Popular Combination Regimens

oncology in the clinicDoctors have determined specific combinations can be useful for specific types of cancer. Although trial-and-error is part of the process, rational choice of drugs is used to formulate combinations.

Some heuristics used to devise combinations include choosing drugs with different anti-cancer biochemical mechanisms, choosing drugs to overcome crosstalk among different metabolic pathways, choosing drugs that the body forms resistance to in different ways,  and choosing drugs with different patterns of dose-limiting toxic effects.

Related: companion diagnostics

Examples

Treatment of lung cancer often employs combination regimens. One accepted treatment for small cell lung cancer is the use of cisplatin and etoposide along with external radiation. Cisplatin and etoposide make a good team as they have different mechanisms of action and divergent toxicities.

Cisplatin disrupts cell replication by cross-linking DNA strands. While effective killers of cancer cells, platinum drugs are notorious for renal toxicity. Renal function must be monitored and patients should be well hydrated before treatment.

pharmacistEtoposide irreparably damages DNA and has a side effect profile typified by bone marrow suppression. Anemic etoposide patients have low red blood cell counts and neutropenic patients have low white blood cell counts due to bone marrow suppression. Neutropenic patients are at increased risk of infection as white blood cells are infection fighters. Anemic patients are often fatigued as red blood cells are required to carry oxygen throughout the body.

Cisplatin and etoposide have synergistic killing effects on cancer and unique side effect profiles making them a powerful combination in the treatment of lung cancer. Combination therapy is not just limited to drug combinations. As the treatment of lung cancer illustrates, radiation and surgery also play a major role in cancer treatment.

