Purpose: These studies were designed to determine whether the synthetic steroid mifepristone inhibits ovarian cancer growth in vitro and in vivo and the molecular mechanisms involved. Experimental Design: The effect of mifepristone on ovarian cancer cell growth in vitro was studied in ovarian cancer cell lines of different genetic backgrounds (SK-OV-3, Caov-3, OV2008, and IGROV-1). In addition, the growth inhibition capacity of mifepristone on ovarian carcinoma xenografts was tested in nude mice. Results: Mifepristone inhibited ovarian cancer cell proliferation in a dose-and time-dependent manner. The cytostatic effect of mifepristone was confirmed in a clonogenic survival assay and was not linked to loss of viability. Mifepristone blocked DNA synthesis, arrested the cell cycle at the G 1 -S transition, up-regulated cyclin-dependent kinase (cdk) inhibitors p21 cip1 and p27 kip1 , down-regulated transcription factor E2F1, decreased expression of the E2F1-regulated genes cdk1 (cdc2) and cyclin A, and modestly decreased cdk2 and cyclin E levels. The abrupt arrest in cell growth induced by mifepristone correlated with reduced cdk2 activity, increased association of cdk2 with p21 cip1 and p27 kip1 , increased nuclear localization of the cdk inhibitors, and reduced nuclear abundance of cdk2 and cyclin E. In vivo, mifepristone significantly delayed the growth of ovarian carcinoma xenografts in a dose-dependent manner and without apparent toxic effects for the animals. Conclusions: These preclinical studies show that mifepristone is effective as a single agent in vitro and in vivo, inhibiting the growth of human epithelial ovarian cancer cells. Mifepristone markedly reduces cdk2 activity likely due to increased association of cdk2 with the cdk inhibitors p21 cip1 and p27 kip1 and reduced nuclear cdk2/cyclin E complex availability. Acting as a cytostatic agent, mifepristone promises to be of translational significance in ovarian cancer therapeutics.Mifepristone, commonly known as RU486, was first synthesized in the early 1980s and described as a progesterone receptor antagonist (1). The potent antagonism of mifepristone on uterine progesterone receptors led to its clinical application for termination of pregnancy, emergency contraception, luteal phase contraception, and menstrual regulation (2). However, when targeting cells other than uterine cells, the progesterone antagonistic activity of mifepristone is less clear. For instance, in fibroblasts and T47D breast cancer cells, treatment with activators of protein kinase A abrogated the antagonistic activity of mifepristone that instead elicited partial agonistic effects (3,4). In HeLa cells, mifepristone significantly induced progesterone-regulated reporter genes, and this agonistic effect was synergistically enhanced by elevating cyclic AMP or by overexpressing the catalytic subunit of protein kinase A (5). The molecular basis for the mixed agonist/antagonist transcriptional regulation of mifepristone in a cell type -specific manner seems to depend on the ratio...