epirubicin + cisplatin + S-1

Epirubicin + cisplatin + S-1 is a combination chemotherapy regimen used primarily in the treatment of advanced or metastatic gastric cancer. This regimen combines three agents with distinct mechanisms of action: - Epirubicin is an anthracycline antibiotic that intercalates DNA, inhibiting topoisomerase II and leading to DNA strand breaks and apoptosis. - Cisplatin is a platinum-based compound that forms DNA crosslinks, disrupting DNA replication and transcription, ultimately causing cell death. - S-1 is an oral fluoropyrimidine derivative composed of tegafur (a prodrug of 5-fluorouracil), gimeracil (an inhibitor of dihydropyrimidine dehydrogenase to increase 5-FU bioavailability), and oteracil (to reduce gastrointestinal toxicity). It inhibits thymidylate synthase, impairing DNA synthesis. This combination aims to maximize antitumor efficacy by targeting cancer cells through multiple cytotoxic pathways. The regimen has been investigated as a first-line therapy for advanced gastric cancer, offering the convenience of oral administration for the fluoropyrimidine component compared to traditional intravenous 5-FU regimens.