pomalidomide + liposomal doxorubicin + vincristine + dexamethasone

This is a four-drug combination regimen consisting of **pomalidomide** (an immunomodulatory agent), **liposomal doxorubicin** (an anthracycline cytotoxic agent formulated for improved pharmacokinetics and reduced cardiotoxicity), **vincristine** (a vinca alkaloid microtubule inhibitor), and **dexamethasone** (a synthetic glucocorticoid corticosteroid). The individual agents target multiple mechanisms: pomalidomide modulates the immune system and exerts anti-angiogenic/anti-myeloma effects; liposomal doxorubicin intercalates DNA and inhibits topoisomerase II, causing cytotoxicity; vincristine inhibits microtubule polymerization and arrests cell division in metaphase; dexamethasone induces apoptosis in lymphoid cells and modulates inflammation. This multi-agent regimen is under investigation in hematologic malignancies, such as relapsed or refractory multiple myeloma, and is a logical extension/modification of previously published regimens that combined immunomodulatory agents or thalidomide analogs with liposomal doxorubicin, vincristine, and dexamethasone[7][9][6][1].