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Background: VEGF-A is the most potent pro-angiogenic factor and is upregulated in a variety of tumors. Therapies were developed to neutralize VEGF signalling, such as Bevacizumab (Bev). Despite promising pre-clinical results, the average response rate to Bev is reduced for most cancers, with significant side effects. In breast cancer (BC) several studies and a meta-analysis have also confirmed a limited i efficacy in unselected populations. Lack of predictive biomarkers prevents a good patient selection. As such guidelines consider Bev only in a minority of cases. Additionally, depending on the individual tumor, VEGF-A can either block or promote metastasis. In this context, an assay able to predict individual responses to Bev, including its impact on metastasis would prove of great value. Methods: We developed an assay, using zebrafish xenografts(zX), where tumor response and the impact on angiogenesis and metastasis (mets) can be readily analysed. By using Triple negative BC (TNBC) cell line models (Hs578T and MDA-MB-468) and zebrafish patient derived xenografts(zPDX) we evaluated the impact of Bev on proliferation, apoptotis, tumor size, angiogenesis and metastasis. Results: a) Human TNBC cell lines display different tumoral features in zX: Hs578T presented the most vascularized tumors (vessel density ~32.4%) and the lowest metastatic capacity (2.6% of xenografts presented mets, n=77). In contrast, MDA-MB-468 that only recruits blood vessels to the base of the tumor, showed a higher metastatic potential (42.5%, n=87). No direct correlation between vessel density and metastasis could be seen. b) zX were able to reveal different individual tumor responses to Bev in 4 days. Analysis of cell death revealed higher apoptosis rate in Hs578T xenografts (1.6-fold, p Conclusions: Our results show that the zebrafish larvae xenografts have enough resolution to display differential tumor responses to Bev in TNBC models and zPDX in just 4 days. We propose zebrafish cancer xenografts as a promising fast in vivo platform for Bev screening, allowing analysis of personalized responses. Citation Format: Cátia Almeida, Raquel Mendes, Joana Mourato Ribeiro, Maria João Cardoso, Fátima Cardoso, Miguel Godinho Ferreira, Rita Fior. Zebrafish xenografts as a fast screening platform for bevacizumab impact on tumor growth, angiogenesis and micrometastasis in breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-03-04.

Cancer frequency and prevalence have been increasing in the past decades, with devastating impacts on patients and their families. Despite the great advances in targeted approaches, there is still a lack of methods to predict individual patient responses, and therefore treatments are tailored according to average response rates. “Omics” approaches are used for patient stratification and choice of therapeutic options towards a more precise medicine. These methods, however, do not consider all genetic and non-genetic dynamic interactions that occur upon drug treatment. Therefore, the need to directly challenge patient cells in a personalized manner remains. The present review addresses the state of the art of patient-derived in vitro and in vivo models, from organoids to mouse and zebrafish Avatars. The predictive power of each model based on the retrospective correlation with the patient clinical outcome will be considered. Finally, the review is focused on the emerging zebrafish Avatars and their unique characteristics allowing a fast analysis of local and systemic effects of drug treatments at the single-cell level. We also address the technical challenges that the field has yet to overcome.