We recently had a patient with acute promyelocytic leukemia (APL) whose treatment plan included tretinoin. Our research on the drug showed it to be the same medication that is used for the treatment of acne. Is the formulation of tretinoin used to treat APL the same as that used to treat acne? —Angie Caton, RN
The formulations used to treat APL and acne are not the same. The oral formulation of tretinoin (Vesanoid) is used to treat acute promyelocytic leukemia.1,2 The topical formulation of tretinoin, which is sold under several brand names, is used to treat acne vulgaris and keratosis pilaris.
Tretinoin binds to one or more nuclear receptors, and decreases proliferation and induces differentiation of APL cells. It enhances maturation of promyelocytes, repopulating bone marrow and blood with normal hematopoietic cells to help achieve complete remission. As Vesanoid, the drug is available in 10 mg capsules for oral administration. Doses for remission induction are 45mg/m2/day in two divided doses.1,2
Isotretinoin (Accutane) is also a formulation commonly used in acne therapy. Its use in oncology is limited to investigational use in pediatric oncology patients, specifically in patients with high risk neuroblastoma.3,4 Tretinoin (all-trans retinoic acid) and isotretinion (13-cis retenoic acid) are classified as retinoids. —Sandra Cuellar, PharmD, BCOP
1. Ohno R. All-trans retinoic acid (Tretinoin) [in Japanese]. Gan To Kagaku Ryoho. 1997;24(6):741-746.
2. National Comprehensive Cancer Network. Acute myeloid leukemia. Version 2.2012. http://www.nccn.org/professionals/physician_gls/pdf/aml.pdf. Accessed September 17, 2012.
3. Bauters TG, Laureys G, Van de Velde V, et al. Practical implications for the administration of 13-cis retinoic acid in pediatric oncology. Int J Clin Pharm. 2011;33(4):597-598.
4. Veal GJ, Cole M, Errington J, et al; UKCCSG Pharmacology Working Group. Pharmacokinetics and metabolism of 13-cis-retinoic acid (isotretinoin) in children with high-risk neuroblastoma—a study of the United Kingdom Children’s Cancer Study Group. Br J Cancer. 2007;96(3):424-431.