Regimen Constituent Medicines Application
7+3 Cytarabine, Daunorubicin, Idarubicin, Mitoxantrone Leukemia
ABVD Doxorubicin, Bleomycin, Vinblastine, Dacarbazine Hodgkin’s Disease
ABVE Doxorubicin, Bleomycin, Vincristine, Etoposide Hodgkin’s lymphoma
ABVE-PC Doxorubicin, Bleomycin, Vincristine, Etoposide, Prednisone, Cyclophosphamide Hodgkin’s lymphoma
AC Doxorubicin, Cyclophosphamide Breast cancer
AC-T Doxorubicin, Cyclophosphamide, Paclitaxel Breast cancer
AD Doxorubicin, Dacarbazine Sarcoma
ADE Cytarabine, Daunorubicin, Etoposide Leukemia
ADOC Cyclophosphamide, Cisplatin, Vincristine, Doxorubicin Thyroid Cancer
BEACOPP Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, Prednisone Advanced Hodgkin’s lymphoma
BEP Bleomycin, Etoposide, Cisplatin Ovarian and testicular germ cell tumors
BuMel Busulfan, Melphalan Neuroblastoma
CAF Cyclophosphamide, Doxorubicin, Fluorouracil Breast cancer
CAPIRI Capecitabine, Irinotecan Colorectal cancer
CAPOX Capecitabine, Oxaliplatin Advanced colorectal cancer
CB Cetuximab, Bevacizumab Colorectal cancer
CBI Cetuximab, Bevacizumab, Irinotecan Colorectal cancer
CEF Cyclophosphamide, Epirubicin, Fluorouracil Breast cancer
CEM Carboplatin, Etoposide, Melphalan Neuroblastoma
CEPP Cyclophosphamide, Etoposide, Procarbazine, Prednisone Lymphoma
CEV Carboplatin, Etoposide, Vincristine Retinoblastoma
CFAR Cyclophosphamide, Fludarabine, Alemtuzumab, Rituximab Leukemia
CHOP Doxorubicin, Vincristine, Prednisone Non-Hodgkin’s lymphoma
CHOP-R Cyclophosphamide, Doxorubicin. Vincristine, Prednisone, Rituximab Non-Hodgkin’s lymphoma
CIM Cisplatin, Ifosfamide Uterine Sarcoma
CMC Cladribine, Mitoxantrone, Cyclophosphamide Leukemia
CMF Cyclophosphamide, Methotrexate, Fluorouracil Breast cancer
CLAG Cladribine, Cytarabine Leukemia
CLAG-M Cladribine, Cytarabine, Mitoxantrone Leukemia
COPDAC Cyclophosphamide, Vincristine Prednisone, Dacarbazine Hodgkin Disease
COP or CVP Cyclophosphamide, Vincristine, Prednisone Leukemia, Lymphoma
COPP Cyclophosphamide, Vincristine, Procarbazine, Prednisone Hodgkin’s Disease, Non-Hodgkin lymphoma
COPP-APP Cyclophosphamide, Vincristine, Procarbazine, Prednisone. Doxorubicin, Bleomycin, Vinblastine Hodgkin’s Disease
CVP Cyclophosphamide, Vincristine, Prednisone Non-Hodgkin’s Lymphoma
DHAP Cisplatin, Cytarabine, Dexamethasone Lymphoma
DVD Doxorubicin, Vincristine, Dexamethasone Multiple Myeloma
ECF Epirubicin, Cisplatin, 5-Flourouracil Esophageal Cancer and Gastric Cancer
ECX Epirubicin, Oxaliplatin, Capecitabine Esophageal Cancer and Gastric Cancer
EOF Epirubicin, Oxaliplatin, 5-Flourouracil Esophageal Cancer and Gastric Cancer
EOX Epirubicin, Oxaliplatin, Capecitabine Esophageal Cancer and Gastric Cancer
EP Etoposide, Cisplatin Testicular Cancer and Thymoma
EPOCH Etoposide Phosphate, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin Aggressive forms of non-Hodgkin lymphoma, including mantle cell lymphoma
ESHAP Etoposide, Methylprednisolone, Cisplatin, Cytarabine Non-Hodgkin’s Lymphoma
FAMTX Methotrexate, 5-Fluorouracil, Doxorubicin Gastric Cancer
FC Fludarabine, Cyclophosphamide Leukemia
FEC Fluorouracil, Epirubicin, Cyclophosphamide. Breast cancer, including breast cancer that has spread or come back
FLAG-IDA Fludarabine, Cytarabine, Idarubicin Leukemia
FLO 5-Flourouracil, Leucovorin, Oxaliplatin Colorectal Cancer and Gastric Cancer
FLOX 5-Flourouracil, Leucovorin, Oxaliplatin Colorectal Cancer
FOLFIRI Leucovorin, Fluorouracil, Irinotecan Advanced Colorectal Cancer
FOLFIRINOX Leucovorin, Fluorouracil, Irinotecan, Oxaliplatin Pancreatic cancer
FOLFOX (incl. FOLFOX-4, FOLFOX-6, and FOLFOX-7) Leucovorin, Fluorouracil, Oxaliplatin Colorectal Cancer
FU-LV Fluorouracil, Leucovorin Colorectal Cancer, Esophageal Cancer
GEMOX Gemcitabin, Oxaliplatin Pancreatic Cancer
GEMOX-B Gemcitabin, Oxaliplatin, Bevacizumab Liver Cancer
GVD Gemcitabine, Vinorelbine, Doxorubicin Hodgkin’s Disease
Hyper-CVAD Cyclophosphamide, Doxorubicin, Vincristine, Dexamethasone Leukemia
ICE Ifosfamide, Carboplatin, Etoposide Hodgkin’s Disease, Non-Hodgkin’s Lymphoma
ICE-V Ifosfamide, Carboplatin, Etoposide, Vincristine Small Cell Lung Cancer
IFL Irinotecan, 5-Flourouracil, Leucovorin Colorectal Cancer
IROX Oxaliplatin, Irinotecan Colorectal Cancer
JEB Carboplatin, Etoposide, Bleomycin Ovarian Cancer
LV5FU2 5-Flourouracil, Leucovorin Colorectal Cancer
LV5FU-P 5-Flourouracil, Irinotecan, Leucovorin biliary cancer
MAID Mesnex, Doxorubicin, Ifosfamide, Dacarbazine Sarcomas
MFL Methotrexate, 5-Fluorouracil, Leucovorin Breast Cancer
MINE Ifosfamide, Mitoxantrone, Etoposide Sarcomas
MOPP Mechlorethamine, Vincristine, Procarbazine, Prednisone Hodgkin’s Disease
MP Melphalan, Prednisone Multiple Myeloma
MPV Methotrexate, Leucovorin, Procarbazine, Vincristine Lymphoma
MVAC Methotrexate, Vinblastine, Doxorubicin, Cisplatin Bladder cancer
OEPA Vincristine, Etoposide, Prednisone, Doxorubicin Hodgkin Disease
OFF Oxaliplatin, Fluorouracil, Leucovorin Pancreatic Cancer
PAC Cisplatin, Doxorubicin, Cyclophosphamide Lymphoma
PAD Bortezomib, Doxorubicin, Dexamethasone Myeloma
PCR Pentostatin, Cyclophosphamide, Rituximab Leukemia
PCV Procarbazine, Lomustine, Vincristine Brain tumors
PEB Cisplatin, Etoposide, Bleomycin Germ cell tumors
PEI Cisplatin, Etoposide, Ifosfamide
R-CHOP Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone Non-Hodgkin Lymphoma
R-CVP Cyclophosphamide, Vincristine, Prednisone, Rituximab Non-Hodgkin Lymphoma
R-FCM Cyclophosphamide, Rituximab, Fludarabine, Mitoxantrone Non-Hodgkin Lymphoma
R-MPV Rituximab, Methotrexate, Leucovorin, Procarbazine, Vincristine Lymphoma
R-EPOCH Rituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin Non-Hodgkin’s Lymphoma
R-GemOx Rituximab, Gemcitabine, Oxaliplatin Non-Hodgkin’s Lymphoma
RICE Rituximab, Ifosfamide, Carboplatin, Etoposide Non-Hodgkin’s Lymphoma
Stanford V Mechlorethamine, Doxorubicin, Vinblastine, Vincristine, Bleomycin, Etoposide, Prednisone Hodgkin’s Disease
TAC Docetaxel, Doxorubicin, Cyclophosphamide Breast Cancer
TC Docetaxel, Cyclophosphamide Breast Cancer
TCH Docetaxel, Carboplatin, Trastuzumab Breast Cancer
TIP Paclitaxel, Ifosfamide, Cisplatin Testicular Cancer
TPC Trastuzumab, Paclitaxel, Carboplatin Breast Cancer
TPF Docetaxel, Cisplatin, Fluorouracil Head and Neck Cancer
VAC Vincristine, Dactinomycin, Cyclophosphamide Rhabdomyosarcoma, Ovarian Germ Cell Tumors
VAD Vincristine, Doxorubicin, Dexamethasone Multiple Myeloma
VAMP Vincristine, Doxorubicin, Methotrexate, Prednisone Childhood Hodgkin’s Lymphoma
VMP Bortezomib, Melphalan, Prednisone Multiple Myeloma
VMPT Bortezomib, Melphalan, Prednisone, Thalidomide Multiple Myeloma
VeIP Vinblastine, Ifosfamide, Cisplatin Ovarian Cancer
VIP Etoposide, Ifosfamide, Cisplatin Testicular Cancer
XELIRI Capecitabine, Irinotecan Colorectal Cancer, Esophagal Cancer
XELOX Capecitabine, Oxaliplatin Colorectal Cancer