Ovarian cancer is a gynecological malignancy that is commonly treated by cytoreductive surgery followed by cisplatin treatment. However, the cisplatin treatment, although successful initially, is not effective in the treatment of the recurrent disease that invariably surfaces within a few months of the initial treatment. The refractory behavior is attributed to the increased levels of cellular thiols apparently caused by the cisplatin treatment. This observation prompted us to choose a cytotoxic drug whose activity is potentiated by cellular thiols with enhanced specificity toward the thiol-rich cisplatin-resistant cells. We used NCX-4016 [2-(acetyloxy) benzoic acid 3-(nitrooxymethyl)phenyl ester], a derivative of aspirin containing a nitro group that releases nitric oxide in a sustained fashion for several hours in cells and in vivo, and we studied its cytotoxic efficacy against human ovarian cancer cells (HOCCs). Cisplatin-sensitive and cisplatin-resistant (CR) HOCCs were treated with 100 M NCX-4016 for 6 h, and͞or 0.5 g͞ml cisplatin for 1 h and assayed for clonogenecity. NCX-4016 significantly reduced the surviving fractions of cisplatin-sensitive (63 ؎ 6%) and CR (70 ؎ 10%) HOCCs. NCX-4016 also caused a 50% reduction in the levels of cellular glutathione in CR HOCCs. Treatment of cells with NCX-4016 followed by cisplatin showed a significantly greater extent of toxicity when compared with treatment of cells with NCX-4016 or cisplatin alone. In conclusion, this study showed that NCX-4016 is a potential inhibitor of the proliferation of CR HOCCs and thus might specifically kill cisplatin-refractory cancer cells in patients with recurrent ovarian cancer.cisplatin resistance ͉ glutathione ͉ nitric oxide ͉ cytotoxicity ͉ nonsteroidal antiinflammatory drug O varian cancer is the second most commonly diagnosed gynecological malignancy and the fourth leading cause of mortality among women in the United States (1). The high mortality rate is attributed to the lack of early diagnosis of the malignancy and difficulties associated with treatment. The standard treatment includes cytoreductive surgery followed by the administration of chemotherapeutic agents. Platinum-based compounds (e.g., cisplatin and carboplatin) in combination with taxanes (e.g., taxol or paclitaxel), anthracyclines (e.g., doxorubicin), or alkylating agents (e.g., melphalan) are administered to treat the advanced-stage disease (2). However, the overall clinical response with such treatments is only 40-60%. The primary factor that limits the success of chemotherapy in ovarian cancer is the acquired drug resistance in the tumor cell population. Administration of cisplatin results in the development of drug resistance in the cancer cells. Postulated mechanisms of drug resistance include decreased intracellular accumulation of the drug, increased levels of thiols, which inactivate the platinum compound, and the enhancement of DNA repair (3). Even a slight increase in the cisplatin resistance of the tumor may pose a clinically important problem requiring ...