# Spatial-omics-guided treatment selection

Source: https://onco.cc/technologies/spatial-omics-guided-therapy/  
OnCo record `spatial-omics-guided-therapy` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Choosing treatment from a map of where each cell type sits in the tumour, not just from a list of its mutations.

## Summary

Spatial transcriptomics and multiplex imaging show that immune exclusion, stromal barriers and clonal geography predict response in ways bulk sequencing cannot; tertiary lymphoid structures, for example, predict immunotherapy benefit across tumour types. Turning these maps into a clinical assay requires standardisation, lower cost and prospective validation. Today they are correlative science inside trials, not decision tools.

## Fields

- Kind: Technology
- Status: emerging
- Last checked: 2026-09-08
- Tags: frontier; promising
- Principle: Spatially resolved RNA or protein profiling quantifies the architecture of the tumour microenvironment; machine learning turns that architecture into a predictive score.
- Strengths: Captures exclusion and heterogeneity that bulk assays average away; Uses the same tissue block as routine pathology; Predictive features already identified
- Limitations: Cost and turnaround far from clinical; No standardised platform or scoring; Prospective validation missing

## Sources

- ClinicalTrials.gov: spatial transcriptomics cancer: https://clinicaltrials.gov/search?term=spatial%20transcriptomics%20cancer

## Connected records

- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/), [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- technologies: [Digital pathology & AI](https://onco.cc/technologies/digital-pathology-ai/), [Pathology & radiology foundation models](https://onco.cc/technologies/pathology-foundation-model/), [Proteomics & phosphoproteomics](https://onco.cc/technologies/proteomics/), [Single-cell & spatial profiling](https://onco.cc/technologies/single-cell-spatial/)
- companies: [10x Genomics](https://onco.cc/companies/10x-genomics/), [BostonGene](https://onco.cc/companies/bostongene/), [Owkin](https://onco.cc/companies/owkin/)
- terms: [Hot vs cold tumours](https://onco.cc/terms/cold-vs-hot/), [Tumour-infiltrating lymphocytes (TILs)](https://onco.cc/terms/tils/)
- roadmaps: [Diagnostics roadmap: stains → gene panels → blood tests that decide treatment](https://onco.cc/roadmaps/diagnostics-roadmap/), [Paths to cures: interception, eradication, control](https://onco.cc/roadmaps/cure-paths/), [Radical oncology: what could change the war by 2035](https://onco.cc/roadmaps/frontier-2035/)

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