Abstract:
Most human tumors find ways to resist anticancer drug monotherapy. Akt is considered a likely peptide providing such monotherapy drug resistance. Data indicates that Akt chemoresistance is induced in a p53-dependent manner and that inhibition of Akt may be an effective means of overcoming chemoresistance in cancer cells expressing wild-type p53. Breast, ovarian, lung cancer and leukemia cells lines were treated with combinations of Akt activation inhibitor Triciribine (TCN) or Triciribine phosphate (TCNP) and chemotherapeutic drugs to determine the efficiency of combination therapy. Additionally, cells were introduced into xenograft models to determine in vivo effects of combination treatment. Combining TCN or TCNP with other anticancer drugs overcame cytotoxic or treatment resistance. Thus, TCN and TCNP are shown to broaden the spectrum of human tumors that can be effectively treated.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims priority to currently pending U.S. Provisional Patent Application No. 60/828,154, entitled “Combination of the Akt Activation Inhibitor Triciribine/Triciribine Phosphate with Cytotoxic and Anti-Signaling Molecules for Cancer Therapy”, filed on Oct. 4, 2006, the contents of which are herein incorporated by reference. 
     
    
     GOVERNMENT SUPPORT 
       [0002]    This invention was made with government support under CA67771, CA098473, CA106829, CA107078, CA077935, and CA089242 awarded by the National Institutes of Health. The government has certain rights in the invention 
     
    
     FIELD OF INVENTION 
       [0003]    This invention relates to cancer treatment using a combination treatment approach. Specifically, the Akt pathway is targeted to sensitize cancerous cells to one or more other cancer treatment drugs. 
       BACKGROUND OF THE INVENTION 
       [0004]    Most human tumors find ways to resist anticancer drug monotherapy. Akt is considered a likely peptide providing such monotherapy drug resistance. Aurora-A, a serine/threonine protein kinase, activates the Akt pathway in a p53-dependent manner, and thus protects cancer cells from chemotherapeutic-induced apoptosis often involved in cancer resistance to anticancer drug monotherapy. 
         [0005]    Akt, also called protein kinase B, is a serine/threonine protein kinase that is activated by extracellular stimuli in a phosphatidylinositol 3′-kinase (PI3k)-dependent manner. Akt has emerged as a crucial regulator of a wide range of cellular processes including apoptosis, proliferation, differentiation, and metabolism. Akt is phosphorylated, and therefore activated, by phosphoinositide dependent kinase 1 (PDK1) and the mammalian target of rapamycin complex 2 (mTORC2). Deregulation of the Akt signaling pathway has been documented as a frequent occurrence in a number of human malignancies. Ectopic expression of Akt induces cell survival and malignant transformation, whereas inhibition of Akt activity stimulates apoptosis. Furthermore, over-expression of active Akt often accompanies increased chemoresistance in cancer cells. 
         [0006]    Cisplatin [CDDP, cis-Diammine-dicholoroplatinum(II)], an anti-tumor drug known to induce apoptosis of cancer cells by damaging nuclear DNA, is among the most effective agents used in human cancer chemotherapy. CDDP increases p53 content, leading to up-regulation of proteins promoting cell cycle arrest, such as p21, and of pro-apoptotic proteins such as Bax and Fas leading to activations of both the mitochondrial and death-receptor apoptotic pathways, resulting in the activation of the execution caspase-3 and -7. 
         [0007]    Taxol is a plant alkaloid anti-tumor drug which acts on microtubule growth during mitosis. Taxol stabilizes the β tubulin subunit of the microtubule, preventing the dissociation of the microtubule preventing cellular transport and further mitosis. Taxol has likewise been shown to induce apoptosis by stopping Bcl-2. 
         [0008]    Farnesyltransferase inhibitors (FTI) and geranylgeranyltransferase inhibitors (GGTI) target farnesyltransferase and geranylgeranyltrasferase, respectively, preventing posttranscriptional modification and function of the Ras protein. Conversely, proteasome inhibitors prevent proteasome activity, preventing the degradation of proteins. Recent proteasome inhibitors selectively abrogate proteasome activity by reacting with the hydroxyl group and N-terminal theronine in the proteasome&#39;s active site. 
