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This is a six-drug combination regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone, and bortezomib. It combines agents from the R-CHOP protocol (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) with the addition of bortezomib. - **Rituximab** is a monoclonal antibody targeting CD20 on B lymphocytes and mediates cell lysis via immune mechanisms. - **Cyclophosphamide**, **doxorubicin**, and **vincristine** are cytotoxic chemotherapy agents that disrupt DNA synthesis or mitosis in rapidly dividing cells. - **Prednisone** is a corticosteroid that induces apoptosis in certain cancer cells and modulates immune response. - **Bortezomib** is a proteasome inhibitor that disrupts protein degradation pathways leading to apoptosis in malignant cells. This combination has been studied primarily for hematologic malignancies such as non-germinal center B-cell-like diffuse large B-cell lymphoma (non-GCB DLBCL) and mantle cell lymphoma (MCL), often as an experimental or alternative frontline therapy to standard regimens like R-CHOP or VR-CAP[1][4][6]. The rationale for adding bortezomib is to enhance efficacy by targeting additional cellular pathways involved in lymphoma pathogenesis.
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