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This is a multi-agent combination chemotherapy regimen consisting of five components: - 5-fluorouracil (5-FU): an antimetabolite that inhibits thymidylate synthase, disrupting DNA synthesis and repair. - Leucovorin (folinic acid): enhances the binding of 5-FU to thymidylate synthase, increasing its cytotoxicity. - Doxorubicin: an anthracycline antibiotic that intercalates into DNA and inhibits topoisomerase II, leading to DNA strand breaks. - Cyclophosphamide: an alkylating agent that crosslinks DNA strands, preventing cell division and causing apoptosis. - Granulocyte-macrophage colony-stimulating factor (GM-CSF): a cytokine used as supportive care to stimulate white blood cell production and reduce chemotherapy-induced neutropenia. This combination has been studied primarily in advanced breast cancer. The addition of GM-CSF aims to ameliorate hematologic toxicity from the intensive chemotherapy regimen[1][2][3]. The regimen is sometimes referred to as "FLAC" (for the four chemotherapeutic agents) plus GM-CSF.
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