Cisplatin, Doxorubicin, Etoposide, Vincristine

This combination chemotherapy regimen consists of cisplatin, doxorubicin, etoposide, and vincristine. It is sometimes referred to as CODE (cisplatin, vincristine, doxorubicin, etoposide) plus granulocyte colony-stimulating factor (G-CSF). It has been studied primarily for the treatment of non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). ## Dosing and Administration The CODE regimen typically consists of: - Cisplatin: 25 mg/m², administered weekly (weeks 1 through 9) - Vincristine: 1 mg/m², administered on weeks 1, 2, 4, 6, and 8 - Doxorubicin: 40 mg/m², administered on weeks 1, 3, 5, 7, and 9 - Etoposide: 80 mg/m² intravenously on day 1 and 160 mg/m² orally on days 2 and 3 during weeks 1, 3, 5, 7, and 9 In some protocols, granulocyte colony-stimulating factor (G-CSF) at 5 μg/kg is administered subcutaneously on days when patients are not receiving chemotherapy to help manage hematologic toxicities. ## Clinical Efficacy In a phase II trial for advanced or metastatic non-small-cell lung cancer, the CODE regimen showed: - Overall response rate of 24% (95% confidence interval, 12%-39%) - Median survival of 7.1 months The researchers concluded that the CODE chemotherapy regimen has activity similar to other previously described cisplatin-based regimens but with significant toxicity. For small-cell lung cancer, various combinations of these agents have been studied, including: - CAV (cyclophosphamide, doxorubicin, vincristine) followed by consolidation with cisplatin and etoposide - EP (cisplatin and etoposide) compared with CAV - Alternating CAV and EP regimens ## Toxicity Profile The principal toxicities observed with this combination include: **Hematologic toxicities:** - Grade 3-4 anemia - Grade 3-4 thrombocytopenia - Grade 3-4 neutropenia - Neutropenic febrile episodes requiring antibiotics **Non-hematologic toxicities:** - Weight loss - Fatigue - Nausea/vomiting - Peripheral neuropathy - Alopecia ## Alternative Combinations The search results also mention related combination regimens that use some of these agents: - CAV (cyclophosphamide, doxorubicin, vincristine) - EP (cisplatin and etoposide) - Cisplatin, etoposide, and vincristine (without doxorubicin) Based on the available evidence, the CODE regimen has shown moderate activity in non-small cell lung cancer but with significant toxicity concerns that may limit its widespread use.

Other names

cisplatin, doxorubicin, etoposide, and vincristine combination chemotherapy regimen