The antitumour effect and toxicity of cis-platinum and N-methylformamide in combination

Active vs. passive resistance, dose-response relationships, high dose chemotherapy, and resistance modulation: a hypothesis

With chemotherapy, the in vitro and clinical dose-response curve is steep in some situations, but is relatively flat in others, possibly due to the mechanism by which tumors are resistant to chemotherapy. For tumors with resistance due to factors that actively decrease chemotherapy efficacy (e.g., p-glycoprotein, glutathione, etc.), one would predict that high dose chemotherapy and therapy with some resistance modulating agents would increase therapeutic efficacy. Such "active" resistance would most likely generally arise from gene amplification or over expression, and would be characterized by a shoulder on the log response vs. dose curve, with eventual saturation of the protective mechanism. On the other hand, one would expect that high dose chemotherapy and most resistance modulating agents would be of little value for tumors with resistance due to defective apoptosis or due to a deficiency in or decreased drug affinity for a drug target, drug activating enzyme, drug active uptake system, or essential cofactor. Such "passive" resistance would most likely generally arise from gene down regulation, deletion, or mutation, and would probably be characterized by a relatively flat log response vs. dose curve, or by a curve in which a steep initial section is followed by a plateau, as target, etc., is saturated. (If response were plotted vs. log dose, then compared to the curve for a sensitive cell line, the curve for active resistance would be analogous to the pharmacodynamic curve seen with competitive antagonism [i.e., a sigmoid curve shifted to the right], and the curve for most types of passive resistance would be analogous to the pharmacodynamic curve seen with noncompetitive antagonism [i.e., a sigmoid curve with reduced maximal efficacy]. As such, one might also refer to active vs. passive resistance as competitive vs. noncompetitive resistance, respectively.) Many tumor types probably possess a combination of active and passive mechanisms of resistance. New in vivo strategies could be helpful in defining dose-response relationships, mechanisms of resistance, and targets for resistance modulation. Such in vivo studies would be conducted initially in animals, but might also be tested clinically if animal studies demonstrated them to be feasible and useful. These in vivo studies would be conducted by randomizing 5-25 subjects to one of 10-20 dose levels over a potentially useful therapeutic range. Nonlinear regression analysis would then be used to define the characteristics of a curve generated by plotting against dose the log percent tumor remaining after the first course of therapy. While this might offer insight into the nature of resistance mechanisms present initially, plotting further tumor shrinkage vs. dose-intensity vs. course number for each later treatment course (or plotting dose-intensity vs. time to tumor progression) might provide information on how tumors become increasingly resistant to drugs following treatment.

Combination therapy with cisplatin: modulation of activity and tumour sensitivity

Although cisplatin is applied with success in clinical oncology, this success is limited because some cancers are initially unresponsive to cisplatin or become so during treatment. In this review, some strategies to overcome this problem are discussed. Among these are combination with the differentiation inducing agent, retinoic acid, combination with radiotherapy, and the use of hyperthermia.

Importance of cell cycle perturbations on the effectiveness of N-methylformamide and anti-neoplastic drugs in combination

The effect of N-methylformamide (NMF) in combination with Adriamycin (ADM) and cis-diamminedichloroplatinum (DDP) on the cell survival and cell cycle kinetics of two human tumour lines was assessed: HT29 colon carcinoma and M14 melanoma cells were exposed to ADM and DDP alone or in combination with a non-cytotoxic dose of NMF, according to different schedules. The results demonstrate that NMF exposure sensitized both tumour cell lines to the lethal activity of ADM and DDP; however, reverse sequences had to be applied to reach an increase in the lethal activity of the two different drugs. The ADM-NMF combination determined a powerful decrease in the surviving fraction of the two cell lines when ADM was given as the first agent (ADM----NMF), while the reverse sequence did not increase the ADM cytotoxic effect. With respect to the DDP-NMF association, the sequence which accounted for a greater sensitizing effect was NMF administration followed by DDP treatment (NMF----DDP). This work demonstrates the importance of timing in combined treatments which involve NMF. A delay in cell proliferation elicited by NMF exposure could be responsible for the effectiveness of the combined treatment.

