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Arsenic Trioxide

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Arsenic Trioxide, Trisenox

  • See Also
  1. Chemotherapy
  • 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
  • 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
  • Dosing
  1. See other references for disease specific dosing protocols
  • 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
  • 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
  • Safety
  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  • Resources
  1. Arsenic Trioxide (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a482eccd-8837-47ea-904d-2f2c294d10fa