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.

Regimen Constituent Medicines Application
ABVD Doxorubicin, Bleomycin, Vinblastine, Dacarbazine Hodgkin’s lymphoma
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
ADE Cytarabine, Daunorubicin, Etoposide Leukemia
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
CAPOX Capecitabine, Oxaliplatin Advanced colorectal cancer
CEM Carboplatin, Etoposide, Melphalan Neuroblastoma
CEV Carboplatin, Etoposide, Vincristine Retinoblastoma
CHOP Doxorubicin, Vincristine, 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.
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
EPOCH Etoposide Phosphate, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin Aggressive forms of non-Hodgkin lymphoma, including mantle cell lymphoma
FEC Fluorouracil, Epirubicin, Cyclophosphamide. Breast cancer, including breast cancer that has spread or come back
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
ICE Ifosfamide, Carboplatin, Etoposide Hodgkin’s Disease, Non-Hodgkin’s Lymphoma
JEB Carboplatin, Etoposide, Bleomycin Ovarian Cancer
MAID Mesnex, Doxorubicin, Ifosfamide, Dacarbazine Sarcomas
MOPP Mechlorethamine, Vincristine, Procarbazine, Prednisone Hodgkin’s Disease
MVAC Methotrexate, Vinblastine, Doxorubicin, Cisplatin Bladder cancer
OEPA Vincristine, Etoposide, Prednisone, Doxorubicin Hodgkin Disease
OFF Oxaliplatin, Fluorouracil, Leucovorin Pancreatic Cancer
PAD Bortezomib, Doxorubicin, Dexamethasone Myeloma
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’s Lymphoma
R-EPOCH Rituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin 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
TPF Docetaxel, Cisplatin, Fluorouracil Head and Neck Cancer
XELIRI Capecitabine, Irinotecan Stomach Cancer
XELOX Capecitabine, Oxaliplatin Colorectal Cancer
VAC Vincristine, Dactinomycin, Cyclophosphamide Rhabdomyosarcoma, Ovarian Germ Cell Tumors
VAMP Vincristine, Doxorubicin, Methotrexate, Prednisone Childhood Hodgkin’s Lymphoma
VeIP Vinblastine, Ifosfamide, Cisplatin Ovarian Cancer
VIP Etoposide, Ifosfamide, Cisplatin Testicular Cancer
XELIRI Capecitabine, Irinotecan Colorectal Cancer, Esophagal Cancer
Capecitabine, Oxaliplatin Colorectal Cancer

Rational Selection of Combination Constituents

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.