# Tretinoin (all-trans retinoic acid, ATRA)

Source: https://onco.cc/drugs/tretinoin-atra/  
OnCo record `tretinoin-atra` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The vitamin-A derivative that made acute promyelocytic leukaemia the first cancer cured by differentiation therapy rather than by killing cells.

## Summary

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.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-08
- Also known as: All-trans retinoic acid; ATRA; Retinoic acid
- Tags: gap-fill
- Brand: Vesanoid
- Modality: Oral retinoid (differentiation agent)
- Mechanism: Binds the RARA moiety of PML-RARA at pharmacologic doses, releasing co-repressors and forcing terminal differentiation of promyelocytes.
- Approvals: US 1995: Induction of remission in APL (t(15;17)/PML-RARA)

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Tretinoin
- Label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=tretinoin%20capsules

## Connected records

- cancers: [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Acute promyelocytic leukaemia](https://onco.cc/cancers/apl/)
- technologies: [Epigenetic drugs (HDAC, DNMT, EZH2, IDH, menin, BET)](https://onco.cc/technologies/epigenetic-drugs/)
- companies: [Roche / Genentech](https://onco.cc/companies/roche-genentech/)
- terms: [Differentiation syndrome](https://onco.cc/terms/differentiation-syndrome/)
- trials: [APL0406](https://onco.cc/trials/apl0406/), [Combination Chemotherapy, Biological Therapy, and Bone Marrow Transplantation in Treating Patients With Acute Myeloid Leukemia](https://onco.cc/trials/nct00002658/), [Investigating the Potential Role of a Novel Quadrate Combination Therapy Mifepristone(Antiprogestrone), Tamoxifen, Retinoic Acid and Cannabidiol ( Selective Cyp 26 Inhibitor) for Treating Early Breast Cancer](https://onco.cc/trials/nct05016349/), [Romiplostim N01 Plus ATRA for Persistent Isolated Chemotherapy-Induced Thrombocytopenia After Complete Remission of Gastrointestinal Solid Tumors](https://onco.cc/trials/nct07586813/)
- targets: [PML](https://onco.cc/targets/pml/), [Retinoic acid receptor alpha (RARA)](https://onco.cc/targets/rara/)
- people: [Janet Rowley](https://onco.cc/people/janet-rowley/), [Saijuan Chen](https://onco.cc/people/chen-saijuan/), [Zhu Chen](https://onco.cc/people/chen-zhu/)
- institutions: [Ruijin Hospital, Shanghai Jiao Tong University](https://onco.cc/institutions/ruijin-hospital/)
- drugs: [Isotretinoin](https://onco.cc/drugs/isotretinoin/)

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