Despite advances in cancer genomics and the increased use of genomic medicine, metastatic cancer is still mostly an incurable and fatal disease. With diminishing returns from traditional drug discovery strategies, and high clinical failure rates, more emphasis is being placed on alternative drug discovery platforms, such as ex vivo approaches. Ex vivo approaches aim to embed biological relevance and inter-patient variability at an earlier stage of drug discovery, and to offer more precise treatment stratification for patients. However, these techniques also have a high potential to offer personalised therapies to patients, complementing and enhancing genomic medicine. Although an array of approaches are available to researchers, only a minority of techniques have made it through to direct patient treatment within robust clinical trials. Within this review, we discuss the current challenges to ex vivo approaches within clinical practice and summarise the contemporary literature which has directed patient treatment. Finally, we map out how ex vivo approaches could transition from a small-scale, predominantly research based technology to a robust and validated predictive tool. In future, these pre-clinical approaches may be integrated into clinical cancer pathways to assist in the personalisation of therapy choices and to hopefully improve patient experiences and outcomes.

尽管癌症基因组学取得了进步，基因组医学的使用也在增加，但转移性癌症仍然是一种无法治愈的致命疾病。随着传统药物发现策略的收益递减和高临床失败率，越来越多的重点放在替代药物发现平台上，例如离体方法。离体方法旨在在药物发现的早期阶段嵌入生物学相关性和患者间变异性，并为患者提供更精确的治疗分层。然而，这些技术也具有为患者提供个性化治疗、补充和增强基因组医学的巨大潜力。尽管研究人员可以使用一系列方法，但只有少数技术能够在稳健的临床试验中指导患者治疗。在这篇综述中，我们讨论了临床实践中离体方法当前面临的挑战，并总结了指导患者治疗的当代文献。最后，我们绘制出离体方法如何从小规模、主要基于研究的技术转变为强大且经过验证的预测工具。将来，这些临床前方法可能会整合到临床癌症途径中，以帮助个性化治疗选择，并有望改善患者的体验和结果。主要基于研究的技术转变为强大且经过验证的预测工具。将来，这些临床前方法可能会整合到临床癌症途径中，以帮助个性化治疗选择，并有望改善患者的体验和结果。主要基于研究的技术转变为强大且经过验证的预测工具。将来，这些临床前方法可能会整合到临床癌症途径中，以帮助个性化治疗选择，并有望改善患者的体验和结果。