CC223 enhances cisplatin sensitivity of platinum-resistant ovarian cancer by inducing cell cycle arrest

Platinum-based chemotherapy is the standard treatment for ovarian cancer. However, the emergence of platinum resistance greatly limits its effectiveness. Investigating novel therapeutic strategies to overcome platinum resistance is imperative to extend survival in ovarian cancer patients. The cytotoxic effects of CC223 on SKOV3DDP and A2780DDP were evaluated using the CCK8 assay. Based on the ovarian cancer organoid model, drug screening testing was employed to assess the sensitivity of ovarian cancer to CC223. The impact of CC223 on the biological behaviors of SKOV3DDP and A2780DDP was evaluated using colony formation, migration, and invasion assays. The synergistic effect of CC223 and cisplatin was analyzed by combining the CCK8 assay with SynergyFinder software (ZIP score). Concurrently, the difference in drug response between the CC223-cisplatin combination and cisplatin monotherapy was validated using cell lines, organoids, and tumor xenograft models. The activation status of the AKT-mTOR pathway was detected by immunohistochemistry and western blotting in ovarian cancer cell lines and organoids, while flow cytometry analysis was used to assess the effect of the CC223-cisplatin combination on the cell cycle. We found that CC223 could exert a killing effect on platinum-resistant ovarian cancer cells and organoids. CC223 suppressed the proliferation, migration and invasion of platinum-resistant ovarian cancer cells in a dose-dependent manner. Moreover, the combined treatment with CC223 and cisplatin exhibited synergistic anti-proliferative effects in vitro and in vivo. In patient-derived organoids(PDOs) of ovarian cancer, we found enhanced mTOR activation, and the PDOs-guided drug sensitivity analysis revealed that CC223 could enhance sensitivity to cisplatin. Hyperactivation of mTOR signaling in platinum-resistant ovarian cancer cells leads to the poor prognosis of ovarian cancer patients. CC223 could potently suppress the aberrantly activated AKT-mTOR pathway in platinum-resistant ovarian cancer cells. Furthermore, the combined therapy of CC223 and cisplatin can affect cell proliferation by arresting the G0/G1 phase. Our study demonstrated that CC223 could enhance the sensitivity of cisplatin by effectively inhibiting the activation of the AKT-mTOR pathway and potentially arresting the G0/G1 phase. These findings suggest that the synergistic effect of CC223 and cisplatin holds promise as a potential therapeutic strategy for platinum-resistant ovarian cancer.