OnCo
ideasIdea

Grow blood-borne tumour cells to test drugs on the cells that actually spread

Drug tests normally use cells from the original tumour. Growing the rarer cells found in blood would test drugs against the cells that are actually travelling.

Cultures and xenografts derived from circulating tumour cells have been established in small-cell lung, breast and prostate cancer, with success rates that rise with CTC burden. They capture the metastasis-competent population and can be sampled repeatedly without a biopsy. Scaling the protocols, publishing failure rates honestly, and linking drug sensitivity to subsequent clinical course would create the first functional assay of metastatic competence.

Hypothesis
Ex vivo models can be established from circulating tumour cells in over 40% of patients with high CTC burden, and their drug sensitivity predicts subsequent clinical response better than sequencing of the archival primary.
Rationale
CTC-derived explant models in small-cell lung cancer reproduce patient chemosensitivity and molecular subtype, and are the field's best worked example. Serial sampling makes resistance trackable in a way tissue biopsy cannot.
What would test it
Multi-centre protocol harmonisation study in small-cell lung and prostate cancer, reporting establishment rate, time to model and concordance of ex vivo sensitivity with clinical response in 100 patients.
Maturity
preclinical evidence
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
7
Bottlenecks it attacks

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