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The combination of etoposide, fluorouracil (also known as 5-fluorouracil or 5-FU), and levofolinic acid (the active isomer of folinic acid/leucovorin) is a chemotherapy regimen commonly referred to as the ELF regimen. This combination has been used primarily in the treatment of advanced gastric cancer and other gastrointestinal malignancies. - **Etoposide** is a topoisomerase II inhibitor that induces DNA strand breaks and prevents cell division in rapidly dividing cells. - **Fluorouracil** is an antimetabolite that inhibits thymidylate synthase, disrupting DNA synthesis. - **Levofolinic acid** enhances the binding of fluorouracil to thymidylate synthase, increasing its cytotoxicity; it does not have direct anticancer activity but potentiates the effect of fluorouracil. The ELF regimen has demonstrated moderate efficacy with manageable toxicity profiles in clinical studies for advanced gastric cancer[1][2]. Levofolinic acid may also be referred to as leucovorin or folinic acid; it is used interchangeably with its racemic form in clinical practice[4][5].
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