Combination chemotherapy involves the use of two or more anticancer medications.

It’s a common approach in cancer treatment as it may be more effective than single-drug chemotherapy regimens in certain cancers. However, it carries an increased risk of side effects and drug interactions.

This article explores the reasoning, effectiveness, and risks associated with combination chemotherapy for cancer.

Chemotherapy refers to medication-based cancer treatments. The goal of chemotherapy is typically to reduce cancer cells or shrink a tumor and prevent cancer from spreading to other parts of the body.

Combination chemotherapy relies on the use of at least two different medications to achieve these goals.

It’s not the same as combination therapy for cancer, which refers to the use of two different types of treatment for cancer. This could include combinations like surgery and radiation or chemotherapy and immunotherapy.

However, the reasoning is similar. In general, combining more than one cancer treatment increases effectiveness. This is also true for chemotherapy drugs, which use a variety of mechanisms to aggressively target cancer cells.

In addition, using more than one medication decreases the likelihood that cancerous cells will develop resistance to a particular drug, according to 2022 research.

There are many types of chemotherapy drugs and therefore many possible combinations. The medication prescribed by your doctor will depend on what kind of cancer you have and how advanced it is, as well as which other treatments are available.

A few examples of combination chemotherapy regimens are described below.

ABVD for Hodgkin’s lymphoma

Combination chemotherapy is a common treatment for Hodgkin’s lymphoma. There are several possible drug combinations.

According to the American Cancer Society (ACS), the most commonly used regimen in the United States is ABVD, which refers to a combination of:

  • doxorubicin (Adriamycin)
  • bleomycin (Blenoxane)
  • vinblastine (Velban)
  • dacarbazine (DTIC-Dome)

BEP for testicular cancer

BEP is a chemotherapy regimen used in the treatment of testicular cancer. It involves three chemotherapy drugs:

Other first-line combination chemotherapies for testicular cancer include EP and VIP. EP refers to a combination of etoposide and cisplatin. VIP refers to a combination of etoposide, ifosfamide (Ifex), and cisplatin.

Combination chemotherapy for small cell lung cancer

Small cell lung cancer (SCLC) can be treated with surgery, radiation therapy, and combination chemotherapy.

Four common combinations of chemotherapy drugs for SCLC include:

  • cisplatin and etoposide
  • carboplatin (Paraplatin) and etoposide
  • cisplatin and irinotecan (Camptosar)
  • carboplatin and irinotecan

Depending on the type of cancer, combination chemotherapy may be used:

  • Before primary treatment. This is known as neoadjuvant chemotherapy. It means that chemo is used before the main treatment, like surgery or radiation therapy, to increase the success of the main treatment.
  • After primary treatment. This is known as adjuvant chemotherapy. It takes place after the main treatment, such as surgery to remove a malignant tumor, in an effort to improve the outcome of the primary treatment and prevent the cancer from returning.
  • Together with other treatments. With some types of cancer, like head and neck, lung, and anal cancer, combination chemotherapy may be combined with radiation therapy to help shrink a tumor.
  • As the main treatment. Sometimes, combined chemotherapy is the primary treatment. That means it’s the treatment that is most likely to successfully eliminate cancer.

When a cure isn’t possible, combination chemotherapy can also be used to stop cancer from progressing. In palliative care, it is sometimes used to reduce cancer symptoms.

According to the National Cancer Institute, combination chemotherapy is common in the treatment of many cancers, although some regimens are more established than others.

In addition, there are many new combinations of anticancer drugs currently undergoing clinical trials.

According to a 2017 review, combination chemotherapy was first proposed in the 1960s for the treatment of lymphocytic leukemia in children. The four-drug treatment, abbreviated as POMP, helped shrink tumors and lengthen the time spent in remission.

Since then, combination chemotherapy has become a critical part of cancer care. The authors of the above review report that combination chemotherapy is usually more effective than a single drug.

The ACS also suggests that multiple chemotherapy drugs are more likely to be effective than a single drug.

But in general, the effectiveness of combination chemotherapy varies greatly from one type of cancer to the next. Effectiveness also depends on how advanced the cancer is and whether it’s spread to other parts of your body.

Factors such as your age and overall health can also affect how well combination chemotherapy works.

In some cases, a single chemotherapy drug is preferable. According to a 2019 review, single-drug chemotherapy may be preferable in the treatment of certain types of metastatic breast cancer due to reduced side effects and similar effectiveness.

Chemotherapeutic drugs have to be aggressive in order to eliminate fast-growing cancer cells. But they are not selective, which means that they can also damage healthy cells.

As a result, all chemotherapy carries a significant risk of side effects. Some common side effects of chemotherapy include:

Since combination chemotherapy involves at least two chemo drugs, it could increase your risk of side effects. The medications might cause different side effects or amplify the effects they have in common.

The side effects and their severity will depend on which drugs you are prescribed and their doses. If your doctor suggests a form of combination chemotherapy to treat your cancer, they will review the risks associated with the treatment and talk with you about the side effects and how to manage them.

Combination chemotherapy is a longstanding form of cancer treatment that involves two or more anticancer drugs. Combination regimens vary from one type of cancer to the next and may be used as primary treatments, neoadjuvant or adjuvant therapies, or combined with other therapies.

Many chemotherapy drugs are available, and they all work slightly differently. In general, combining two or more chemotherapy drugs for some types of cancer may make the treatment more effective.

Your doctor can help you understand the risks, benefits, and what to expect if you’re undergoing combination chemotherapy.