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Arsenic trioxide is an inorganic antineoplastic agent that serves as a cornerstone in the treatment of acute promyelocytic leukemia (APL). Its primary mechanism in APL involves binding to the PML-RARα fusion protein, inducing its degradation and subsequently promoting the differentiation and apoptosis of leukemic cells. Beyond hematologic malignancies, arsenic trioxide is being investigated for its activity in solid tumors as a radiosensitizer and anti-angiogenic agent. It exerts pleiotropic effects, including the induction of reactive oxygen species (ROS), inhibition of the Notch and Hedgehog signaling pathways, and activation of the intrinsic mitochondrial apoptotic pathway through caspase activation. It has been studied in various formulations, including intravenous solutions for systemic therapy and topical gels for cutaneous lesions.
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