Thirty-two such combinations were evaluated and VE-821 in vivo showed that single agents, did not substantially alter growth, and only certain combinations suppressed growth. The extent of growth fold inhibition was calculated by dividing the alamarBlue fluorescence values for the PF-04217903 treated cells with fluorescence values for cells treated with the vehicle. With the aim of translating the drug combinations to possible human use, we eventually focused only on drugs currently approved by the FDA that targeted the RTKs mutated in GBM. Erlotinib did not show significant inhibition even at a concentration of 100 mM. Lack of erlotinib activity may be attributed to its low solubility in DMSO compared to gefitinib and was therefore eliminated from the subsequent analysis. Remaining were these four inhibitors: gefitinib, imatinib, sunitinib and sorafenib. To test for synergistic cytotoxic effect on GBM oncospheres, one tenthand one fourth the IC50 values were next used. Single drugs and pair-wise combinations of these drugs were analyzed in GBM oncosphere lines for proliferation and caspase induction. Drug combinations containing sunitinib were best at inducing apoptosis, and the best combination for inhibiting growth appeared to be gefitinib plus sunitinib. To investigate the differences observed in the growth inhibition and caspase assay of the GBM oncospheres, the ability of the oncospheres to recover and proliferate following treatment with RTK inhibitors was analyzed. Cells were treated with RTK inhibitors at 25% of IC50 concentrations for 24 hours. The drugs were withdrawn after 24 hours and the ability of the oncospheres to regrow was assessed after two additional weeks of culture in the growth media using alamar blue cell growth assay. The growth assessment revealed that oncospheres treated with single agents or with the combination of RTK inhibitors were able to regrow with the exception of the cells treated with the combination of gefitinib and sunitinib. Moreover, observation of the cells treated with the drugs with light microscopy revealed that cells treated either with single agents or combinations of RTK inhibitors other than gefitinib and sunitinib were able to form oncospheres, whereas the cells treated with a combination of gefitinib and sunitinib were unable to form oncospheres. 020913 cells formed fewer neurospheres when treated with sunitinib compared to gefitinib reflecting the growth inhibition seen earlier in alamar blue assay. This observation suggests that gefitinib and sunitinib forms a specific combination that effectively inhibits growth of GBM oncospheres. The goal of this work was to determine if we could find a combination of approved RTK inhibitors that might be superior to single agent therapy, and test this combination in preclinical animal models of glioblastoma. Monotherapy of RTK targeting agents have been largely ineffective and there is enough in vitro experimental evidence to support the use of combination therapy targeting multiple tyrosine kinases. We first identified possible effective RTK combination using in vitro cell proliferation studies. Next we planned to test efficacy in improved preclinical animal models at FDA approved doses to try and mimic what might be achievable in a clinical trial. In this study, gefitinib and sunitinib was the best in vitro combination, based on its ability to reduce proliferation and kill GBM oncospheres. The pattern of effective inhibitor combinations suggests that successful simultaneous inhibition of EGFR and PDGFR and other tyrosine kinases was necessary.