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Background: Arsenic compounds are among the most toxic substances used in medicine, yet arsenic trioxide is now a curative first-line drug for acute promyelocytic leukaemia (APL), and an oral realgar-based formula from traditional Chinese medicine has matched it in a randomised trial. Ayurveda uses several arsenic minerals, notably Haratala (orpiment), Manahshila (realgar) and Gauri pashana or Somala (arsenic trioxide), in formulations such as Rasamanikya and Malla sindura. Objective: To bring together the modern pharmacology of arsenic in APL and the evidence on Ayurvedic arsenical formulations, and to identify what would be needed to evaluate the latter as cancer therapies. Methods: An integrative narrative review of clinical and mechanistic literature on arsenic trioxide and oral arsenic sulphide in APL, and of pharmaceutical, analytical, toxicological and clinical studies of Ayurvedic arsenicals. Results: Arsenic trioxide induces degradation of the PML-RARα oncoprotein and, combined with all-trans retinoic acid, cures most patients with standard-risk APL. Oral tetra-arsenic tetra-sulphide was non-inferior to intravenous arsenic trioxide in a multicentre randomised trial. Ayurvedic arsenicals have been standardised pharmaceutically; Rasamanikya, for example, contains about 55% arsenic. However, no clinical or preclinical study of an Ayurvedic arsenical in APL was identified, and case reports document chronic arsenic poisoning after long-term use of Ayurvedic medicines. Conclusion: The APL story shows that a traditional arsenical can become an evidence-based therapy, but only through characterisation, mechanistic work and controlled trials. Ayurvedic arsenicals have not yet been tested on this path, and their use in cancer outside research settings is not supported.