zoledronic acid + paclitaxel + carboplatin + metformin

This regimen is an investigational multi-drug combination comprising zoledronic acid, paclitaxel, carboplatin, and metformin, evaluated experimentally for antineoplastic therapy, particularly in solid tumors such as non-small cell lung cancer with bone metastases and ovarian cancer. Zoledronic acid is a nitrogen-containing bisphosphonate that inhibits farnesyl pyrophosphate synthase in osteoclasts to reduce bone resorption and skeletal-related events, and has additional anti-tumor and anti-angiogenic effects. Paclitaxel is a microtubule-stabilizing taxane that promotes tubulin polymerization and prevents microtubule depolymerization, leading to mitotic arrest and apoptosis in rapidly dividing cells. Carboplatin is a platinum-based DNA-damaging agent that forms intra- and inter-strand DNA crosslinks, thereby inhibiting DNA replication and transcription and triggering apoptosis. Metformin is an oral biguanide that activates AMP-activated protein kinase (AMPK), decreases hepatic gluconeogenesis, and in oncology settings is explored for its indirect insulin-lowering and direct AMPK–mTOR pathway–modulating effects that may enhance chemosensitivity. Together, this four-drug combination is designed to provide cytotoxic chemotherapy, modulation of tumor metabolism and signaling, and protection against or treatment of bone metastases while potentially improving overall antitumor efficacy.