cisplatin + nimustine + temozolomide

This is a combination chemotherapy regimen consisting of three small-molecule alkylating agents—cisplatin, nimustine (also known as ACNU), and temozolomide. Each drug has a distinct but complementary mechanism of action targeting DNA in cancer cells, leading to cell death. Cisplatin forms DNA crosslinks that inhibit DNA replication and transcription; nimustine is a nitrosourea that alkylates and carbamoylates DNA and RNA; temozolomide methylates guanine residues in DNA, resulting in cytotoxicity. This combination has been studied primarily for the treatment of newly diagnosed glioblastoma, where it is used as neoadjuvant chemotherapy (cisplatin + nimustine) prior to radiotherapy followed by adjuvant temozolomide[1]. The rationale for combining these agents is to exploit their synergistic effects on tumor cell killing while attempting to overcome resistance mechanisms seen with single-agent therapy. However, this regimen has shown significant toxicity concerns[1].