         [0009]    Chemoresistance represents a major obstacle for successful cancer therapy. Increased dosage is required for resistant cells; however large dose treatments often lead to severe side effects in multiple organs. 
         [0010]    Akt over expression often accompanies increased chemoresistance in cancer cells. Several studies have established mechanisms by which Akt may contribute to CDDP resistance. For instance, Akt attenuates the CDDP-mediated up-regulation of p53. Phosphorylation of MDM2 by Akt inactivates p53 and in turn prevents p53-mediated cell cycle arrest. Akt also protects anti-apoptotic proteins such as XIAP from CDDP-induced down-regulation. In addition, Akt activity promotes cellular resistance to CDDP through the inhibitions of CDDP-induced JNK and p38 activations required for CDDP&#39;s anti-tumor activity 
       SUMMARY OF INVENTION 
       [0011]    The invention provides a method of treating cancer, through a combination drug treatment. Akt expression renders cells resistant to cisplatin (CDDP), etoposide and paclitaxel-induced apoptosis. Akt1 and Akt2 may be stimulated by Aurora-A activity, providing chemotherapy resistance within wild-type p53 but not p53-null cancer cells. Knockdown of Aurora-A by RNAi sensitizes cells to CDDP-induced apoptosis and decreases phospho-Akt levels in wild-type p53 cells. Reintroduction of p53 decreases Akt1 and Akt2 activation and restores CDDP. Introduction of TCN (also referred to herein as “API-2”), overcomes the effects of Aurora-A on cell survival and Bax mitochondrial translocation by inhibiting Akt. Taken collectively, these data indicate that Akt chemoresistance is induced in a p53-dependent manner and that inhibition of Akt may be an effective means of overcoming chemoresistance in cancer cells expressing wild-type p53. 
         [0012]    Therefore, this invention provides that inhibiting Akt activation will lead to sensitization of tumors to anticancer drugs including cytotoxic agents such as cisplatins and taxanes and anti-signaling agents such as farnesyltransferase inhibitors (FTIs); geranylgeranyltransferase inhibitors (GGTIs); mammalian target of rapamycin (mTOR) inhibitors such as rapamycin and RAD 001; Mek inhibitors such as U0126, STAT3 inhibitors such as JSI-124 and Withacnistin, receptor tyrosine kinase inhibitors such as the EGFR inhibitors IRESSA and Tarceva, proteasome inhibitors such as HL-1 and Velcade, ErbB2 antibodies such as Herceptin, EGFR inhibitors such as Erbitux, VEGF antibodies such as Avastin, VEGF/PDGF binding molecules such as GFB-204, Raf inhibitors such as Bay compound. Combining the Akt activation inhibitor Triciribine or Triciribine phosphate with other anticancer drugs will overcome this resistance and broaden the spectrum of human tumors that can be effectively treated. 
         [0013]    In one embodiment, Triciribine or Triciribine Phosphate is coadministered with a cytotoxic, anti-signaling or other anticancer agent to treat a cancerous cell or mass. The invention decreases the likelihood of tumor survival, as cancerous cells cannot activate Akt to overcome anticancer drugs. The method involves a synergistic action between an Akt inhibitor and an anticancer drug, removing a survival pathway and inhibiting the growth potential of the cancerous cells. 
         [0014]    In another embodiment, the invention provides for increasing the response of Akt-activated tumors to anticancer drugs. Akt-activated tumors are more difficult to treat, due to the enhanced survivability of the tumor against the anticancer drug provided by Akt pathways. Disrupting Akt during traditional anticancer treatment removes the Akt survival pathway, allowing the traditional drugs to effectively eliminate cancer cells via apoptosis. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         [0015]    For a fuller understanding of the invention, reference should be made to the following detailed description, taken in connection with the accompanying drawings, in which: 
           [0016]      FIGS. 1A to 1C  show survival percentages and Akt protein levels of human ovarian cancer cell lines treated with differing concentrations of CDDP. 
