Arsenic trioxide
An ancient poison turned cure: with retinoic acid it cures more than 95% of acute promyelocytic leukaemia without conventional chemotherapy.
Developed from traditional Chinese medicine in Harbin (1990s); approved 2000 for relapsed APL and 2018 first line with tretinoin after APL0406 (Lo-Coco, NEJM 2013) showed ATRA-ATO superior to ATRA-chemotherapy in standard-risk APL. Toxicities: differentiation syndrome, QT prolongation, hepatotoxicity. Oral arsenic (Realgar-Indigo naturalis) is used in China.
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Generic; daily infusions in the clinic during consolidation.
- Commercial insurance
- covered on label
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
- Appraised for
- Acute promyelocytic leukaemia (untreated low-to-intermediate risk with ATRA, and relapsed)
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE TA526 · SMC advice: arsenic trioxide. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2000 | Relapsed/refractory APL |
| US | 2018 | Newly diagnosed low-risk APL with tretinoin |
| EU | 2002 | APL |
Trials
topRecruiting now (live from ClinicalTrials.gov)
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Latest papers
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