bortezomib + rituximab + cyclophosphamide + doxorubicin + prednisone

This is a five-drug combination regimen consisting of bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone. It is used as an immunochemotherapy protocol for the treatment of certain hematologic malignancies, particularly non-Hodgkin lymphomas such as mantle cell lymphoma and previously untreated diffuse large B-cell lymphoma. The regimen combines multiple mechanisms of action: - Bortezomib is a proteasome inhibitor that disrupts protein degradation pathways in cancer cells. - Rituximab is a monoclonal antibody targeting CD20 on B-cells, leading to their destruction. - Cyclophosphamide and doxorubicin are cytotoxic chemotherapeutic agents with alkylating and DNA intercalation/topoisomerase II inhibition activity respectively. - Prednisone is a corticosteroid with anti-inflammatory and lympholytic effects. The combination aims to maximize antitumor efficacy by attacking malignant cells through complementary mechanisms—targeted immunotherapy (rituximab), proteasome inhibition (bortezomib), direct cytotoxicity (cyclophosphamide/doxorubicin), and immune modulation (prednisone). This regimen has been approved in Europe for the treatment of adult patients with previously untreated mantle cell lymphoma[6].