etoposide + methotrexate + lomustine + cyclophosphamide + thiotepa

This combination involves five chemotherapy drugs: **etoposide**, **methotrexate**, **lomustine**, **cyclophosphamide**, and **thiotepa**. - **Etoposide** works by inhibiting topoisomerase II, an enzyme that allows cancer cells to grow and divide. It causes DNA double-strand breaks, leading to cell apoptosis[5]. - **Methotrexate** inhibits dihydrofolate reductase, essential for DNA synthesis, thereby preventing cancer cells from dividing[5]. - **Lomustine** is an alkylating agent that binds to DNA, causing cross-linking and preventing DNA replication[3]. - **Cyclophosphamide** is an alkylating agent that damages DNA through cross-linking, leading to cell death[3]. - **Thiotepa** is also an alkylating agent, similar to cyclophosphamide and lomustine, used to treat various cancers and in bone marrow transplantation conditioning[6][8].