Drug Antagonism and Single Agent Dominance Result from Differences in Death Kinetics

Cancer treatment generally involves drugs used in combinations. Most prior work has focused on identifying and understanding synergistic drug-drug interactions; however, understanding antagonistic interactions remains an important and understudied issue. To enrich for antagonism and reveal common features of these combinations, we screened all pairwise combinations of drugs characterized as activators regulated cell death. This network is strongly enriched for antagonism, particularly a form of antagonism that we call “single agent dominance”. Single agent dominance refers to antagonisms in which a two-drug combination phenocopies one of the two agents. Dominance results from differences in death onset time, with dominant drugs acting earlier than their suppressed counterparts. We explored mechanisms by which parthanatotic agents dominate apoptotic agents, finding dominance in this scenario caused by mutually exclusive and conflicting use of PARP1. Taken together, our study reveals death kinetics as a predictive feature of antagonism, due to inhibitory crosstalk between death pathways.