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Lung cancer remains the leading cause of cancer mortality. Efficacious targeted therapy options are urgently needed for lung cancer prevention and treatment. Epidermal growth factor receptor (EGFR) mutant lung cancer represents about 15% of lung cancer cases generally occurring in patients with minimal to no smoking history and with higher prevalence in females. Linkages to environmental exposures have been postulated. Our group synthesized Mito-lonidamine (Mito-LND), a mitochondrial targeted analog of lonidamine which inhibits aerobic glycolysis in cancer cells. We previously identified that Mito-LND induces mitophagy in KRAS mutant lung cells and inhibits lung tumorigenesis and brain metastasis in vivo. Yet, the cancer inhibitory capacity of Mito-LND in EGFR mutant lung cancer has not been investigated. Viability staining assessed Mito-LND induced cell death in EGFR mutant cell lines PC9 (parent) and PC9BrM3 (brain metastatic). Transcriptomic profiling was conducted following Mito-LND treatment and results analyzed in Metacore to assess molecular changes. Deconvolution analysis interrogated alterations in immune cell populations. To discern cell death mechanisms, we evaluated FDA-approved inhibitors for autophagy (chloroquine, CQ), mitophagy/apoptosis (cyclosporin A, CsA) and necrosis (Ponatinib) in EGFR mutant cell lines using viability assays with Mito-LND treatment. In PC9 cells, the IC50 for Mito-LND at 24h and 48h was 1.5µM and 0.5µM, respectively and in PC9BrM3 cells at 24h and 48h was 1.5µM and 0.7µM, respectively. These data support that EGFR mutant cell lines are >2-fold more sensitive to Mito-LND induced cell death compared to KRAS mutant lung cell lines H2030 and H2030BrM3. Transcriptomic profiling results show that Mito-LND treatment upregulated pathway maps linked to heat shock protein and HIF-1A signaling in both PC9 and PC9BrM3 cells. Process networks linked to unfolded protein response, response to hypoxia and oxidative stress, apoptosis and the immune response were upregulated with Mito-LND treatment. Deconvolution analysis revealed monocytes and macrophages were upregulated in Mito-LND treated EGFR mutant cell lines, with CD8+ T cells increased in PC9BrM3 cells and regulatory T cells increased in PC9 cells. Last, CsA significantly inhibited Mito-LND induced cell death in both cell lines, while CQ had no effect suggesting blocking apoptosis, but not late autophagy inhibits cell death induction in EGFR mutant cell lines. Further, necrosis inhibition with Ponatinib synergistically increased Mito-LND induced cell death in EGFR mutant cell lines. These results begin to define the cancer inhibitory mechanisms of Mito-LND in EGFR mutant lung cancer cells which appear to differ from those observed in KRAS mutant lung cancer cells. Future directions include dissecting apoptotic and necrosis driven Mito-LND induced cell death using additional pharmacological inhibitors and genetic approaches. Citation Format: Katherine M. Weh, Connor Howard, Yun Zhang, Jean-Jack Riethoven, Jennifer Clarke, Gang Cheng, Balaraman Kalyanaraman, Ming You, Laura Kresty. Mechanisms by which Mito-lonidamine inhibits EGFR mutant lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6141.