There is accumulating evidence suggesting that tumor necrosis factorrelated apoptosis-inducing ligand (TRAIL)-receptor (R) 2 is a promising molecular target for cancer therapy. Therefore, we investigated the effect of chemotherapeutic agents on TRAIL-R2-mediated apoptosis and cytotoxicity in various human solid cancer cells. Treatment of the ACHN human renal cell carcinoma (RCC) cell line with agonistic TRAIL-R2 antibody (lexatumumab) in combination with 5-fluorouracil, vinblastine, paclitaxel, or docetaxel did not overcome resistance to these agents. However, treatment with lexatumumab in combination with doxorubicin had a synergistic cytotoxicity. Synergy was also achieved in two other human RCC cell lines, Caki-1 and Caki-2, and in eight primary RCC cell cultures. Sequential treatment with doxorubicin followed by lexatumumab induced significantly more cytotoxicity than reverse treatment or simultaneous treatment. Low concentrations of doxorubicin (0.1 and 1 µ µ µ µg/mL) significantly increased TRAIL-R2 expression at both the mRNA and protein levels. T umor necrosis factor-related apoptosis-inducing ligand (TRAIL) is potentially an effective anticancer agent because it selectively induces apoptosis in a variety of tumor cells, yet it is relatively non-toxic to normal cells.(1,2) TRAIL triggers apoptosis by binding to two receptors: TRAIL-receptor (R) 1 and TRAIL-R2. Activation of these receptors results in a signal transduction cascade that initiates intrinsic and extrinsic apoptotic pathways. (4) In addition, TRAIL binds to two other receptors, TRAIL-R3 (DcR1) and TRAIL-R4 (DcR2), which lack a functional cytoplasmic death domain, and to the secreted tumor necrosis factor receptor homolog osteoprotegerin.(3,5) These receptors have been proposed to inhibit TRAIL-induced apoptosis. Potentially, the degree of TRAIL-R1-and TRAIL-R2-mediated apoptosis induced by TRAIL might be lowered in the presence of DcR1 and DcR2 activation. Therefore, using a specific activator of TRAIL-R1 or TRAIL-R2 is preferable to exclude interference from competition with DcR.It was reported that mouse or rabbit monoclonal antibodies (mAb) to human TRAIL-R1 or TRAIL-R2 have antitumor activities in vitro and in vivo.(6,7) These agonistic antibodies work by activating TRAIL-mediated apoptotic pathways in a manner similar to TRAIL, as agonistic TRAIL-R1 antibody induces poly(adenosine diphosphate-ribose) polymerase cleavage and the agonistic TRAIL-R2 antibody induces activation of caspases and c-Jun N-terminal kinase and p38 in tumor cells. (8) It has also been reported that mapatumumab, a fully human agonistic mAb specific for TRAIL-R1, reduces the viability of multiple types of tumor cells in vitro and inhibits tumor growth in vivo.(9) We recently reported that lexatumumab, a human agonistic TRAIL-R2 mAb, induces apoptotic cell death in renal cell carcinoma (RCC) cells. However, it requires cross-linking with IgG:Fc to exert apoptotic activity as a single agent.(10) Developing ways to optimize the effects of lexatumumab, particularly throu...