           [0017]      FIGS. 2A and 2B  show protein levels in breast and ovarian cancer cells after mTOR inhibition. mTOR inhibition activates Akt while decreasing p-S6 phosphorylation. 
           [0018]      FIG. 3  shows lung cancer cell proliferation after combination treatment with TCN and a geranylgeranyltransferase I inhibitor. 
           [0019]      FIG. 4  depicts lung cancer cell proliferation after combination treatment with TCN and a farnesyltransferase inhibitor. 
           [0020]      FIG. 5  depicts lung cancer cell proliferation after combination treatment with TCN and an epidermal growth factor receptor tyrosine kinase inhibitor. 
           [0021]      FIG. 6  depicts lung cancer cell proliferation after combination treatment with TCN and a proteasome inhibitor. 
           [0022]      FIG. 7  depicts lung cancer cell proliferation after combination treatment with TCN and a proteasome inhibitor. 
           [0023]      FIG. 8  depicts lung cancer cell proliferation after combination treatment with TCN and a proteasome inhibitor. 
           [0024]      FIG. 9  depicts lung cancer cell proliferation after combination treatment with TCN and a HER2 blocker. 
           [0025]      FIG. 10  depicts lung cancer cell proliferation after combination treatment with TCN and a JAK2/STAT3 inhibitor. 
           [0026]      FIG. 11  depicts lung cancer cell proliferation after combination treatment with TCN and a MEK inhibitor. 
           [0027]      FIGS. 12A and 12B  show ovarian and breast cells treated with mTOR inhibitor, API-2 (TCN), or a combination. Phosphorylation of Akt increased after mTOR inhibitor treatment. The combination of API-2 with either drug attenuated the mTOR inhibitor-induced Akt activation. 
           [0028]      FIGS. 13A and 13B  depict the inhibition of cell growth after combination treatment of mTOR inhibitor with API-2 (TCN). Combining either mTOR inhibitor with API-2 depressed cell growth further, while API-2 treatment alone nearly equaled the combination treatment. 
           [0029]      FIG. 14  depicts the inhibition of cell growth after combination treatment of mTOR inhibitor with API-2 (TCN). Combining either mTOR inhibitor with API-2 depressed cell growth further, while API-2 treatment alone nearly equaled the combination treatment. 
           [0030]      FIG. 15  depicts the cell survival of CDDP-resistant ovarian cancer cells treated with CDDP at differing concentrations, alone or with API-2. 
           [0031]      FIG. 16  shows cell survival of CDDP-resistant ovarian cancer cells treated with API-2 alone or in combination with CDDP. 
           [0032]      FIGS. 17A  and B show cell survival of CDDP-resistant ovarian cancer cells, with or without ectopic expression of Aurora-A. The cells were treated with API-2 alone or in combination with CDDP. 
           [0033]      FIGS. 18A and 18B  show cell survival of CDDP-resistant ovarian cancer cells, with or without ectopic expression of Aurora-A. The cells were treated with API-2 alone or in combination with CDDP. 
           [0034]      FIG. 19  depicts apoptosis of CDDP-resistant ovarian cancer cells after treatment with Taxol, TCN or a combination. 
           [0035]      FIGS. 20A and 20B  show the synergistic effect of TCN and CDDP in inhibition of tumor growth in a xenograft model. Ovarian CDDP-resistant cells were injected into mice and later treated with CDDP or API-2 alone, or a combination. Tumor growth curves (left) and tumor size (right) were significantly reduced with both API-2 and CDDP, as compared to either treatment alone. 
           [0036]      FIG. 21  shows the tumor volume of induced breast cancer in a transgenic mouse. 
           [0037]      FIG. 22  shows the tumor volume of induced breast cancer in a transgenic mouse after treatment with geranylgeranyltransferase inhibitor alone or in combination with TCN. 
           [0038]      FIG. 23  shows protein levels of MDA-MB-435 cancer cells with differing concentrations of TCN, STAT3 siRNA, or a combination of TCN and STAT3 siRNA. 
           [0039]      FIG. 24  shows proliferation, apoptosis, and survivability of breast cancer cells with TCN, STAT3 siRNA, or a combination of TCN and STAT3 siRNA. A combination of the drugs shows an inhibitory effect on proliferation and induction of cell death. 
