Preclinical evaluation of olaparib and metformin combination in BRCA1 wildtype ovarian cancer

• Anti-tumor effects of olaparib are enhanced by metformin in BRCA intact ovarian cancer cells in vitro and in vivo.
• Olaparib activates AMPK in ovarian cancer cells.
• This is a promising treatment regimen for women with epithelial ovarian cancer irrespective of BRCA status.

ObjectivesBRCA mutated ovarian cancers show increased responsiveness to PARP inhibitors. PARP inhibitors target DNA repair and provide a second hit to BRCA mutated tumors, resulting in “synthetic lethality”. We investigated a combination of metformin and olaparib to provide “synthetic lethality” in BRCA intact ovarian cancer cells.MethodsOvarian cancer cell lines (UWB1.289, UWB1.289.BRCA, SKOV3, OVCAR5, A2780 and C200) were treated with a combination of metformin and olaparib. Cell viability was assessed by MTT and colony formation assays. Flow cytometry was used to detect cell cycle events. In vivo studies were performed in SKOV3 or A2780 xenografts in nude mice. Animals were treated with single agent, metformin or olaparib or combination. Molecular downstream effects were examined by immunohistochemistry.ResultsCompared to single drug treatment, combination of olaparib and metformin resulted in significant reduction of cell proliferation and colony formation (p < 0.001) in ovarian cancer cells. This treatment was associated with a significant S-phase cell cycle arrest (p < 0.05). Combination of olaparib and metformin significantly inhibited SKOV3 and A2780 ovarian tumor xenografts which were accompanied with decreased Ki-index (p < 0.001). Metformin did not affect DNA damage signaling, while olaparib induced adenosine monophosphate activated kinase activation; that was further potentiated with metformin combination in vivo.ConclusionCombining PARP inhibitors with metformin enhances its anti-proliferative activity in BRCA mutant ovarian cancer cells. Furthermore, the combination showed significant activity in BRCA intact cancer cells in vitro and in vivo. This is a promising treatment regimen for women with epithelial ovarian cancer irrespective of BRCA status.