bevacizumab + lomustine + procarbazine + temozolomide

This is a combination regimen consisting of four drugs—bevacizumab, lomustine, procarbazine, and temozolomide—used in the treatment of high-grade gliomas such as glioblastoma multiforme. Each component has a distinct mechanism: - **Bevacizumab** is a monoclonal antibody that inhibits vascular endothelial growth factor A (VEGF-A), thereby blocking angiogenesis (the formation of new blood vessels) essential for tumor growth. - **Lomustine** and **procarbazine** are alkylating agents that damage DNA and inhibit cancer cell replication. Lomustine is a nitrosourea compound, while procarbazine is part of the methylhydrazine class. - **Temozolomide** is an oral alkylating agent that methylates DNA at the O6 and N7 positions of guanine, leading to cytotoxicity in rapidly dividing tumor cells. This combination does not have an established unique brand name or code name; it represents an off-label or investigational multi-agent chemotherapy protocol. The regimen may be considered for recurrent or progressive glioblastoma after standard therapy failure. While combinations like bevacizumab plus lomustine or PCV (procarbazine, lomustine, vincristine) are more commonly studied and used[2][5][6], there are reports and clinical interest in combining these agents with temozolomide for aggressive disease management[6]. Evidence suggests improved progression-free survival with some combinations but no clear overall survival benefit when bevacizumab is added to nitrosoureas like lomustine[1][7][10].