The purpose of this study was to investigate the anti-tumor activities of proanthocyanidin (PA) from grape seeds and doxorubicin (DOX) in vitro as well as in vivo, either alone or in combination and to explore the immunomodulatory mechanism in tumor-bearing mice. PA (12.5 approximately 200 mg/l) or DOX (0.01 approximately 1 mg/l) for 24 h significantly inhibited YAC-1 cell proliferation (IC(50) 57.53 or 0.198 mg/l, respectively) in a concentration-dependent manner using microculture tetrazolium (MTT) assay. Meanwhile, a combination of PA (12.5, 25 mg/l) with DOX strongly inhibited cell proliferation with IC(50) values of DOX decreasing by 0.09 and 0.045 mg/l, respectively. In mouse tumor xenograft models, intraperitoneal administrations of PA (10 mg/kg) daily or DOX (2 mg/kg) every other day for 9 days significantly inhibited the growth of sarcoma 180, whereas a combination of the two strongly inhibited tumor growth as compared with PA or DOX alone (p<0.01). In contrast to PA treatment, DOX inhibited Con A-stimulated lymphocyte proliferation, IL-2 and IFN-gamma productions, NK cell cytotoxicity and CD4+/CD8+ ratio, while the administration of PA combined with DOX significantly enhanced the above immune responses as compared with the tumor-bearing control (p<0.01). Taken together, these results suggest that PA has anti-tumor activity and increases the anti-tumor activity of DOX, and the mechanism might be related partially to immunopotentiating activities through the enhancements of lymphocyte proliferation, NK cell cytotoxicity, CD4+/CD8+ ratio, IL-2 and IFN-gamma productions.