Background and Objectives: The integration of chemotherapy (ChT) and immune checkpoint inhibitors (ICIs) has become a standard approach in oncology. Although the addition of ICIs to double-agent ChT regimens has demonstrated clinical benefit in multiple studies, other trials have reported no significant improvement. ChT is hypothesized to potentiate the effects of ICIs through multiple mechanisms, including tumor antigen release and modulation of the tumor microenvironment. This study aimed to evaluate whether nivolumab enhances the cytotoxic effects of cisplatin or paclitaxel in lung adenocarcinoma (A549) cell lines under immune-independent conditions. Materials and Methods: A549 lung alveolar carcinoma cell lines were treated with varying concentrations of nivolumab, cisplatin, and paclitaxel, individually and in combinations. Cytotoxicity and apoptosis were assessed using mitochondrial membrane potential analysis, cell viability assays, and morphological evaluation of cellular and nuclear alterations characteristic of apoptotic cell death. Results: Nivolumab alone exhibited no cytotoxic activity. The combination of cisplatin at its IC50 (half-maximal inhibitory concentration) (3 µg/mL) with 13 µg/mL nivolumab yielded the most pronounced cytotoxicity (89%) compared to cisplatin alone (49%, p < 0.001). Paclitaxel combined with nivolumab increased cytotoxicity to 69% versus 51% for paclitaxel alone (p < 0.05). The enhancement effect was greater with cisplatin than with paclitaxel. Notably, adding nivolumab to the cisplatin–paclitaxel combination reduced cytotoxicity from 73% to 64%. Mechanistic analysis revealed a significant reduction in Rhodamine 123 fluorescence intensity in drug-treated groups versus controls (p < 0.001), indicating loss of mitochondrial membrane potential, a hallmark of intrinsic apoptotic activation, suggesting apoptotic priming. Conclusions: Nivolumab potentiates the cytotoxic effects of cisplatin and paclitaxel in A549 lung adenocarcinoma cells, with a more pronounced effect observed in combination with cisplatin. This enhancement is associated with mitochondrial membrane potential loss, supporting mitochondrial apoptotic priming as a potential underlying mechanism of drug synergy.
Okşak et al. (Fri,) studied this question.