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This combination therapy involves the pan-histone deacetylase (HDAC) inhibitor vorinostat, the vitamin niacinamide, and the topoisomerase II inhibitor etoposide. Developed as an experimental regimen by Columbia University, it is primarily investigated for relapsed or refractory lymphoid malignancies, including Hodgkin's disease and various non-Hodgkin lymphomas. Vorinostat works by inhibiting class I and II HDACs, leading to increased histone acetylation and induction of apoptosis. Niacinamide, a form of vitamin B3, is utilized at high doses in this context to potentially inhibit sirtuins (like SIRT1) and enhance the anti-tumor activity of HDAC inhibitors. Etoposide provides a cytotoxic component by causing DNA strand breaks through the inhibition of topoisomerase II.
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