Effects of the combination of camptothecin and doxorubicin or etoposide on rat glioma cells and camptothecin-resistant variants.

From the rat C6 glioma cell line in culture, we selected camptothecin-resistant variants by growth in the presence of increasing amounts of this drug (C6(CPT10), C6(CPT50)and C6(CPT100), growing respectively with 10, 50 and 100 ng ml(-1)camptothecin). The degree of resistance to camptothecin ranged between 15-fold (C6(CPT10)) and 30-fold (C6(CPT50)and C6(CPT100)). The C6(CPT10)cell line presented a collateral sensitivity to etoposide (3.6-fold), while the C6(CPT50)and C6(CPT100)cell lines were cross-resistant to etoposide (1.8-fold) The resistant lines were characterised by a two-fold reduced content and catalytic activity of topoisomerase I, and C6(CPT50)and C6(CPT100)presented a significant increase in topoisomerase IIalpha content and catalytic activity and a marked overexpression of P-glycoprotein. We explored the cytotoxicity of combinations of a topoisomerase I inhibitor (camptothecin) and a topoisomerase II inhibitor (doxorubicin or etoposide) at several molar ratios, allowing the evaluation of their synergistic or antagonistic effects on cell survival using the median effect principle. The simultaneous combination of camptothecin and doxorubicin or etoposide was additive or antagonistic in C6 cells, slightly synergistic in the C6(CPT10)line and never more than additive in the C6(CPT50)and C6(CPT100)cell lines. The sequential combination of doxorubicin and camptothecin gave additivity in the order camptothecin --> doxorubicin and antagonism in the order doxorubicin --> camptothecin. Clinical protocols combining a topoisomerase I and a topoisomerase II inhibitor should be considered with caution because antagonistic effects have been observed with combinations of camptothecin and doxorubicin. Copyright 2001 Cancer Research Campaign