Purpose:We investigated whether BRCA1mRNA expression levels may represent a biomarker of survival in sporadic epithelial ovarian cancer following chemotherapy treatment. Experimental Design: The effect of loss of BRCA1 expression on chemotherapy response in ovarian cancer was measured in vitro using dose inhibition assays and AnnexinV flow cytometry. Univariate and multivariate analyses were done to evaluate the relationship between BRCA1 mRNA expression levels and survival after chemotherapy treatment in 70 fresh frozen ovarian tumors. Results: We show that inhibition of endogenous BRCA1 expression in ovarian cancer cell lines results in increased sensitivity to platinum therapy and decreased sensitivity to antimicrotubule agents. In addition, we show that patients with low/intermediate levels of BRCA1 mRNA have a significantly improved overall survival following treatment with platinum-based chemotherapy in comparison with patients with high levels of BRCA1mRNA (57.2 versus18.2 months; P = 0.0017; hazard ratio, 2.9). Furthermore, overall median survival for higher-BRCA1-expressing patients was found to increase following taxane-containing chemotherapy (23.0 versus 18.2 months; P = 0.12; hazard ratio, 0.53). Conclusions: We provide evidence to support a role for BRCA1 mRNA expression as a predictive marker of survival in sporadic epithelial ovarian cancer.The BRCA1 tumor suppressor gene is associated with susceptibility to both hereditary breast and ovarian cancer (1,2). Approximately 5% to 15% of ovarian cancers are inherited and BRCA1 germ-line mutations account for 90% of these cases conferring a cumulative lifetime risk of 54% compared with 1.8% within the general population (3, 4). Although somatic mutations of BRCA1 are uncommon in sporadic ovarian tumors (5), down-regulation of BRCA1 has been reported in >72% of high-grade sporadic ovarian cancers, suggesting that BRCA1 may also play a major role in the development of sporadic epithelial ovarian cancer (6, 7). Epigenetic inactivation of BRCA1 is at least partially due to hypermethylation of the BRCA1 promoter, which has been observed in up to 15% of cases (8,9).Several preclinical breast cancer studies have indicated that BRCA1 is an important determinant of response to both DNAdamaging and taxane-based chemotherapy. Evidence that BRCA1 deficiency, whether through inherited mutation or epigenetic down-regulation, confers marked sensitivity to DNAdamaging agents is derived from numerous in vitro studies (10 -15). Furthermore, several retrospective breast cancer clinical studies are in agreement with these preclinical findings. It has been shown that BRCA1 mutation carriers gain a significant survival advantage from DNA damage -based chemotherapy compared with non -mutation carriers (16,17). In addition, reduced BRCA1 protein expression in sporadic epithelial ovarian cancer was found to correlate with improved survival (18). Finally, a retrospective analysis of BRCA1 mRNA levels in a cohort of sporadic lung tumors showed that low-BRCA1-expressing ...