig cells and degeneration/atrophy of the seminiferous epithelium in the testis were observed in male rats at a dose of 50 mg/kg/day (approximately 2.6 times the human AUC at the recommended dose).

📄 Patient Package Insert ~3 min read ▾

This Patient Information has been approved by the U.S. Food and Drug Administration. Issued: 01/2023 PATIENT INFORMATION ORSERDU ® (or-SER-doo) (elacestrant) tablets What is ORSERDU?

ORSERDU is a prescription medicine to treat women who have gone through menopause and adult men with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, ESR1 -mutated advanced breast cancer or breast cancer that has spread to other parts of the body (metastatic), and whose disease has progressed after endocrine therapy. Your healthcare provider will perform a test to make sure that ORSERDU is right for you. It is not known if ORSERDU is safe and effective in children.

Before taking ORSERDU, tell your healthcare provider about all of your medical conditions, including if you: have liver problems are pregnant or plan to become pregnant. ORSERDU can harm your unborn baby. Females who are able to become pregnant: Your healthcare provider may do a pregnancy test before you start treatment with ORSERDU.

You should use effective (contraception) birth control during treatment with ORSERDU and for 1 week after the last dose. Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with ORSERDU. Males with female partners who are able to become pregnant: You should use effective (contraception) birth control during treatment with ORSERDU and for 1 week after the last dose. are breastfeeding or plan to breastfeed.

It is not known if ORSERDU passes into your breast milk. Do not breastfeed during treatment with ORSERDU and for 1 week after the last dose. Tell your healthcare provider about all of the medicines you take, including prescription and over-the counter medicines, vitamins, and herbal supplements.

ORSERDU and other medicines may affect each other causing side effects. Know the medicines you take. Keep a list of them to show your healthcare provider or pharmacist when you get a new medicine.

How should I take ORSERDU? Take ORSERDU exactly as your healthcare provider tells you. Do not change your dose or stop taking ORSERDU unless your healthcare provider tells you.

Take ORSERDU 1 time each day, at about the same time each day. Take ORSERDU with food. Taking ORSERDU with food may help reduce nausea and vomiting.

Swallow ORSERDU tablets whole. Do not chew, crush or split the tablets before swallowing. Do not take any ORSERDU tablets that are broken, cracked, or that look damaged.

If you miss a dose of ORSERDU or vomit after taking a dose of ORSERDU, do not take another dose of ORSERDU on that day. Skip the dose and take your next dose the following day at your regularly scheduled time. What are the possible side effects of ORSERDU?

ORSERDU may cause serious side effects, including: Increased fat (lipid) levels in your blood (hypercholesterolemia and hypertriglyceridemia) . Your healthcare provider will do blood tests to check your lipid levels before and during your treatment with ORSERDU. The most common side effects of ORSERDU include: muscle and joint (musculoskeletal) pain nausea increased cholesterol and triglyceride levels in your blood increased liver function tests tiredness decreased red blood cell counts vomiting decreased salt (sodium) levels in your blood increased kidney function test decreased appetite diarrhea headache constipation stomach-area (abdominal) pain hot flush indigestion or heartburn Your healthcare provider may decrease your dose, temporarily stop, or completely stop treatment with ORSERDU, if you develop certain side effects.

ORSERDU may affect fertility in males and in females who are able to become pregnant. Talk to your healthcare provider if this is a concern for you. These are not all of the possible side effects of ORSERDU.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store ORSERDU?

Store ORSERDU at room temperature 68℉ to 77℉ (20℃ to 25℃). Keep ORSERD… [Excerpted — this section continues on DailyMed.]

📄 Package Label / Principal Display Panel 57 words ▾

PRINCIPAL DISPLAY PANEL - NDC:72187-0101-3 - Orserdu Bottle Label - 86mg NDC 72187-0101-3 Orserdu ® (elacestrant) tablets 86 mg Rx Only 30 Tablets Orserdu Bottle Label - 86mg

PRINCIPAL DISPLAY PANEL - NDC: 72187-0102-3 - Orserdu Bottle Label - 345mg NDC 72187-0102-3 Orserdu ® (elacestrant) tablets 345 mg Rx Only 30 Tablets Orserdu Bottle Label - 345mg