Synergism between 5-fluorouracil and N-methylformamide in HT29 human colon cancer line

In HT29 cells 5-fluorouracil (5FU) cytotoxicity is enhanced by subsequent incubation of cells in medium containing 1% N-methylformamide (NMF). This enhancement does not appear to be related to differences in the repair of 5FU-induced DNA damage. It is proposed that the inhibition of DNA synthesis by NMF (that is reversible and does not result in any detectable toxicity) becomes a lethal event in a cell in which DNA synthesis has already been altered by 5FU exposure. The synergism is sequence dependent (i.e. it does not occur when NMF is given before 5FU) and specific for some cell types as shown by the fact that no synergism was found in L1210 mouse leukaemia cells. In nude mice transplanted s.c. with HT29 cells daily 5FU treatment (for 5 days) followed by daily NMF treatment (for 10 days) caused much greater inhibition of tumour growth than either drug alone or the same combination given in the opposite order (NMF then 5FU). These results, if confirmed on other human colon tumours, could be of clinical interest as a means of increasing the therapeutic efficacy of 5FU in patients with colon cancer.

X ray responses of a human colon tumor cell line after exposure to the differentiation-inducing agent N-methylformamide: concentration dependence and reversibility characteristics

The combination of differentiation-inducing agents with conventional cytotoxic agents has been suggested as a potential cancer therapeutic strategy. In this regard, we have chronically exposed (3 passages) a human colon tumor line (clone A) to varying concentrations (0-170 mM) of N-methylformamide and examined the change in sensitivity to ionizing radiation in vitro. The linear-quadratic formalism of survival was used to characterize the single graded dose survival curves. This equation yields two constants (alpha and beta) relating to cellular inactivation produced by either single events (alpha) or by the combination of two events (beta). As the N-methylformamide concentration increased, the alpha parameter increased while the beta parameter concomitantly decreased, yielding a concentration dependent radiosensitization which was most marked in the low dose region of the survival curve. Upon removal of NMF, the original radiation resistance was regained within 2-3 cell culture doubling times.

The influence of sodium ascorbate, menadione sodium bisulfite or pyridoxal hydrochloride on the toxic and antineoplastic action of N-methylformamide in P 388 leukemia or M 5076 sarcoma in mice

The toxicity of daily subcutaneously applied 500 mg/kg N-methylformamide (NMF) during a period of 8 days in female CD-mice was ameliorated when 100 mg/kg sodium ascorbate, 60 mg/kg menadione bisulfite or 80 mg/kg pyridoxal hydrochloride were applied simultaneously. The comparison of the daily s.c. application of 360 mg/kg NMF with the intermittent s.c. injection of 720 mg/kg NMF with an interval of 48 h in P 388 leukemia showed that the daily application of NMF induced an increase of life span of 82% whereas the intermittent schedule effected a 142% increase of life span. The simultaneous combination of 360 mg/kg NMF with 60 mg/kg sodium ascorbate applied daily caused a 133% increase of life span and the simultaneous combination of 360 mg/kg NMF with 30 mg/kg menadione sodium bisulfite lead to a 126% increase of life span. The combined daily s.c. application of 360 mg/kg NMF with 30 mg/kg pyridoxal hydrochloride induced only a minimal difference compared to the daily application of 360 mg/kg NMF alone. The combination of 720 mg/kg NMF with 120 mg/kg sodium ascorbate applied in intervals of 48 h showed a 164% increase of life span. In advanced M 5076 sarcoma the daily s.c. application of 360 mg/kg NMF effected a 82% increase of life span and the combination of 360 mg/kg NMF with 60 mg/kg sodium ascorbate effected a 135% increase of life span.