bevacizumab + carmustine + temozolomide

This is a combination therapy consisting of three agents—bevacizumab, carmustine, and temozolomide—used primarily in the treatment of glioblastoma (GBM) and other high-grade gliomas. Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), inhibiting angiogenesis and thereby restricting tumor blood supply. Carmustine is an alkylating nitrosourea compound that crosslinks DNA and RNA, leading to cytotoxicity in rapidly dividing tumor cells; it can be administered intravenously or as an implantable wafer during surgery. Temozolomide is an oral alkylating agent that methylates DNA at the O6 position of guanine, resulting in apoptosis of cancer cells. The combination aims to maximize antitumor efficacy by targeting both tumor cell proliferation (carmustine, temozolomide) and the supporting vasculature (bevacizumab). Clinical studies have shown this regimen may improve progression-free survival and overall survival compared to standard therapies for newly diagnosed or recurrent GBM[6][8]. Toxicities are generally manageable but may include hematologic suppression, infection risk (notably with carmustine wafers), fatigue, thrombocytopenia, neutropenia, anemia, leukopenia, and rare events such as stroke[5][6][8].