An Adipocyte-like Signature in Ovarian Cancer Minimal Residual Disease Identifies Metabolic Vulnerabilities of Tumor Initiating Cells

Recurrence and metastasis are the main causes of death for cancer patients. Relapse can also occur when complete response is achieved, due to the Minimal Residual Disease (MRD) cells that survive treatment. Here we show that the knowledge gap in solid tumors MRD biology can be reduced studying ovarian cancer and we provide the first molecular characterization of MRD. Transcriptomics analysis of 120 tumor biopsies from 17 patients with different response to treatment revealed that the MRD cells have a very specific adipocyte-like signature. These cells also upregulate fatty acid oxidation (FAO), displaying a vulnerability that can be targeted therapeutically. These findings identify FAO as an attractive target to eradicate MRD in ovarian cancer and make a compelling case for the use of FAO inhibitors in neo-adjuvant settings. RNA-Seq of pre- and post-chemotherapy high-grade serous ovarian tumours