doxorubicin + l-asparaginase + methotrexate + prednisone

A multi-agent chemotherapy combination comprising the anthracycline antineoplastic doxorubicin, the enzyme L-asparaginase, the antifolate antimetabolite methotrexate, and the glucocorticoid prednisone. This combination leverages complementary mechanisms: doxorubicin intercalates DNA and inhibits topoisomerase II to induce DNA breaks; L-asparaginase depletes extracellular asparagine, selectively starving leukemic lymphoblasts; methotrexate inhibits dihydrofolate reductase and thymidylate/purine synthesis to block DNA replication; and prednisone induces lymphoid apoptosis via glucocorticoid receptor activation. Such agents are widely used in acute lymphoblastic leukemia regimens, where L-asparaginase has documented synergistic schedule-dependent activity with methotrexate, and anthracyclines plus steroids are standard backbones in ALL therapy[1][4].