Background: Hepatoma is a common malignancy in the world with high morbidity and
mortality. The treatment of hepatoma is limited by its poor response to many chemotherapeutic
agents. Although paclitaxel (PTX) is widely used in clinical chemotherapy, the low sensitivity to
hepatoma restricts its application. Combination therapy is a promising approach to resolve this
Objective: To evaluate the interaction between paclitaxel, bufalin (BFL) and cinobufagin (CBF),
and explore the optimum combination efficiently.
Methods: HepG2 cells were treated with PTX, BFL and CBF individually or in combination. Their
interactions were evaluated by two classical models (Chou-Talalay model and Bliss independence).
Response surface methodology (RSM) was used to explore the optimum combination.
Furthermore, the optimum drug combination was verified by the morphological experiment.
Results: Synergistic effects were observed when cells were exposed to binary mixtures of
PTX+CBF and BFL+CBF. Although the interaction of PTX and BFL was summative, a strong
synergistic effect was observed when cells were exposed to ternary mixtures of PTX+BFL+CBF.
The interaction results of RSM were consistent with classical models, but more efficient.
Moreover, the optimum combination dose was given by RSM without the combinatorial explosion
of exhaustive testing.
Conclusion: The combination of BFL and CBF synergistically enhanced the potency of PTX
against HepG2 cells. RSM could give an accurate evaluation for drug interactions and efficient
prediction of optimum combination.