The
CYVADIC combination has enjoyed popular medical support for over a decade in the treatment of
soft-tissue sarcomas, and there is much documented evidence in the literature of the relative success of this and related regimens. A multivariate regression meta-analysis has been undertaken of the collective experience of this group of regimens, to assess statistically the relative importance of each component of
CYVADIC using the intensities of the four components to predict objective tumour response. This analysis demonstrates that the tumour response to a specific regimen may be reasonably predicted from an expression that is highly sensitive to the
dacarbazine dose intensity, with a significant additional contribution being introduced by the level of
vincristine administered. There is convincing statistical evidence that, when administered as part of a
CYVADIC chemotherapeutic regimen, the presence of
doxorubicin (with an intensity of about 0.8) will produce a significant optimal effect on tumour responses. In such situations there is no detected significant benefit from increasing the dose of
doxorubicin beyond this critical level of intensity. These findings suggest that it is
dacarbazine and not, as is customarily argued,
doxorubicin that is the most sensitive component in the
CYVADIC treatment of
soft-tissue sarcomas. The veracity of this conclusion should be tested by prospective studies designed specifically to escalate the intensity of
decarbazine treatment, whilst holding the level of
doxorubicin at below standard intensity.