The intracellular distribution of Auger electron-emitting radiopharmaceuticals is a determinant of cytotoxicity. However, the mechanisms by which these agents are routed through the cell are ill understood. The aim of this study was to investigate how trafficking of 111 In-labeled human epidermal growth factor ( 111 In-DTPA-hEGF) relates to that of the EGF receptor (EGFR) and whether coadministration of agents that modulate EGFR signaling alters the efficacy of 111 In-DTPA-hEGF. Methods: The spatiotemporal interaction between AlexaFluor488-EGF (AF488-EGF) and Cy3-conjugated anti-EGFR antibody (Cy3-anti-EGFR) was studied in the breast cancer cell line MDA-MB-468 using fluorescence resonance energy transfer and 2-photon fluorescence lifetime imaging. 111 In internalization and nuclear fractionation assays were performed to investigate the effect of the ErbB-2-blocking antibody trastuzumab and a prenyltransferase inhibitor, L-778,123, on the subcellular localization of 111 In-DTPA-hEGF in MDA-MB-468 (1.3 · 10 6 EGFR per cell; ErbB-2 negative) and 231-H2N (0.2 · 10 6 EGFR per cell; 0.4 · 10 5 ErbB-2 per cell) cell lines. The cytotoxicity of 111 In-DTPA-hEGF (0-64 nM) plus trastuzumab (0-50 mg/mL) or L-778,123 (0-22.5 mM) was measured using clonogenic assays in a panel of breast cancer cell lines that express different levels of EGFR and ErB-2. Clonogenic survival data were used to calculate combination indices. Tumor growth inhibition was measured in vivo in 231-H2N xenograft-bearing mice treated with 111 In-DTPA-hEGF plus trastuzumab or L-788,123. Results: Using fluorescence resonance energy transfer, we showed that EGF interacts with EGFR in the cytoplasm and nucleus after internalization of the ligand-receptor complex in MDA-MB-468 cells. Nuclear localization of 111 In-DTPA-hEGF is enhanced by trastuzumab and L-788,123. Trastuzumab and L-788,123 sensitized 231-H2N cells to 111 In-DTPA-hEGF. Nuclear localization and cytotoxicity of 111 In-DTPA-hEGF were significantly increased in 231-H2N xenografts by cotreatment with L-788,123 (P , 0.0001). Conclusion: The therapeutic efficacy of 111 In-DTPA-hEGF is increased through the coadministration of selected molecularly targeted drugs that modulate EGFR signaling and trafficking.