The Food and Drug Administration announced the approval of arsenic trioxide injection (Trisenox) in combination with tretinoin for the treatment of adults with newly diagnosed, low-risk acute promyelocytic leukemia (APL) characterized by t(15;17) translocation or PML/RAR-alpha gene expression.

The injection, marketed by Teva, was already approved in APL with t(15;17) translocation or PML/RAR-alpha gene expression for induction of remission and consolidation when patients have proven refractory to, or have relapsed from, retinoid and anthracycline chemotherapy.

The expanded indication was granted by the FDA on Jan. 12 after priority review. It is based on published studies and a review of Teva’s global safety database for arsenic trioxide.

A recent randomized, phase 3 trial compared tretinoin plus arsenic trioxide with tretinoin plus chemotherapy as first-line treatment for APL ( J Clin Oncol. 2017 Feb 20;35[6]:605-12 ). It found that 100% of 127 patients in the tretinoin plus arsenic trioxide arm achieved complete remission, compared with 97% of 136 patients in the tretinoin plus chemotherapy arm. After a median follow-up of 40.6 months, the event-free survival at 50 months for patients in the tretinoin/arsenic trioxide arm was 97.3% vs. 80% for tretinoin/chemotherapy (P = .001).

The arsenic trioxide injection carries a boxed warning for differentiation syndrome and cardiac conduction abnormalities.


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