dexamethasone + floxuridine + irinotecan + oxaliplatin

This is a multi-agent chemotherapy regimen combining four drugs—dexamethasone, floxuridine, irinotecan, and oxaliplatin—used primarily in the treatment of metastatic colorectal cancer with liver involvement. The regimen typically involves hepatic arterial infusion (HAI) of floxuridine and dexamethasone to target liver metastases directly, while systemic administration of irinotecan and oxaliplatin addresses both local and extrahepatic disease. - **Dexamethasone** is a synthetic glucocorticoid used for its anti-inflammatory and immunosuppressive effects as well as to reduce chemotherapy-induced side effects. - **Floxuridine** is an antimetabolite that inhibits DNA synthesis by acting as a pyrimidine analog. - **Irinotecan** is a topoisomerase I inhibitor that prevents DNA replication in cancer cells. - **Oxaliplatin** is a platinum-based chemotherapeutic agent that causes DNA crosslinking leading to apoptosis. This combination has been studied in patients with unresectable or previously treated colorectal liver metastases. Clinical trials have shown promising response rates (up to 90% partial/complete remission in some studies), improved median survival times, but also notable toxicities such as diarrhea, neutropenia, neurotoxicity, and hepatotoxicity[1][6][9]. The regimen remains investigational but has been explored for both adjuvant therapy after resection and for unresectable disease.