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.

RegimenConstituent MedicinesApplication
7+3Cytarabine, Daunorubicin, Idarubicin, MitoxantroneLeukemia
ABVDDoxorubicin, Bleomycin, Vinblastine, DacarbazineHodgkin’s Disease
ABVEDoxorubicin, Bleomycin, Vincristine, EtoposideHodgkin’s lymphoma
ABVE-PCDoxorubicin, Bleomycin, Vincristine, Etoposide, Prednisone, CyclophosphamideHodgkin’s lymphoma
ACDoxorubicin, CyclophosphamideBreast cancer
AC-TDoxorubicin, Cyclophosphamide, PaclitaxelBreast cancer
ADDoxorubicin, DacarbazineSarcoma
ADECytarabine, Daunorubicin, EtoposideLeukemia
ADOCCyclophosphamide, Cisplatin, Vincristine, DoxorubicinThyroid Cancer
BEACOPPBleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, PrednisoneAdvanced Hodgkin’s lymphoma
BEPBleomycin, Etoposide, CisplatinOvarian and testicular germ cell tumors
BuMelBusulfan, MelphalanNeuroblastoma
CAFCyclophosphamide, Doxorubicin, FluorouracilBreast cancer
CAPIRICapecitabine, IrinotecanColorectal cancer
CAPOXCapecitabine, OxaliplatinAdvanced colorectal cancer
CBCetuximab, BevacizumabColorectal cancer
CBICetuximab, Bevacizumab, IrinotecanColorectal cancer
CEFCyclophosphamide, Epirubicin, FluorouracilBreast cancer
CEMCarboplatin, Etoposide, MelphalanNeuroblastoma
CEPPCyclophosphamide, Etoposide, Procarbazine, PrednisoneLymphoma
CEVCarboplatin, Etoposide, VincristineRetinoblastoma
CFARCyclophosphamide, Fludarabine, Alemtuzumab, RituximabLeukemia
CHOPDoxorubicin, Vincristine, PrednisoneNon-Hodgkin’s lymphoma
CHOP-RCyclophosphamide, Doxorubicin. Vincristine, Prednisone, RituximabNon-Hodgkin’s lymphoma
CIMCisplatin, IfosfamideUterine Sarcoma
CMCCladribine, Mitoxantrone, CyclophosphamideLeukemia
CMFCyclophosphamide, Methotrexate, FluorouracilBreast cancer
CLAGCladribine, CytarabineLeukemia
CLAG-MCladribine, Cytarabine, MitoxantroneLeukemia
COPDACCyclophosphamide, Vincristine Prednisone, DacarbazineHodgkin Disease
COP or CVPCyclophosphamide, Vincristine, PrednisoneLeukemia, Lymphoma
COPPCyclophosphamide, Vincristine, Procarbazine, PrednisoneHodgkin’s Disease, Non-Hodgkin lymphoma
COPP-APPCyclophosphamide, Vincristine, Procarbazine, Prednisone. Doxorubicin, Bleomycin, VinblastineHodgkin’s Disease
CVPCyclophosphamide, Vincristine, PrednisoneNon-Hodgkin’s Lymphoma
DHAPCisplatin, Cytarabine, DexamethasoneLymphoma
DVDDoxorubicin, Vincristine, DexamethasoneMultiple Myeloma
ECFEpirubicin, Cisplatin, 5-FlourouracilEsophageal Cancer and Gastric Cancer
ECXEpirubicin, Oxaliplatin, CapecitabineEsophageal Cancer and Gastric Cancer
EOFEpirubicin, Oxaliplatin, 5-FlourouracilEsophageal Cancer and Gastric Cancer
EOXEpirubicin, Oxaliplatin, CapecitabineEsophageal Cancer and Gastric Cancer
EPEtoposide, CisplatinTesticular Cancer and Thymoma
EPOCHEtoposide Phosphate, Prednisone, Vincristine, Cyclophosphamide, DoxorubicinAggressive forms of non-Hodgkin lymphoma, including mantle cell lymphoma
ESHAPEtoposide, Methylprednisolone, Cisplatin, CytarabineNon-Hodgkin’s Lymphoma
FAMTXMethotrexate, 5-Fluorouracil, DoxorubicinGastric Cancer
FCFludarabine, CyclophosphamideLeukemia
FECFluorouracil, Epirubicin, Cyclophosphamide.Breast cancer, including breast cancer that has spread or come back
FLAG-IDAFludarabine, Cytarabine, IdarubicinLeukemia
FLO5-Flourouracil, Leucovorin, OxaliplatinColorectal Cancer and Gastric Cancer
FLOX5-Flourouracil, Leucovorin, OxaliplatinColorectal Cancer
