II. Indications

  1. FDA approved (adults and children age >5 years old)
    1. Acute Promyelocytic Leukemia (APL, refractory)
  2. Off-Label
    1. Chronic Myelogenous Leukemia
    2. Acute Lymphocytic Leukemia

III. Mechanism

  1. Small-molecule Arsenic-based antineoplastic (As2O3)
    1. Also used in manufacturing (wood preservatives, Pesticides, and glass)
  2. Degrades the PML Protein-Retinoic Acid receptor alpha fusion Protein (PML/RARa)
  3. Inhibits cell proliferation and induces apoptosis of APL cells (as well as other cancer cells)
  4. Promotes dell differentiation and Angiogenesis

IV. Dosing

  1. See other references for disease specific dosing protocols

V. Adverse Effects

  1. APL Differentiation Syndrome
    1. Presents with fever and Dyspnea
    2. Signs include Pulmonary Infiltrates, Pleural Effusions, Pericardial Effusions, weight gain, Cardiomyopathy, Hypotension
  2. EKG Abnormalities
    1. QTc Prolongation (Torsades de Pointes risks)
    2. Atrioventricular Block
  3. Gastrointestinal
    1. Nausea and Vomiting
    2. Diarrhea
  4. Miscellaneous
    1. Alopecia
    2. Hyperglycemia

VI. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Electrolytes
    3. Renal Function
    4. Electrocardiogram
    5. INR

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception

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Related Studies

Ontology: arsenic trioxide (C0052416)

Definition (NCI_NCI-GLOSS) A drug used to treat acute promyelocytic leukemia (APL) that has not gotten better or that has come back after treatment with other anticancer drugs. It is also being studied in the treatment of other types of cancer.
Definition (NCI) A small-molecule arsenic compound with antineoplastic activity. The mechanism of action of arsenic trioxide is not completely understood. This agent causes damage to or degradation of the promyelocytic leukemia protein/retinoic acid receptor-alpha (PML/RARa) fusion protein; induces apoptosis in acute promyelocytic leukemia (APL) cells and in many other tumor cell types; promotes cell differentiation and suppresses cell proliferation in many different tumor cell types; and is pro-angiogenic. (NCI04)
Definition (PDQ) A small-molecule arsenic compound with antineoplastic activity. The mechanism of action of arsenic trioxide is not completely understood. This agent causes damage to or degradation of the promyelocytic leukemia protein/retinoic acid receptor-alpha (PML/RARa) fusion protein; induces apoptosis in acute promyelocytic leukemia (APL) cells and in many other tumor cell types; promotes cell differentiation and suppresses cell proliferation in many different tumor cell types; and is pro-angiogenic. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43067&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43067&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1005" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197) , Hazardous or Poisonous Substance (T131)
MSH C006632
SnomedCT 400907001, 72251000
LNC LP19295-2, MTHU008146
English arsenic(III) oxide, arsenous anhydride, diarsenic trioxide, Arsenic Sesquioxide, Arsenous Acid Anhydride, Arsenous Oxide, White Arsenic, Arsenic (III) Oxide, arsenic trioxide, arsenic trioxide (medication), ARSENIC TRIOXIDE, arsenic trioxide [Chemical/Ingredient], Arsenic Trioxide, Arsenic trioxide, Arsenous oxide, White arsenic, Arsenic trioxide (product), Arsenic trioxide (substance), AS2O3
Spanish arsénico blanco, trióxido de arsénico (producto), trióxido de arsénico (sustancia), trióxido de arsénico, óxido arsenoso