Today, drug combinations are frequently used in the treatment of cancer to
increase therapeutic efficacy. Currently used clinical protocols for cancer
combination therapies are mainly obtained empirically or on the basis of r
esults from previous clinical trials. Information obtained from clinical pr
otocols is invaluable, but it is time-consuming, expensive and does not pro
vide data on the biochemical and molecular mechanisms of interaction of the
drugs used in combination treatments at cellular level. Therefore, in vitr
o drug combination studies on established cell lines or primary cell cultur
es play an important role in designing and optimising combination protocols
. A variety of in vitro assays and different mathematics models have been d
eveloped to investigate cytotoxic effects and to analyse the type of drug i
nteractions. Increased knowledge of the cellular targets of traditional and
new drugs and the development of new technologies have resulted in a new r
ole for the in vitro tests which are no longer used only to evaluate the cy
totoxic effects of drugs, but also to investigate the interference on cell
cycle, induction of apoptosis and molecular or biochemical interactions. A
review on in vitro preclinical tests used to evaluate the effects of drug c
ombinations and to design the rationale of combined chemotherapy protocols
is presented. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.