Popular Combination Regimens

Doctors 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.

Regimen Constituent Medicines Application
ABVD Doxorubicin hydrochloride (Adriamycin), Bleomycin, Vinblastine, Dacarbazine Hodgkin’s lymphoma
AC Doxorubicin hydrochloride (Adriamycin), Cyclophosphamide Breast cancer, including breast cancer that has spread or returned
BEACOPP Bleomycin Sulfate, Etoposide Phosphate, Doxorubicin Hydrochloride (Adriamycin), Cyclophosphamide, Vincristine Sulfate (Oncovin), Procarbazine Hydrochloride, Prednisone Advanced Hodgkin’s lymphoma
BEP Bleomycin Sulfate, Etoposide Phosphate, Cisplatin Ovarian and testicular germ cell tumors
CAF Cyclophosphamide, Doxorubicin hydrochloride, Fluorouracil Breast cancer
CAPOX Capecitabine, Oxaliplatin Advanced colorectal cancer
CHOP Doxorubicin, Hydrochloride (hydroxydaunorubicin), Vincristine Sulfate, Prednisone. Non-Hodgkin lymphoma
CMF Cyclophosphamide, Methotrexate, Fluorouracil Breast cancer
CMV A virus that may be carried in an inactive state for life by healthy individuals. It is a cause of severe pneumonia in people with a suppressed immune system, such as those undergoing bone marrow transplantation or those with leukemia or lymphoma.
COP or CVP Cyclophosphamide, Vincristine Sulfate, Prednisone Slow-growing forms of Non-Hodgkin Lymphoma (NHL), Chronic Lymphocytic Leukemia (CLL)
COPP Cyclophosphamide, Vincristine Sulfate (Oncovin), Procarbazine Hydrochloride, Prednisone Hodgkin’s Disease, Non-Hodgkin lymphoma
EPOCH Etoposide Phosphate, Prednisone, Vincristine Sulfate (Oncovin), Cyclophosphamide, Doxorubicin Hydrochloride (Hydroxydaunorubicin). Aggressive forms of non-Hodgkin lymphoma, including mantle cell lymphoma.
FEC Fluorouracil, Epirubicin Hydrochloride, Cyclophosphamide. Breast cancer, including breast cancer that has spread or come back
FOLFIRI Leucovorin Calcium (Folinic Acid), Fluorouracil, Irinotecan Hydrochloride. Advanced Colorectal Cancer that has spread
FOLFIRINOX Leucovorin Calcium, Fluorouracil, Irinotecan Hydrochloride, Oxaliplatin Pancreatic cancer that has spread to other parts of the body
FOLFOX (incl. FOLFOX-4, FOLFOX-6, and FOLFOX-7 Leucovorin Calcium (Folinic Acid), Fluorouracil, Oxaliplatin Colorectal Cancer
GEMOX Gemcitabine Hydrochloride, Oxaliplatin Pancreatic Cancer
ICE Ifosfamide, Carboplatin, Etoposide Phosphate Hodgkin’s Disease, Non-Hodgkin’s Lymphoma
MAID Mesnex, Doxorubicin, Ifosfamide, Dacarbazine Sarcomas
MOPP Mechlorethamine Hydrochloride, Vincristine Sulfate (Oncovin), Procarbazine Hydrochloride, Prednisone Hodgkin’s Disease
PCV Procarbazine Hydrochloride, Lomustine (CCNU), Vincristine Sulfate Certain types of brain tumors.
PEB Cisplatin (Platinol), Etoposide Phosphate, Bleomycin Sulfate Certain types of malignant (cancer) germ cell tumors that are not in the brain.
PEI It is also called alcohol ablation, ethanol ablation, and percutaneous ethanol injection. Drugs in regimen: An injection of ethanol (alcohol) through the skin directly into a tumor to kill cancer cells.
Stanford V Mechlorethamine, Doxorubicin Hydrochloride, Vinblastine Sulfate, Vncristine Sulfate, Bleomycin Sulfate, Etoposide Phosphate, Prednisone Hodgkin’s Disease.
TAC Docetaxel (Taxotere), Doxorubicin Hydrochloride (Adriamycin), Cyclophosphamide Breast Cancer
XELOX Capecitabine (Xeloda), Oxaliplatin Colorectal Cancer
VAC Vincristine Sulfate, Dactinomycin (Actinomycin-D), Cyclophosphamide Rhabdomyosarcoma in Children, Certain types of Ovarian Germ Cell Tumors
VAMP Vincristine Sulfate, Doxorubicin Hydrochloride (Adriamycin), Methotrexate, Prednisone Childhood Hodgkins Lymphoma
VAC Vincristine Sulfate, Dactinomycin (Actinomycin-D), Cyclophosphamide Rhabdomyosarcoma in Children, Certain types of Ovarian Germ Cell Tumors
VIP Etoposide (VePesid), Ifosfamide, Cisplatin Advanced Testicular Cancer

Rational Selection of Combination Constituents

Some heuristics used to devise combinations include choosing drugs with different anti-cancer biochemical mechanisms, choosing drugs the 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.

Etoposide 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.