cisplatin + doxorubicin + methotrexate + bleomycin

This is an unbranded four-drug cytotoxic chemotherapy combination comprising cisplatin, doxorubicin, methotrexate, and bleomycin, occasionally used as an intensified antineoplastic regimen in solid tumors or germ cell malignancies when multi-agent platinum-, anthracycline-, antimetabolite-, and bleomycin-based therapy is desired. Cisplatin is a platinum coordination complex that forms intra‑ and interstrand DNA crosslinks, triggering apoptosis; doxorubicin is an anthracycline that intercalates into DNA, inhibits topoisomerase II, and generates free radicals; methotrexate is an antifolate antimetabolite that inhibits dihydrofolate reductase and thymidylate/purine synthesis, blocking DNA replication; and bleomycin is a glycopeptide antibiotic that chelates metal ions and induces DNA strand breaks via free radical formation. The combination leverages non‑overlapping mechanisms to increase cytotoxicity against rapidly dividing cancer cells at the cost of additive myelosuppression and organ‑specific toxicities (notably nephrotoxicity and ototoxicity from cisplatin, cardiomyopathy from doxorubicin, mucositis and myelosuppression from methotrexate, and pulmonary toxicity from bleomycin).