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗

Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for this package alone, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q1 2026 · 5 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
1K
Units reimbursed last 4 qtrs
29.3K
Gross reimbursed last 4 qtrs
$24.29M
Avg / prescription
$23,859.45
Avg / unit
$829.28
Latest quarter Q1 2026
234Rx
Fee-for-service vs managed care ⓘ
46% FFS 54% MCO
Fee-for-service · 466 Rx Managed care · 552 Rx
State Medicaid map
Alaska: no data reported AK Maine: no data reported ME Washington: 780 units · 10.0 per 100k residents WA Idaho: no data reported ID Montana: no data reported MT North Dakota: no data reported ND Minnesota: no data reported MN Wisconsin: 1,062 units · 18.0 per 100k residents WI Michigan: no data reported MI New York: 5,160 units · 26.4 per 100k residents NY Vermont: no data reported VT New Hampshire: no data reported NH Oregon: 255 units · 6.0 per 100k residents OR Nevada: no data reported NV Wyoming: no data reported WY South Dakota: no data reported SD Iowa: no data reported IA Illinois: 1,852 units · 14.8 per 100k residents IL Indiana: no data reported IN Ohio: 2,118 units · 18.0 per 100k residents OH Pennsylvania: 3,024 units · 23.3 per 100k residents PA New Jersey: 220 units · 2.4 per 100k residents NJ Massachusetts: 315 units · 4.5 per 100k residents MA California: 6,150 units · 15.8 per 100k residents CA Utah: no data reported UT Colorado: no data reported CO Nebraska: no data reported NE Missouri: 825 units · 13.3 per 100k residents MO Kentucky: no data reported KY West Virginia: no data reported WV Virginia: no data reported VA Maryland: 360 units · 5.8 per 100k residents MD Connecticut: no data reported CT Rhode Island: no data reported RI Arizona: no data reported AZ New Mexico: no data reported NM Kansas: no data reported KS Arkansas: no data reported AR Tennessee: no data reported TN North Carolina: 1,800 units · 16.6 per 100k residents NC South Carolina: no data reported SC Delaware: no data reported DE Oklahoma: no data reported OK Louisiana: no data reported LA Mississippi: no data reported MS Alabama: no data reported AL Georgia: no data reported GA D.C.: no data reported DC Hawaii: no data reported HI Texas: 3,718 units · 12.2 per 100k residents TX Florida: 1,320 units · 5.8 per 100k residents FL
Units reimbursed · per 100k residents
2.426.4
gray = no data reported ⓘ
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 New York 26.4 /100k
2 Pennsylvania 23.3 /100k
3 Ohio 18.0 /100k
4 Wisconsin 18.0 /100k
5 North Carolina 16.6 /100k
6 California 15.8 /100k
7 Illinois 14.8 /100k
8 Missouri 13.3 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

Medicare Part D spend CMS · PART D · 2026 (Q1)

Medicare Part D (outpatient prescription) spending for Orserdu — the program that covers self-administered drugs. 1 manufacturer.
⚠️ Drug-level data: CMS publishes Part D spending by drug, not by NDC — these figures combine every manufacturer, strength and package size sold under the name Orserdu. That’s a different level of aggregation than the Medicaid card above, which is specific to this exact 11-digit NDC (pack size included), so the two aren’t directly comparable.
Period
Total Part D spend
$112.96M
Claims incl. refills
4.4K
Beneficiaries
2K
Spend / beneficiary
$57,779.64
Spend / claim
$25,637.58
Trend by period
💵 About the dollar figures: spending is what Part D plans paid before confidential manufacturer rebates, so the program’s real net cost is lower. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part D Spending by Drug (data.cms.gov), updated quarterly.

About this NDC listing & data coverage

Finished prescription product
What data is (and isn’t) available for this NDC — tap to expand
NDC identity (package / product / labeler codes) ✓ Available
Labeler ✓ Available
Product & package description ✓ Available
Marketing category & status ✓ Available
Active ingredient / dosage form / route ✓ Available
FDA label (SPL via DailyMed) ✓ Available
Package photos ✓ Available
Inactive ingredients (structured) — Not published for this NDC The labeler did not submit a structured excipient list, or no SPL is available.
NADAC pharmacy acquisition price (CMS) — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey.
Orange Book / therapeutic-equivalence data ✓ Available
HCPCS J-code billing crosswalk — Not published for this NDC Most self-administered / retail products have no J-code — that is normal.
Medicaid utilization (CMS SDUD) ✓ Available
“Not published” reflects what the public FDA / CMS / NLM sources provide for this exact package code — it is a property of the data feeds, not a judgment about the product.

Questions about this listing

Why is there no price listed?
The pricing shown on our NDC pages comes from CMS NADAC, a voluntary survey of retail community pharmacy invoices. CMS does not publish a NADAC for every NDC — packages outside the retail survey (institutional and hospital products, bulk packages, discontinued items, and many OTC items) may never receive one. A missing price reflects the survey's scope, not this product's actual cost, and does not mean the product is free or unavailable.
Is the NDC printed on the package the same as the 11-digit billing NDC?
Yes, they identify this exact package in different formats. The form printed on the packaging and shown on DailyMed is the one the FDA registered. Insurance claims use a fixed 11-digit 5-4-2 format, so the short segment is padded with a leading zero and the dashes are dropped. The Identity section at the top of this page lists each form of this code.
Is this package still being marketed?
Yes, per the latest FDA NDC Directory data on this page: this package is listed as actively marketed, with no marketing end date reported by Stemline Therapeutics, Inc.. Listing status can change — the directory data on this page refreshes weekly.
Who lists this product with the FDA?
Stemline Therapeutics, Inc. is the labeler of record for this NDC — the company under whose FDA-assigned code the package is listed. The labeler may be the manufacturer itself or a distributor marketing the product under its own code.
Do I need a prescription for this product?
This NDC is listed with FDA as a prescription product, so it is dispensed under a prescriber's order. Your pharmacist can tell you whether any over-the-counter forms of the same medication exist.
This page identifies an FDA-listed package (the NDC) and reports public regulatory and pricing data about the listing. It is reference information, not a medical recommendation — talk to your pharmacist or prescriber about your own medication.
Where does this data come from?
Listing facts (marketing category, packager status, marketing dates) from the FDA openFDA NDC Directory; label availability from DailyMed; pricing coverage from CMS NADAC; equivalence scope from the FDA Orange Book.
For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.