pemetrexed + cisplatin + carboplatin + bevacizumab + durvalumab + SBRT

This combination regimen represents a multi-modal therapeutic approach primarily investigated for the treatment of advanced non-small cell lung cancer (NSCLC). It integrates cytotoxic chemotherapy (pemetrexed and platinum agents cisplatin or carboplatin), anti-angiogenic therapy (bevacizumab), and immunotherapy (durvalumab), often sequenced with stereotactic body radiation therapy (SBRT). Pemetrexed acts as an antifolate, inhibiting thymidylate synthase and other folate-dependent enzymes to disrupt DNA synthesis. Cisplatin and carboplatin are platinum-based agents that form DNA cross-links, inducing apoptosis. Bevacizumab is a monoclonal antibody that binds to vascular endothelial growth factor (VEGF), inhibiting tumor angiogenesis. Durvalumab is a checkpoint inhibitor that targets programmed cell death ligand 1 (PD-L1), preventing its interaction with PD-1 and B7.1 to restore T-cell anti-tumor activity. SBRT is utilized to provide ablative doses of radiation to specific tumor sites, potentially inducing an abscopal effect and enhancing the efficacy of the systemic immunotherapy.