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The vitamin-A derivative that made acute promyelocytic leukaemia the first cancer cured by differentiation therapy rather than by killing cells.
Tretinoin (all-trans retinoic acid, ATRA) binds the RARA portion of the PML-RARA fusion protein at pharmacological doses, releasing co-repressors and forcing malignant promyelocytes to mature into neutrophils rather than killing them. The Shanghai group led by Huang reported complete remissions with ATRA alone in 1988, and the drug was approved in the US in 1995 for induction of remission in acute promyelocytic leukaemia with t(15;17). Combined first with chemotherapy and later with arsenic trioxide, APL became the most curable adult leukaemia. Differentiation syndrome, with capillary leak, fever and pulmonary infiltrates, is the characteristic danger and is treated with dexamethasone. ATRA is the founding example of differentiation therapy: a vitamin A derivative that cures a leukaemia by teaching its cells to grow up.
Binds the RARA moiety of PML-RARA at pharmacologic doses, releasing co-repressors and forcing terminal differentiation of promyelocytes.
1.Tretinoin (all-trans retinoic acid, ATRA) acts on its target, the hormone receptor or the enzyme that makes the hormone.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026). Generic tretinoin capsules.
Multi-source generic on low-cost tiers; usually no prior authorisation. Cash prices without insurance are modest.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE search: tretinoin (ATRA). Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
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| Region | Year | Indication |
|---|---|---|
| US | 1995 | Induction of remission in APL (t(15;17)/PML-RARA) |
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Query for this drug: (TITLE:"Tretinoin" OR ABSTRACT:"Tretinoin" OR TITLE:"all-trans retinoic acid, ATRA" OR ABSTRACT:"all-trans retinoic acid, ATRA" OR TITLE:"Vesanoid" OR ABSTRACT:"Vesanoid" OR TITLE:"All-trans retinoic acid" OR ABSTRACT:"All-trans retinoic acid" OR TITLE:"ATRA" OR ABSTRACT:"ATRA" OR TITLE:"Retinoic acid" OR ABSTRACT:"Retinoic acid") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Tretinoin (all-trans retinoic acid, ATRA), not a curated reading list.
Shares Saijuan Chen, Retinoic acid receptor alpha (RARA), Zhu Chen, APL0406.
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Shares Differentiation syndrome, Epigenetic drugs (HDAC, DNMT, EZH2, IDH, menin, BET), Acute myeloid leukaemia.
Shares Acute promyelocytic leukaemia, Acute myeloid leukaemia.
Shares Acute promyelocytic leukaemia, Acute myeloid leukaemia.