Acute promyelocytic leukaemia: novel insights into the mechanisms of cure

The fusion oncogene, promyelocytic leukaemia (PML)-retinoic acid receptor-alpha (RARA), initiates acute promyelocytic leukaemia (APL) through both a block to differentiation and increased self-renewal of leukaemic progenitor cells. The current standard of care is retinoic acid (RA) and chemotherapy, but arsenic trioxide also cures many patients with APL, and an RA plus arsenic trioxide combination cures most patients. This Review discusses the recent evidence that reveals surprising new insights into how RA and arsenic trioxide cure this leukaemia, by targeting PML-RAR alpha for degradation. Drug-triggered oncoprotein degradation may be a strategy that is applicable to many cancers.