vincristine + cyclophosphamide + etoposide

Regimen 2 is a combination chemotherapy protocol utilized by Baylor College of Medicine for the treatment of brain tumors in infants and young children under three years of age. This specific regimen consists of systemic administration of vincristine, cyclophosphamide, and oral etoposide, typically delivered in alternating cycles (Cycle C and Cycle D). The protocol is designed to provide intensive systemic therapy while minimizing the need for high-dose craniospinal radiation, which can cause significant neurocognitive side effects in very young patients. In clinical trial settings, such as NCT00052429, Regimen 2 is often supported by cytoprotective agents like mesna to prevent hemorrhagic cystitis and granulocyte colony-stimulating factors (G-CSF) to manage treatment-induced neutropenia. The regimen targets cancer cells through multiple mechanisms, including microtubule inhibition, DNA alkylation, and topoisomerase II inhibition.