Summary Doxorubicin (DXR) has a positive inoculum effect and penetrates poorly into the core of multicellular tumour spheroids (MTS). Cis-platin (DDP) displays neither of these characteristics. We evaluated whether combining these 2 agents would influence the cell kill effect at a tumour mass level. MTS were produced from a PC-10 squamous lung carcinoma cell line. MTS were exposed to either drug first for h with different intervals between exposure. Cells were then trypsinized to a single cell suspension and subjected to clonogenic assay. Combination effects were analyzed by median effect plot analysis. The more MTS ml-' medium, the lower the cell kill effect of DXR. Simultaneous exposure to the 2 drugs was synergistic. DXR exposure first followed by DDP was less efficacious than, or the same as, the simultaneous exposure. In contrast, DDP followed by DXR was more efficacious with the best cell kill at a 1 h interval between each drug. This phenomenon was observed even at non-toxic doses of DDP. The fluorescent microscopic study of DXR indicated that prior exposure of MTS to DDP resulted in increased DXR penetration into the MTS core leading to heightened synergism with this sequence. These data suggest that the proper combination of DXR plus DDP should be in sequence with DDP first. Clinical, toxicological and pharmacological trials of DDP administration first, followed by DXR, are warranted.Doxorubicin (DXR) and cis-platin (DDP) are both highly active anticancer agents widely used in the treatment of human cancer. We introduced a combination of these 2 agents, termed A & P (adriamycin and platinum) (Vogl et al., 1976), which has become the basis, by adding more drugs, for the treatment of patients with ovarian cancer, small cell lung cancer and other neoplasms. Recently, we have demonstrated that DXR has a positive inoculum effect in vitro and loses efficacy at high cell densities, whereas DDP does not (Ohnuma et al., 1986). Moreover, we have shown that DXR penetrates poorly into the core of multicellular tumour spheroids (MTS) whereas DDP shows no such penetration gradient (Inoue et al., 1985). These pharmacological differences at the tumour mass level indicate that DXR should be best used when tumour size is small and cell density low. Therefore, we hypothesized that the proper sequence of A & P should be DDP first, followed by DXR, rather than vice versa. This communication sets forth the experimental proof of our hypothesis and elucidates a possible mechanism for this effect.
Materials and methodsHuman tumour cell line PC-10 squamous lung carcinoma cell line was used in these experiments (Kinjo et al., 1979). Cells were maintained as a monolayer in RPMI-1640 medium (GIBCO, Grand Island, NY), supplemented with 10% (v/v) heat-inactivated foetal bovine serum (FBS) (Gibco) at 37"C in a 5% CO2/95% humidified air atmosphere. These cells were subcultured after trypsinization with 0.2% trypsin (Type III from Conditions of drug exposure and determination of cell survival After 3 weeks of culture, MTS with a diame...