           [0040]      FIG. 25  shows cell cycle status of breast cancer cells with TCN, STAT3 siRNA, or a combination of TCN and STAT3 siRNA. The combination treatment enhances the ability of STAT3 siRNA to induce apoptosis. 
           [0041]      FIGS. 26A and 26B  show Aurora-A activates Akt. Ovarian cancer cells were transfected with Aurora-A or vector and protein levels analyzed. Akt is up-regulated and Akt substrates phosphorylated in Aurora-A transfected cells. 
           [0042]      FIGS. 27A  and B show Aurora-A activates Akt. Ovarian cancer cells were transfected with Aurora-A or vector and protein levels analyzed. Akt is up-regulated and Akt substrates phosphorylated in Aurora-A transfected cells. 
           [0043]      FIGS. 28A and 28B  show Aurora-A transfected ovarian cancer cell survival and protein expression. Cell survival was analyzed after treatment with various chemotherapeutics. Aurora-A induced chemoresistance. 
           [0044]      FIGS. 29A and 29B  show Aurora-A transfected ovarian cancer cell survival and protein expression. Cell survival was analyzed after treatment with various chemotherapeutics. Aurora-A induced chemoresistance. 
           [0045]      FIGS. 30A and 30B  show Aurora-A transfected ovarian cancer cell survival and protein expression. Cell survival was analyzed after treatment with various chemotherapeutics. Aurora-A induced chemoresistance. 
           [0046]      FIG. 31  shows Aurora-A transfected ovarian cancer cell survival and protein expression. Cell survival was analyzed after treatment with various chemotherapeutics. Aurora-A induced chemoresistance. 
           [0047]      FIGS. 32A and 32B  show Aurora-A transfected ovarian cancer cells treated with CDDP. Cell survivability and apoptotic protein analysis indicates Aurora-A induces CDDP resistance. 
           [0048]      FIGS. 33A and 33B  show Aurora-A transfected ovarian cancer cells treated with CDDP. Cell survivability and apoptotic protein analysis indicates Aurora-A induces CDDP resistance. 
           [0049]      FIG. 34  shows Aurora-A transfected ovarian cancer cells treated with CDDP. Cell survivability and apoptotic protein analysis indicates Aurora-A induces CDDP resistance. 
           [0050]      FIG. 35  shows Aurora-A RNAi knockdown reduces tumor cell survivability after CDDP treatment. 
           [0051]      FIGS. 36A and 36B  shows Aurora-A RNAi knockdown reduces tumor cell survivability after CDDP treatment. 
           [0052]      FIG. 37  shows Aurora-A RNAi knockdown reduces tumor cell survivability after CDDP treatment. 
           [0053]      FIGS. 38A and 38B  show ovarian cancer cells treated with CDDP, API-2, or CDDP and API-2. Cell viability was analyzed, showing API-2 overrides Aurora-A-induced CDDP resistance. 
           [0054]      FIGS. 39A and 39B  show ovarian cancer cells treated with CDDP, API-2, or CDDP and API-2. Cell viability was analyzed, showing API-2 overrides Aurora-A-induced CDDP resistance. 
           [0055]      FIGS. 40A and 40B  show ovarian cancer cells treated with CDDP, API-2, or CDDP and API-2. Cell viability was analyzed, showing API-2 overrides Aurora-A-induced CDDP resistance. 
           [0056]      FIGS. 41A and 41B  depict Aurora-A transfected ovarian cancer cells. Ectopic expression of Aurora-A reduces PTEN protein levels in a p53 dependent manner. Further, Aurora-A reduces the ability of Bax to undergo conformational changes and mitochondrial translocation. 
           [0057]      FIGS. 42A and 42B  depict Aurora-A transfected ovarian cancer cells. Ectopic expression of Aurora-A reduces PTEN protein levels in a p53 dependent manner. Further, Aurora-A reduces the ability of Bax to undergo conformational changes and mitochondrial translocation. 
