irinotecan + gemcitabine + capecitabine

A combination chemotherapy regimen comprising irinotecan, gemcitabine, and capecitabine—three cytotoxic agents with different mechanisms of action. Irinotecan is a DNA topoisomerase I inhibitor that leads to double-stranded DNA breaks and apoptosis in rapidly dividing cells. Gemcitabine is a nucleoside analog that is incorporated into DNA during replication, causing chain termination and inhibiting DNA synthesis. Capecitabine is an oral prodrug of 5-fluorouracil (5-FU) that inhibits thymidylate synthase, thereby preventing DNA synthesis and cell replication. This combination is used experimentally and in clinical trials, primarily for advanced or metastatic pancreatic cancer, biliary tract cancer, and occasionally other gastrointestinal malignancies. Each drug is approved individually, but this three-drug combination is investigated for synergistic effects and improved disease control in patients not responding adequately to standard regimens[1][4].