SSRI use and clinical outcomes in epithelial ovarian cancer

Desiré K. Christensen, Guillermo N. Armaiz-Pena, Edgardo Ramirez, Koji Matsuo, Bridget Zimmerman, Behrouz Zand, Eileen Shinn, Michael J. Goodheart, David Bender, Premal H. Thaker, Amina Ahmed, Frank J. Penedo, Koen DeGeest, Luis Mendez, Frederick Domann, Anil K. Sood, Susan K. Lutgendorf*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Selective serotonin reuptake inhibitor (SSRI) use is common among ovarian cancer patients. We examined the effect of SSRIs on survival and progression in ovarian cancer patients and effects of 5-HT on ovarian cancer cell (OCC) proliferation. Ovarian cancer patients from a 6-site study between 1994 and 2010 were included. Cox proportional hazards models were used for multivariate analysis. SSRI use was associated with decreased time to disease recurrence (HR 1.3, CI 1.0-1.6, p=0.03), but not overall survival (HR 1.1, CI 0.9-1.3, p=0.56). Compared to normal ovarian cells, most OCCs had elevated 5-HT2A receptor mRNA expression (up to 1600 fold greater expression). Clonogenic survival increased in cells treated with 10 uM (1.6 fold, p<0.001) and 20uM (1.9 fold, p=0.018) 5-HT. Mice receiving 5-HT injections had increases in tumor weight (p=0.07) and nodules (p=0.08) with increased Ki67 expression. Injections with sertraline doubled mean tumor weight in mice (p=0.16). 5-HT and sertraline both increased Ki67 expression in mouse tumors (p < 0.001). Patients using SSRIs had significantly decreased time to disease progression. It is possible that SSRIs alter serotonin levels in the tumor microenvironment, resulting in activation of proliferation pathways. Further characterization of serotonergic pathways in ovarian cancer is recommended to demonstrate safety of these medications.

Original languageEnglish (US)
Pages (from-to)33179-33191
Number of pages13
Issue number22
StatePublished - May 31 2016


  • Cell proliferation
  • Epithelial ovarian cancer
  • Progression
  • Selective serotonin reuptake inhibitors
  • Serotonin

ASJC Scopus subject areas

  • Oncology


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