           [0058]      FIG. 43  depicts Aurora-A transfected ovarian cancer cells. Ectopic expression of Aurora-A reduces PTEN protein levels in a p53 dependent manner. Further, Aurora-A reduces the ability of Bax to undergo conformational changes and mitochondrial translocation. 
           [0059]      FIGS. 44A and 44B  depict ovarian cancer cells treated with TCN, farnesyltransferase inhibitor FTI-2153, or a combination. Cell proliferation, protein expression, and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0060]      FIG. 45  depicts ovarian cancer cells treated with TCN, farnesyltransferase inhibitor FTI-2153, or a combination. Cell proliferation, protein expression, and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0061]      FIGS. 46A and 46B  depict ovarian cancer cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0062]      FIG. 47  depicts protein expression of ovarian cancer cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination indicating synergistic combination treatment. 
           [0063]      FIGS. 48A and 48B  depict breast cancer cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation, protein expression, and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0064]      FIGS. 49A and 49B  depict breast cancer cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation, protein expression, and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0065]      FIGS. 50A and 50B  depict multiple myeloma cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0066]      FIGS. 51A and 52B  depict multiple myeloma cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0067]      FIGS. 52A and 52B  depicts leukemia cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0068]      FIGS. 53A and 53B  depict leukemia cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation, drug efficiency, and protein expression were analyzed indicating synergistic combination treatment. 
           [0069]      FIGS. 54A and 54B  depict leukemia cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation, drug efficiency, and protein expression were analyzed indicating synergistic combination treatment. 
           [0070]      FIGS. 55A and 55B  depict leukemia cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation, drug efficiency, and protein expression were analyzed indicating synergistic combination treatment. 
           [0071]      FIGS. 56A and 56B  depict leukemia cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation and drug efficiency were analyzed indicating synergistic combination treatment. 
           [0072]      FIGS. 57A and 57B  depict leukemia cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation, drug efficiency, and protein expression were analyzed indicating synergistic combination treatment. 
           [0073]      FIGS. 58A and 58B  depict leukemia cells treated with TCN, farnesyltransferase inhibitor Tipfarnib, or a combination. Cell proliferation, drug efficiency, and protein expression were analyzed indicating synergistic combination treatment. 
           [0074]      FIGS. 59A and 59B  depict two leukemia cells lines treated with TCN or farnesyltransferase inhibitor, Tipfarnib. Cell protein expression was analyzed for Akt and PARP expression. 
           [0075]      FIG. 60  depicts breast cells treated with differing doses of TCN, with or without HER2 inhibitor. Apoptosis, cell proliferation and protein expression were analyzed indicating synergistic combination treatment. 
           [0076]      FIG. 61  depicts breast cells treated with differing doses of TCN, with or without HER2 inhibitor. Apoptosis, cell proliferation and protein expression were analyzed indicating synergistic combination treatment. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0077]    The present invention provides a method of treating cancer with coadministration of Akt inhibitor and a traditional anticancer drug. In particular, the invention provides for using an effective amount of Triciribine (TCN), also known as Akt/PKB inhibitor-2 (API-2), or Triciribine phosphate (TCNP) with an effective amount of an anticancer drug, such as cisplatin, taxane, farnesyltransferase inhibitor, geranylgeranyltransferase inhibitor, rapamycin, RAD001, U0126, Herceptin, or Erbitux. 
         [0078]    A therapeutically effective amount is defined as a quantity of compound sufficient to yield a desired therapeutic response. 
         [0079]    Akt has been shown to up-regulate, sometimes drastically, in tumor masses during chemotherapeutic or radiotherapeutic treatment. The tumor masses become highly resistant to further treatment, producing the belief that Akt is involved in tumor chemoresistance and radioresistance. To determine the effect of treating tumor cells with anti-neoplastic agent and Akt inhibitor, p53 wild-type (A2780S, OV2008, C-13, A549, MCF-7) and p53 null (A2780CP, MDA-MB-435, OVCAR-3, DU-145, U266, HL60, SkBr3) cell lines were treated with varying anti-neoplastic agents alone or in combination with Akt inhibitors TCN, TCN-P, and API-2. 
