Abstract
Purpose
Systemic combination chemotherapy is the only option for patients with unresectable hepatocellular carcinoma (HCC) not suitable for intra-arterial treatment. However, no systemic chemotherapy has been able to provide durable remission. The search for a new combination of drugs for HCC is significant. The combination of doxorubicin and paclitaxel shows promise in breast cancer therapy. This study was carried out to determine the synergistic effect of combined doxorubicin and paclitaxel in the two HCC cell lines: HepG2 and Huh7 in vitro and murine HCC H22-bearing BALB/c mice in vivo.
Methods
The morphology of the two cell lines treated with drugs was photomicrographed. The 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide assay was used to determine the number of surviving cells. Cell cycle was evaluated by flow cytometry. Cell viability was measured by the ability of single cells to form colonies in vitro. Anti-tumor activities against subcutaneoulsy implanted solid tumor induced by H22 cells in mice were evaluated.
Results
Our data demonstrated that the cytotoxicity produced by doxorubicin and paclitaxel was additive in HCC cells, while it was mainly held in the G2/M phase of the cell cycle by paclitaxel. In vivo anti-tumor activity assay also showed that the combination of the two drugs resulted in more significant tumor regression, compared to the single one.
Conclusion
The study may provide a new combination of cytotoxic drugs for HCC chemotherapy.





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References
Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire (1995) A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Engl J Med 332:1256–1261
Adams JD, Flora KP, Goldspiel BR, Wilson JW, Arbuck SG, Finley R (1993) Taxol: a history of pharmaceutical development and current pharmaceutical concerns. J Natl Cancer Inst Monogr 5:141–147
Bourgeois H, Ferru A, Lortholary A, Delozier T, Boisdron-Celle M, Abadie-Lacourtoisie S et al (2006) Phase I–II study of pegylated liposomal doxorubicin combined with weekly paclitaxel as first-line treatment in patients with metastatic breast cancer. Am J Clin Oncol 29:267–275
Carr BI, Iwatsuki S, Baron R, Jain A, Selby R, Madariaga J et al (1993) Intrahepatic arterial cisplatinum and doxorubicin with or without lipiodol for advanced hepatocellular carcinoma (HCC): a prospective randomized study. Proc Annu Meet Am Soc Clin Oncol 12:A668
Geng CX, Zeng ZC, Wang JY (2003) Docetaxel inhibits SMMC-7721 human hepatocellular carcinoma cells growth and induces apoptosis. World J Gastroenterol 9:696–700
Hong RL, Lin CH, Chao TY, Kao WY, Wang CH, Hsieh RK et al (2008) A phase-I study evaluating the combination of pegylated liposomal doxorubicin and paclitaxel as salvage chemotherapy in metastatic breast cancer previously treated with anthracycline. Cancer Chemother Pharmacol 61:847–853
Iesalnieks I, Tange S, Scherer MN, Graeb C, Frank E, Jauch KW et al (2002) Paclitaxel promotes liver graft survival in rats and inhibits hepatocellular carcinoma growth in vitro and is a potentially useful drug for transplant patients with liver cancer. Transplant Proc 34:2316–2317
Johnson PJ (2002) Hepatocellular carcinoma: is current therapy really altering outcome? Gut 51:459–462
Johnson PJ (2003) Are there indications for chemotherapy in hepatocellular carcinoma? Surg Oncol Clin N Am 12:127–134
Lau WY, Ho S, Leung WT, Chan M, Ho R, Johnson PJ et al (1998) Selective internal radiation therapy for non-resectable hepatocellular carcinoma with intra-arterial infusion of yttrium-90 microspheres. Int J Radiat Oncol Biol Phys 40:583–592
Leung WT, Johnson PJ (2001) Systemic therapy for hepatocellular carcinoma. Semin Oncol 28:514–529
Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917
Nagasue N, Kohno H, Chang YC, Taniura H, Yamanoi A, Uchida M et al (1993) Liver resection for hepatocellular carcinoma. Results of 229 consecutive patients during 11 years. Ann Surg 217:375–384
Nerenstone SR, Ihde DC, Friedman MA (1988) Clinical trials in primary hepatocellular carcinoma: current status and future directions. Cancer Treat Rev 15:1–31
Okano J, Nagahara T, Matsumoto K, Murawaki Y (2007) The growth inhibition of liver cancer cells by paclitaxel and the involvement of extracellular signal-regulated kinase and apoptosis. Oncol Rep 17:1195–1200
Palmer DH, Hussain SA, Johnson PJ (2004) Systemic therapies for hepatocellular carcinoma. Expert Opin Investig Drugs 13:1555–1568
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Patt YZ, Charnsangavej C, Yoffe B, Smith R, Lawrence D, Chuang V et al (1994) Hepatic arterial infusion of floxuridine, leucovorin, doxorubicin, and cisplatin for hepatocellular carcinoma: effects of hepatitis B and C viral infection on drug toxicity and patient survival. J Clin Oncol 12:1204–1211
Pelletier G, Roche A, Ink O, Anciaux ML, Derhy S, Rougier P et al (1990) A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 11:181–184
Piccart-Gebhart MJ, Burzykowski T, Buyse M, Sledge G, Carmichael J, Lück HJ et al (2008) Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer. J Clin Oncol 26:1980–1986
Shi P, Wang MM, Jiang LY, Liu HT, Sun JZ (2008) Paclitaxel–doxorubicin sequence is more effective in breast cancer cells with heat shock protein 27 overexpression. Chin Med J (Engl) 121:1975–1979
Strumberg D, Erhard J, Harstrick A, Klaassen U, Müller C, Eberhardt W et al (1998) Phase I study of a weekly 1 h infusion of paclitaxel in patients with unresectable hepatocellular carcinoma. Eur J Cancer 34:1290–1292
Tanaka H, Kubo S, Tsukamoto T, Shuto T, Takemura S, Yamamoto T et al (2005) Recurrence rate and transplantability after liver resection in patients with hepatocellular carcinoma who initially met transplantation criteria. Transplant Proc 37:1254–1256
Thorgeirsson SS, Grisham JW (2002) Molecular pathogenesis of human hepatocellular carcinoma. Nat Genet 31:339–346
World Health Organization (2008) Motality database. WHO statistical information system. Available at: http://www.who.int/whosis/. Accessed July 2008
Yamamoto S, Sato Y, Takeishi T, Hirano K, Kobayashi T, Watanabe T et al (2005) Successful surgical treatment for hepatocellular carcinoma and concomitant risky esophageal varices. Hepatogastroenterology 52:1083–1086
Yeo W, Mok TS, Zee B, Leung TW, Lai PB, Lau WY et al (2005) A randomized phase III study of doxorubicin versus cisplatin/interferon alpha-2b/doxorubicin/fluorouracil (PIAF) combination chemotherapy for unresectable hepatocellular carcinoma. J Natl Cancer Inst 97:1532–1538
Zhang ZL, Liu ZS, Sun Q (2005) Anti-tumor effect of thalidomide and paclitaxel on hepatocellular carcinoma in nude mice. Chin Med J (Engl) 118:1688–1694
Acknowledgments
This work was supported by a grant from the National Nature Science Foundations of China: No30571828. The authors would like to thank Prof. F.Q. Zhang (Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University) for the technical assistance.
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C. Jin, H. Li, Y. He, M. He and L. Bai contributed equally to this work.
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Jin, C., Li, H., He, Y. et al. Combination chemotherapy of doxorubicin and paclitaxel for hepatocellular carcinoma in vitro and in vivo. J Cancer Res Clin Oncol 136, 267–274 (2010). https://doi.org/10.1007/s00432-009-0658-5
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DOI: https://doi.org/10.1007/s00432-009-0658-5