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Sphere forming cells persist in the ascitic fluid of patients with high-grade serous ovarian cancer after first-line therapy and likely contribute to relapse and metastasis. These residual tumor spheres, which are enriched for cancer cells by up to 95% based on detectable TP53 mutations, are slow growing, resistant to platinum-based chemotherapy, and remain a large obstacle towards durable remission. Screening established, rapidly dividing monolayer cell lines in proliferation assays has failed to produce chemotherapeutics capable of eradicating this slow growing population. To identify a consolidation therapy that targets these residual tumor cells we screened nearly 2000 mechanistically annotated, approved and investigational drugs in three cell lines (PEO1, PANC1, A375M) cultured in spheroid and conventional monolayer. To elucidate targetable genes and pathways responsible for spheroid maintenance we performed a whole-genome RNAi screen against PEO1 in both culture conditions. Our pharmacological and genetic profiling provided mechanistic insight into the baseline changes that occur when cells are grown in three dimensional, anchorage independent conditions and identified susceptibilities specific to spheroid populations. Consistent with residual disease, cultured spheres were resistant to many common chemotherapeutics, most notably proteasome inhibitors, but were highly sensitive to the pro-oxidant elesclomol. We verified elesclomol's activity in ex vivo cancer spheroids extracted from the ascitic fluid of patients with advanced high-grade serous ovarian cancer using a simple, culture-free technique. Expression profiling of cultured and ex vivo spheres revealed broad downregulation of genes involved in cell cycle signaling (AURKA, AURKB, PLK1, CDK1, CCNA2, CCNB1, CCNB2, GMNN, CHEK1). Treatment with elesclomol induced expression of chaperone proteins (HSP6, HSP7, HSPA1A, HSPA1B, DNAJA4, DNAJB1), metallothionein proteins (MT1F, MT1M, MT1P2, MT1X, MT2A), and genes involved with the oxidative stress response (HMOX1, ABCB1, SLC7A11) consistent with increased reactive oxygen species caused by high intracellular Cu2+. To pursue this drug as a consolidation therapy in vivo, we evaluated elesclomol's toxicity, pharmacokinetic properties, and efficacy in a murine model for recurrent high-grade serous ovarian cancer. By targeting residual tumor cells with elesclomol after successful treatment with platinum-based therapeutics we hope to prevent recurrence. Citation Format: Ian S. Goldlust, Kelli Wilson, Ludmila Szabova, Xiaohu Zhang, Lesley Mathews-Griner, Maria Vias, Anna Piskorz, Rory Stark, Lee Mendil, Monica Kasbekar, John Braisted, Rajarshi Guha, Crystal McKnight, Paul Shinn, Donna Michelle-Smith, Zoe Weaver Ohler, Mindy Davis, Udo Rudloff, Sam Michael, Madhu Lal-Nag, Scott Martin, Christina Annunziata, Marc Ferrer, James D. Brenton, Craig Thomas. No cell left behind: Residual ovarian spheroids drive recurrence and are sensitive to the pro-oxidant elesclomol. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 278.