         [0080]    To confirm tumor cell reliance on Akt in overcoming chemotherapy and radiotherapy, p53 wild-type (A2780S, OV2008, C-13) and p53 null (A2780CP) cell lines were treated with cis-Diammine-dichloroplatinum II (CDDP), as chemotherapy has been shown to activate an Akt-dependent survival pathway. After CDDP treatment, C-13 and A2780CP exhibited higher survivability than A2780S and OV2008, as shown in  FIGS. 1A through 1C . Results of Western Blot for phosphorylated Akt (p-Akt) indicate C-13 and A2780CP cells had high levels of p-Akt. Further, cell survivability after chemotherapy appears directly connected to Akt up-regulation as C-13 had both the highest p-Akt and survivability. Further, as shown in  FIGS. 2A and 2B , cells were treated with a mammalian target of rapamycin (mTOR) inhibitor. This caused an increase in p-Akt within 1 hour of treatment, confirming a relationship between p-Akt and cell survival after chemotherapy. 
         [0081]    The effect of Akt inhibition on chemotherapeutic cancer treatment was determined through analyzing p53 wild-type A-549 cells treated with 9 different anti-neoplastic agents at varying concentrations. Cell proliferation data was collected and compared to concentration levels of anti-neoplastic agent. The cells were treated with transferase inhibitor agents with or without TCN, seen in  FIGS. 3 through 5 . The addition of TCN has an additive or synergistic effect, with higher TCN concentrations further increasing the inhibitory effectiveness. Cells were treated with a proteasome inhibitor, shown in  FIGS. 6 to 8 . TCN increases the inhibitory effect, however higher levels of TCN have less clear cut results. The cells were then treated with anti-signaling agents alone or in combination with TCN or TCN-P, shown in  FIGS. 9 to 11 , with similar results. 
         [0082]    OVCAR-3, MCF-7, and DU-146 cells were treated with mTOR inhibitors, rapamycin or RAD001, alone or in combination with TCN. Cell lysates were taken and probed for p-Akt, phosphorylated rapamycin target serine/threonine kinase p70S6K, and actin. mTOR inhibitor treatment activates Akt and eliminates phosphorylated p70S6K, as seen in  FIGS. 12A and 12B . However, the addition of TCN prevents activation of Akt and inhibits the growth of cancer cells, even beyond mTOR inhibition treatment alone, shown in  FIGS. 13A through 14 . 
         [0083]    API-2 was further investigated to determine whether it can overcome CDDP resistance by blocking Akt signaling pathways. A2780CP and C-13 cells were treated with increasing amounts of CDDP alone or in combination with 10 μM API-2. As illustrated in  FIG. 15 , CDDP alone has no significant effect on cell survival in either cell line. However, cells treated with API-2 and CDDP underwent significant cell death, even at 5-10 μM doses. C-13 cells were treated with varying amounts of API-2 alone or in combination with 10 μM CDDP to determine the effective dosage amounts of TCN and CDDP. 24 hr after treatment, C-13 cell survival was analyzed, with the results illustrating a synergistic or strong cumulative effect with CDDP and low doses of API-2, shown in  FIG. 16 . The C-13 combination treatment results were confirmed in A2780S and OV2008 cells, as seen in  FIGS. 17A and 17B . The combination treatment decreased the survivability of A2780S and OV2008 cells compared to CDDP treatment alone, as shown in  FIGS. 18A and 18B . 
         [0084]    The effectiveness of TCN combination treatments was determined by treating A2780CP and C-13 cells with TCN, Taxol, or a combination of the two drugs. 
         [0085]    Apoptosis was determined using Capase-Glo 3/7. Treatment with Taxol or TCN individually increased apoptosis slightly. However, the combination of both drugs significantly increased apoptosis, seen in  FIG. 19 , indicating a highly synergistic combination treatment between TCN and Taxol. 
