The combination of different types of antitumor topoisomerase II inhibitors, ICRF-193 and VP-16, has synergistic and antagonistic effects on cell survival, depending on treatment schedule.

VP-16 and ICRF-193 are different types of antitumor topoisomerase II inhibitors, being cleavable and non-cleavable complex-stabilizing types, respectively. To examine the possibility of enhancing the efficacy of combination chemotherapy, we carried out simultaneous and sequencial treatment of cells with the two drugs. When KB cells were exposed continually to low concentrations (0.05 - 0.2 microM) of the drugs, the effects were synergistic. In contrast, when the cells were treated with high concentrations of ICRF-193 and VP-16 for 1 hour, the VP-16-induced cytotoxicity was prevented by ICRF-193 and the degree of prevention was increased by the pretreatment of cells with ICRF-193, while post-treatment with ICRF-193 had little effect on the cytotoxicity of VP-16. ICRF-193 at 1 microM was found to interact with about half molecules of topisomerase IIa and II beta in cells, as judged by increased amounts of a salt-stable complex. ICRF-193 inhibited in vitro VP-16-induced cleavable complex formation, but a much higher concentration was needed to reverse the cleavage already generated by VP-16. Thus, the antagonistic or synergistic effects of ICRF-193 and VP-16 depend on the concentration of the drug, as it may be critical as to how many molecules of cellular topoisomerase II interact with the drugs.