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Here, we conduct a clinical study to validate the zebrafish patient-derived xenograft model (zAvatar) as a fast predictive platform for personalized treatment in colorectal cancer. zAvatars are generated with patient tumor cells, treated exactly with the same therapy as their corresponding patient and analyzed at single-cell resolution. By individually comparing the clinical responses of 55 patients with their zAvatar-test, we develop a decision tree model integrating tumor stage, zAvatar-apoptosis, and zAvatar-metastatic potential. This model accurately forecasts patient progression with 91% accuracy. Importantly, patients with a sensitive zAvatar-test exhibit longer progression-free survival compared to those with a resistant test. We propose the zAvatar-test as a rapid approach to guide clinical decisions, optimizing treatment options and improving the survival of cancer patients.<\/jats:p>","DOI":"10.1038\/s41467-024-49051-0","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T10:03:42Z","timestamp":1717581822000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Zebrafish Avatar-test forecasts clinical response to chemotherapy in patients with colorectal cancer"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6697-7258","authenticated-orcid":false,"given":"Bruna","family":"Costa","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-822X","authenticated-orcid":false,"given":"Marta F.","family":"Estrada","sequence":"additional","affiliation":[]},{"given":"Ant\u00f3nio","family":"Gomes","sequence":"additional","affiliation":[]},{"given":"Laura M.","family":"Fernandez","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2918-3088","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"Azevedo","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2339-0550","authenticated-orcid":false,"given":"Vanda","family":"P\u00f3voa","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5397-2550","authenticated-orcid":false,"given":"M\u00e1rcia","family":"Fontes","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4142-8308","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Alves","sequence":"additional","affiliation":[]},{"given":"Ant\u00f3nio","family":"Galzerano","sequence":"additional","affiliation":[]},{"given":"Mireia","family":"Castillo-Martin","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8380-4722","authenticated-orcid":false,"given":"Ignacio","family":"Herrando","sequence":"additional","affiliation":[]},{"given":"Shermann","family":"Brand\u00e3o","sequence":"additional","affiliation":[]},{"given":"Carla","family":"Carneiro","sequence":"additional","affiliation":[]},{"given":"V\u00edtor","family":"Nunes","sequence":"additional","affiliation":[]},{"given":"Carlos","family":"Carvalho","sequence":"additional","affiliation":[]},{"given":"Amjad","family":"Parvaiz","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9410-4772","authenticated-orcid":false,"given":"Ana","family":"Marreiros","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5550-2428","authenticated-orcid":false,"given":"Rita","family":"Fior","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2024,6,5]]},"reference":[{"key":"49051_CR1","first-page":"145","volume":"70","author":"RL Siegel","year":"2020","unstructured":"Siegel, R. 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