         [0086]    The results indicate an additive effect in in vitro systems. To determine the effectiveness of the combination treatment in vivo, C-13 CDDP-resistant cells were injected subcutaneously into nude mice. 7 days following the injection, the mice were treated with CDDP, API-2, or a combination of CDDP and API-2 once a day. Tumor growth curves were calculated at day 7, 14, 21, and 28. After tumor growth was calculated, the mice were sacrificed and tumor size was determined. API-2 effectively reduced both tumor growth and tumor size, but was less effective than the combinatory CDDP/API-2 treatment, as seen in  FIGS. 20A  and B. 
         [0087]    To confirm these results, ErbB2 breast cancer was induced in transgenic mice. 17 days later, the mice were treated with TCNP and GFB-204, a VEGFR and PDGFR tyrosine phosphorylation inhibitor. As seen in  FIG. 21 , tumor volume decreased rapidly after treatment. The results were replicated using TCNP and GGTI-2418, a geranylgeranyltransferase inhibitor. As with the previous treatment, TCNP and GGTI-2418 resulted in a significant reduction in cancer volume, seen in  FIG. 22 . 
         [0088]    The effect of TCN with protein knockdown technology was analyzed in breast cancer cell lines. Cells were transfected with siRNA STAT3 and TCN was added to the cell media for 72 hr. In  FIG. 23 , cell lysates were collected and probed for pAkt, Akt 1/2, pSTAT3, and STAT3. At lower concentrations, the combination treatment removed phosphorylated Akt. However, siRNA STAT3 with higher TCN concentrations, at 50 μM, Akt 1/2 was also not detected, seen in the far right panel of  FIG. 23 . The cells were also collected to determine proliferation, apoptosis, and cell death, shown in  FIG. 24 . Additionally, the cells were stained and analyzed with flow cytometry to determine the cell cycle status of the cells.  FIG. 25  shows a strong increase in apoptotic cells with a combination treatment of STAT3 siRNA and TCN, compared to TCN alone, confirming the synergistic effect of STAT3 siRNA and TCN. 
         [0089]    p53 has been shown to exert tumor suppression by regulating apoptosis, mainly through up-regulation of pro-apoptotic proteins and down-regulation of anti-apoptotic proteins. It has been shown that p53 up-regulates PTEN while reducing PIK3CA expression, leading to inhibition of the Akt pathway. Further, p53 is phosphorylated, and therefore inhibited, by Aurora-A. To test whether Akt could be activated by Aurora-A to mediate a survival signal, cells were transfected with and without Aurora-A. Protein extracts were analyzed, and indicate Aurora-A activation depends on p53, seen in  FIGS. 26A  though  27 B. Akt1 and Akt2 immmunoprecipitates show Akt1 and Akt2 kinase activity and phosphor-S473-Akt were induced by Aurora-A in a dose dependent manner, whereas total Akt levels were unaffected by Aurora-A. Suppression of Aurora-A through RNAi decreased phosphorylation levels of Akt in transfected cells. Also, the addition of Akt inhibitor API-2 abrogated Akt induction by Aurora-A in A2780S and A2780CP cells regardless of whether the cells were transfected with Aurora-A. 
         [0090]    The effects of ovarian tumor response were then evaluated with HA-tagged Aurora-A transfected cells, with wild-type or mutant p 53 . After expression of HA tagged Aurora-A was confirmed by immunoblot, transfected cells were treated with 10 μM CDDP, 100 nM taxol, 5 μM VP16, or 2 μM doxorubicin. MTT analyses at differing times indicate overexpression of Aurora-A significantly reduces CDDP, VP-16, and taxol sensitivity, but has little effect on doxorubicin. However, ectopic expression of Aurora-A has no significant effect on survival of A2780CP cells, seen in  FIGS. 28A to 31 , implying Aurora-A-induced chemoresistance associates with p53 status. To determine the applicability of the findings to other cells, OV22008 cells with wild-type p53 were transfected with Aurora-A. Upon introduction of Aurora-A, the cells were exposed to CDDP and exhibited reduced cell death, indicating Aurora-A induced CDDP resistance. 