FOLFIRILeucovorin, Fluorouracil, IrinotecanAdvanced Colorectal Cancer
FOLFIRINOXLeucovorin, Fluorouracil, Irinotecan, OxaliplatinPancreatic cancer
FOLFOX (incl. FOLFOX-4, FOLFOX-6, and FOLFOX-7)Leucovorin, Fluorouracil, OxaliplatinColorectal Cancer
FU-LVFluorouracil, LeucovorinColorectal Cancer, Esophageal Cancer
GEMOXGemcitabin, OxaliplatinPancreatic Cancer
GEMOX-BGemcitabin, Oxaliplatin, BevacizumabLiver Cancer
GVDGemcitabine, Vinorelbine, DoxorubicinHodgkin’s Disease
Hyper-CVADCyclophosphamide, Doxorubicin, Vincristine, DexamethasoneLeukemia
ICEIfosfamide, Carboplatin, EtoposideHodgkin’s Disease, Non-Hodgkin’s Lymphoma
ICE-VIfosfamide, Carboplatin, Etoposide, VincristineSmall Cell Lung Cancer
IFLIrinotecan, 5-Flourouracil, LeucovorinColorectal Cancer
IROXOxaliplatin, IrinotecanColorectal Cancer
JEBCarboplatin, Etoposide, BleomycinOvarian Cancer
LV5FU25-Flourouracil, LeucovorinColorectal Cancer
LV5FU-P5-Flourouracil, Irinotecan, Leucovorinbiliary cancer
MAIDMesnex, Doxorubicin, Ifosfamide, DacarbazineSarcomas
MFLMethotrexate, 5-Fluorouracil, LeucovorinBreast Cancer
MINEIfosfamide, Mitoxantrone, EtoposideSarcomas
MOPPMechlorethamine, Vincristine, Procarbazine, PrednisoneHodgkin’s Disease
MPMelphalan, PrednisoneMultiple Myeloma
MPVMethotrexate, Leucovorin, Procarbazine, VincristineLymphoma
MVACMethotrexate, Vinblastine, Doxorubicin, CisplatinBladder cancer
OEPAVincristine, Etoposide, Prednisone, DoxorubicinHodgkin Disease
OFFOxaliplatin, Fluorouracil, LeucovorinPancreatic Cancer
PACCisplatin, Doxorubicin, CyclophosphamideLymphoma
PADBortezomib, Doxorubicin, DexamethasoneMyeloma
PCRPentostatin, Cyclophosphamide, RituximabLeukemia
PCVProcarbazine, Lomustine, VincristineBrain tumors
PEBCisplatin, Etoposide, BleomycinGerm cell tumors
PEICisplatin, Etoposide, Ifosfamide
R-CHOPRituximab, Cyclophosphamide, Doxorubicin, Vincristine, PrednisoneNon-Hodgkin Lymphoma
R-CVPCyclophosphamide, Vincristine, Prednisone, RituximabNon-Hodgkin Lymphoma
R-FCMCyclophosphamide, Rituximab, Fludarabine, MitoxantroneNon-Hodgkin Lymphoma
R-MPVRituximab, Methotrexate, Leucovorin, Procarbazine, VincristineLymphoma
R-EPOCHRituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide, DoxorubicinNon-Hodgkin’s Lymphoma
R-GemOxRituximab, Gemcitabine, OxaliplatinNon-Hodgkin’s Lymphoma
RICERituximab, Ifosfamide, Carboplatin, EtoposideNon-Hodgkin’s Lymphoma
Stanford VMechlorethamine, Doxorubicin, Vinblastine, Vincristine, Bleomycin, Etoposide, PrednisoneHodgkin’s Disease
TACDocetaxel, Doxorubicin, CyclophosphamideBreast Cancer
TCDocetaxel, CyclophosphamideBreast Cancer
TCHDocetaxel, Carboplatin, TrastuzumabBreast Cancer
TIPPaclitaxel, Ifosfamide, CisplatinTesticular Cancer
TPCTrastuzumab, Paclitaxel, CarboplatinBreast Cancer
TPFDocetaxel, Cisplatin, FluorouracilHead and Neck Cancer
VACVincristine, Dactinomycin, CyclophosphamideRhabdomyosarcoma, Ovarian Germ Cell Tumors
VADVincristine, Doxorubicin, DexamethasoneMultiple Myeloma
VAMPVincristine, Doxorubicin, Methotrexate, PrednisoneChildhood Hodgkin’s Lymphoma
VMPBortezomib, Melphalan, PrednisoneMultiple Myeloma
VMPTBortezomib, Melphalan, Prednisone, ThalidomideMultiple Myeloma
VeIPVinblastine, Ifosfamide, CisplatinOvarian Cancer
VIPEtoposide, Ifosfamide, CisplatinTesticular Cancer
XELIRICapecitabine, IrinotecanColorectal Cancer, Esophagal Cancer
XELOXCapecitabine, OxaliplatinColorectal Cancer