# zAvatar-test—A functional precision model to personalize ovarian cancer treatments: Results from a co-clinical study

## TL;DR

A new zebrafish model called zAvatar-test accurately predicts ovarian cancer treatment responses, helping personalize therapies for better patient outcomes.

## Contribution

The zAvatar-test is a novel functional precision model using zebrafish embryos to predict ovarian cancer treatment responses with high accuracy.

## Key findings

- The zAvatar-test achieved 91% accuracy in predicting patient outcomes in a cohort of 32 patients.
- zAvatar-sensitive patients had longer progression-free survival (17 vs. 6 months).
- Venetoclax showed potential to sensitize multidrug-resistant tumors in a proof-of-concept study.

## Abstract

In ovarian cancer, 80% of patients relapse after first-line therapy. In recurrent cases, oncologists lack reliable tests to guide chemotherapy choices, creating an unmet clinical need. Here, we develop the ovarian cancer zebrafish Avatar-test, a functional in vivo model using patient tumor cells implanted in zebrafish embryos to predict treatment responses. We present the largest observational study (32 patients), where the zAvatar-test achieves 91% accuracy in predicting patient outcomes. Patients with a zAvatar-sensitive-test correlate with longer progression-free survival (17 vs. 6 months). Tumors in zAvatars are dynamic, with human-host cell interactions, and higher metastatic potential in poor-prognosis cases. Finally, as a proof of concept, we demonstrate that venetoclax has the potential to sensitize multidrug-resistant tumors. Altogether, this clinical study demonstrates that the zAvatar-test may help clinicians personalize treatments for ovarian cancer patients. We are now conducting a multicentric randomized clinical trial to evaluate the zAvatar-test as a companion tool in clinical oncology.

•zAvatar-test predicts ovarian cancer therapy response with 91% accuracy (32 patients)•zAvatar-sensitive patients show longer progression-free survival and overall survival•Treatment efficacy tested in 10 days without in vitro cell expansion•Ongoing randomized trial will evaluate the zAvatar-test’s clinical benefit

zAvatar-test predicts ovarian cancer therapy response with 91% accuracy (32 patients)

zAvatar-sensitive patients show longer progression-free survival and overall survival

Treatment efficacy tested in 10 days without in vitro cell expansion

Ongoing randomized trial will evaluate the zAvatar-test’s clinical benefit

Estrada et al. report a co-clinical study showing that patient-derived ovarian cancer zebrafish Avatars (zAvatars) predict therapeutic response with 91% accuracy, in a cohort of 32 patients. The zAvatar-test stratifies patients by survival outcomes and enables drug repurposing, advancing functional precision oncology.