cisplatin + carboplatin + vinorelbine + pemetrexed

This is a combination chemotherapy regimen consisting of four antineoplastic agents—cisplatin, carboplatin, vinorelbine, and pemetrexed. All four are small molecule chemotherapeutic drugs with distinct but complementary mechanisms of action. Cisplatin and carboplatin are platinum-based compounds that induce DNA crosslinking and damage, leading to apoptosis in rapidly dividing cells. Vinorelbine is a vinca alkaloid that inhibits microtubule assembly, disrupting mitosis. Pemetrexed is an antifolate that inhibits multiple folate-dependent enzymes involved in nucleotide synthesis (including thymidylate synthase), thereby blocking DNA and RNA synthesis. This combination targets cancer cells through multiple cytotoxic pathways. The use of all four agents together as a single regimen is not standard clinical practice; however, each pairwise or triplet combination has been studied extensively for the treatment of non-small cell lung cancer (NSCLC), particularly in advanced or metastatic settings[1][2][4][5]. The rationale for combining these drugs would be to maximize cytotoxic efficacy by attacking tumor cells via different mechanisms while potentially increasing toxicity.