Modulation of apoptosis signaling pathways and cell cycle regulation.

Apoptosis can be described as multiple pathways converging from numerous different initiating events and insults, such as anticancer agents. These pathways converge on a common irreversible execution phase in which proteases and nucleases digest the doomed cell. Counteracting the signals to die are a variety of pathways that enhance cell survival and that may become constitutively active as a result of oncogenic transformation. Studies of apoptosis have identified many cellular factors that play a role in the decision as to whether a cell lives or dies. These factors include the p53 tumor suppressor, the Bcl-2 family of proteins, and a variety of intracellular signal transduction pathways, all of which may provide novel therapeutic targets. It also is possible to take advantage of the defect in cell cycle regulation that occurs in cells with mutant p53; such cells are susceptible to agents that inhibit DNA damage-induced cell cycle checkpoints at S and G2 phase. Cell cycle perturbation occurs following treatment with all anticancer drugs and a knowledge of the kinetics of such events should facilitate design of synergistic rather than antagonistic schedules. These concepts have been developed in cell culture models and it is essential to determine whether the mechanisms defined also occur in patients receiving therapy. Accordingly, tumors need to undergo serial biopsies during therapy and be analyzed for perturbation in cell cycle or apoptosis-regulating proteins. The results of such studies should facilitate the rational design of chemotherapy combinations.