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Simple Summary: PT-112 is a novel pyrophosphate–platinum conjugate under Phase 1/2 clinical development for the treatment of several tumor types. In this study, using mouse tumor cells with well-characterized mitochondrial and metabolic status, we investigated the mechanisms underlying PT-112's cancer cell death effects. Our results showed that cells with defective mitochondria were more sensitive to PT-112 when compared to cells with normal mitochondrial function. Moreover, PT-112 induced tumor cell death in those sensitive cells through non-conventional mechanisms, including increased mitochondrial stress, free radical generation and immunogenic cell death, a form of cell death that elicits an immune response. Taken together, the present findings suggest the potential for predictors of PT-112 sensitivity in the clinical setting on the basis of metabolic function. PT-112 is a novel pyrophosphate–platinum conjugate, with clinical activity reported in advanced pretreated solid tumors. While PT-112 has been shown to induce robust immunogenic cell death (ICD) in vivo but only minimally bind DNA, the molecular mechanism underlying PT-112 target disruption in cancer cells is still under elucidation. The murine L929 in vitro system was used to test whether differential metabolic status alters PT-112's effects, including cell cytotoxicity. The results showed that tumor cells presenting mutations in mitochondrial DNA (mtDNA) (L929dt and L929dt cybrid cells) and reliant on glycolysis for survival were more sensitive to cell death induced by PT-112 compared to the parental and cybrid cells with an intact oxidative phosphorylation (OXPHOS) pathway (L929 and dtL929 cybrid cells). The type of cell death induced by PT-112 did not follow the classical apoptotic pathway: the general caspase inhibitor Z-VAD-fmk did not inhibit PT-112-induced cell death, alone or in combination with the necroptosis inhibitor necrostatin-1. Interestingly, PT-112 initiated autophagy in all cell lines, though this process was not complete. Autophagy is known to be associated with an integrated stress response in cancer cells and with subsequent ICD. PT-112 also induced a massive accumulation of mitochondrial reactive oxygen species, as well as changes in mitochondrial polarization—only in the sensitive cells harboring mitochondrial dysfunction—along with calreticulin cell-surface exposure consistent with ICD. PT-112 substantially reduced the amount of mitochondrial CoQ10 in L929 cells, while the basal CoQ10 levels were below our detection limits in L929dt cells, suggesting a potential relationship between a low basal level of CoQ10 and PT-112 sensitivity. Finally, the expression of HIF-1α was much higher in cells sensitive to PT-112 compared to cells with an intact OXPHOS pathway, suggesting potential clinical applications. [ABSTRACT FROM AUTHOR]