         [0091]    To determine the pathway in which Aurora-A induces CDDP resistance, cells were transfected with adenovirus. 48 hours later, the cells were treated with CDDP and cell survival was assayed at various times. Reintroduction of p53 restored CDDP sensitivity in non-Aurora-A-transfected cells, shown in  FIGS. 32A to 34  indicating Aurora-A protects cells from CDDP-induced apoptosis through a p53 dependent manner. To further validate Aurora-A&#39;s involvement in CDDP resistance, Aurora-A was knocked down using RNAi. Knockdown of Aurora-A enhances CDDP-induced apoptosis and abrogates Aurora-A-induced CDDP resistance, shown in  FIGS. 35 through 37B . 
         [0092]    A2780CP, A2780S, and OV2008 cells were transfected with Aurora-A or pcDNA3 vector and treated with API-2, CDDP, LY294002 with CDDP, or API-2 with CDDP. Cell viability was calculated at varying time points, showing API-2 alone considerably reduces cell survival in A2780S-Aurora-A, OV2008-Aurora-A and A2780CP cells. Seen in  FIG. 38 , combination treatment of API-2 with CDDP abrogates Aurora-A-induced CDDP resistance, and reverses phenotypic A2780CP CDDP resistance. 
         [0093]    A2780S and A2780CP cell lysates were analyzed for PTEN to prove p53 is required for Aurora-A-induced CDDP resistance. Aurora-A reduces PTEN expression in A2780S, but not A2780CP, cells, as seen in  FIGS. 39A to 43 . HA-tagged wild-type p53 restores PTEN expression in A2780CP-vector, but not A2780-CP-Aurora-A cells, showing p53 function is abrogated by Aurora-A. Further, ectopic expression of p53 stimulates PTEN promoter activity in A2780CP cells but fails to activate the promoter in Aurora-A cells. Moreover, since Bax is a major target of p53, and is vital in chemotherapeutic agent-induced apoptosis, cell lysates were analyzed for Bax. Following CDDP treatment, cell lysates were immunoprecipitated and immunostained for anti-active Bax antibody. The results show Aurora-A reduces Bax expression and conformational changes, and Bax translocation into the mitochondria. 
         [0094]    The effectiveness of TCN with various chemotherapeutics was determined using lung cancer A-549 cells. The cells were treated with varying concentrations of TCN at varying chemotherapeutic agent doses. 72 hr after treatment, cell proliferation and IC 50  drug effectiveness were analyzed. Further cell lysates were probed for Akt levels and phosphorylation. Combination of TCN with farnesyltransferase inhibitor significantly improves treatment effectiveness, indicating a synergistic effect between TCN and farnesyltransferase inhibitors, as shown in  FIGS. 44A through 46B . Further, phosphorylated Akt is severely reduced at low doses of TCN, while total Akt remains unaffected, shown in  FIGS. 45 and 47 . The results were carried over to other cells lines to test the applicability of combination treatment and reduce cell-specific testing artifacts. Synergistic effects are seen in breast cancer cells,  FIGS. 48A through 50B , multiple myeloma cells,  FIGS. 52A and 52B , and leukemia cells,  FIGS. 53A through 58B . Protein lysates from leukemia cells were collected 24 hr after treatment, and indicate PARP is activated at higher doses of TCN and farnesyltransferase inhibitor, Tipifarnib, as shown in  FIGS. 59A and 59B . 
         [0095]    The effects of TCN combination treatment were then analyzed in breast cancer cells with 30 μM HER2 inhibitor, Herceptin. Apoptosis and cell proliferation were assayed using trypan blue after 72 hr. As seen in  FIGS. 60 and 61 , cell death increased slightly with increased TCN dosages. Cell proliferation was drastically reduced at low TCN dosages, but further proliferative inhibition was limited. Additionally, cell lysates were collected and Western blotted for Erb2 and p-Akt, indicating Erb2 and p-Akt levels drop with increasing TCN. 
         [0096]    The disclosure of all publications cited above are expressly incorporated herein by reference, each in its entirety, to the same extent as if each were incorporated by reference individually. 
         [0097]    It is also to be understood that the following claims are intended to cover all of the generic and specific features of the invention herein described, and all statements of the scope of the invention which, as a matter of language, might be said to fall therebetween. Now that the invention has been described,