cyclophosphamide + doxorubicin + vincristine + ibrutinib + cytarabine

This is a five-drug combination regimen that incorporates ibrutinib, a Bruton tyrosine kinase (BTK) inhibitor, with four chemotherapy agents. Cyclophosphamide is an alkylating agent that cross-links DNA, doxorubicin is an anthracycline that intercalates DNA and inhibits topoisomerase II, vincristine is a vinca alkaloid that inhibits microtubule formation, and cytarabine is a nucleoside analog that inhibits DNA synthesis. Ibrutinib irreversibly inhibits BTK by covalently binding to it, blocking B-cell receptor signaling pathways. This combination has been explored primarily in hematologic malignancies, particularly in aggressive B-cell lymphomas and leukemias where BTK signaling may play a role in disease pathogenesis.