A Patient's Guide to Functional Profiling Platforms
Treatment Stopped Working? Or Looking for a Clinical Trial?
Don't despair. There may be other options.
When cancer progresses, the question arises whether you should try another treatment, to continue at all, or whether you should try a clinical trial. Yet the central question often remains unanswered: Is there actually a treatment out there that could help me? 2nd and 3rd line tumor response rates are often under 20% and even guideline-recommended targeted therapies might work in only about half of the few genomically eligible patients.[1]
One approach is to look for an unbiased, patient-oriented resources such as OpenCancer.AI, built by founders who have gone through the cancer journey themselves to help patients find and compare diagnostic testing, second opinions, and other resources to discuss with their care team. That platform does also list clinical laboratories that perform functional profiling. No, it’s not a fitness test in a gym. It’s another diagnostic options you may not have heard of yet, but which may make all the difference for you to find the most effective treatment.
What You Need to Know About Functional Profiling
1. It measures something genomic testing cannot
Pathology identifies the cancer. Biomarkers and genomic testing suggest what might or should work. All this is and remains the foundation of your care with your oncologist. However, functional profiling goes much further: it exposes a patient's live cancer tissue to selected drugs and directly observes whether your tumor is sensitive or resistant to those drugs. In short, it provides patient-specific empirical evidence what could work for you rather than another prediction.
2. It requires fresh, live tumor tissue
These tests generally cannot use archived, formalin-fixed pathology specimens. Tissue must be collected during surgery, biopsy, thoracentesis or paracentesis and shipped promptly while viable. That means that you need to contact the laboratory before the procedure so collection, cooling and overnight shipping can be coordinated.
3. The evidence is growing, but insurance coverage is limited
Functional profiling is usually paid for out of pocket, and some oncologists remain unfamiliar with newer platforms and evidence. For example clinical trials have shown that functional profiling lead to improved median progression-free survival increased from 3 to 11 months in recurrent platinum-resistant ovarian cancer, and median overall survival increased from 7.5 to 12 months in recurrent glioblastoma.[2,3] These studies do not validate every platform, but they show that assay-guided treatment selection can improve patient outcomes.
In July 2026, the American Society of Clinical Oncology (ASCO) archived its older assessments opposing the approach and stated that they should no longer guide coverage or clinical decisions concerning modern functional precision medicine.[4] Patients encountering resistance may wish to share this notice with their oncologist.
Comparing Certified Functional Profiling Options
SageMedic - SAGE Oncotest. The test creates patient-derived three-dimensional microtumors and separately measures cytotoxic kill and antiproliferation. It is the only platform reviewed here reporting both endpoints separately, enabling broader and more interpretable testing of chemotherapy, targeted therapies and potential clinical-trial drugs. Typical turnaround is 7-10 days. Learn more about the SAGE Oncotest technology.
Nagourney Cancer Institute - EVA-PCD. This established cytotoxicity platform tests native tumor microspheroids for programmed cell death. Its distinctive advantage is that Dr. Robert Nagourney is a practicing oncologist who can interpret the results and, when appropriate, prescribe and implement a tested regimen himself. Typical turnaround is also 7-10 days.[5] See the Nagourney functional profiling program.
Cordgenics - ChemoID. This cytotoxicity test evaluates bulk tumor cells and cancer stem-like cells. It has the strongest published randomized outcome evidence among these platforms.[2,3] Its focus on standard cytotoxic and guideline-listed therapies may simplify implementation, but offers a narrower search for targeted, repurposed or investigational options. Typical turnaround is 2-3 weeks. See the ChemoID program.
Cure First - PARIS Test. Cure First grows patient-derived organoids and uses an ATP-based viability endpoint. Organoids can support broad screening but may take 2-3 weeks or longer, especially for slower-growing tumors. Cure First is a nonprofit; patients should ask about reduced-cost or financial-assistance testing.[6,7]
First Ascent Biomedical - xDRIVE. First Ascent tests dissociated cultures containing three-dimensional clusters and individual cells using ATP luminescence. It has encouraging prospective pediatric evidence, but the single ATP endpoint cannot distinguish killing from growth inhibition. Typical turnaround is 7-10 days.[8]
Travera - Rapid Therapy Selection. Travera measures drug-induced weight changes in purified single tumor cells and reports in about 2 days. The biological meaning of early weight change is less established than cell death or proliferation, and it is unclear whether such as short exposure can accurately predict effectiveness of drugs that usually take several weeks to month.[9]
What to Look for in a CLIA-Certified Laboratory
Confirm that testing is performed in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory and can be reported for clinical use. Then ask:
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Does the test preserve native three-dimensional tumor tissue similar to how it is in my body or does it just dissociate it into single cells and/or require organoids to grow from it?
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Does it measure tumor-cell death or can it also measure whether it can stop tumor growth in its tracks?
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Can it evaluate chemotherapy, targeted therapies, and perhaps even clinical-trial drugs?
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What are the tissue requirement, reporting success rate, turnaround time and cost?
The readout matters. Cytotoxicity assays identify drugs that kill tumor cells and are particularly suited to chemotherapy. Antiproliferation assays detect therapies that stop cell division, including many targeted agents. Many platforms use adenosine triphosphate (ATP) readout as a metabolic surrogate for tumor viability to measure cytotoxicity, but it is just one signal that can measure only a limited number of drugs reliably.
Our Verdict
​For the broadest testing across chemotherapy, targeted therapies and potential clinical-trial drugs, the SAGE Oncotest is likely the most universally applicable because it separately measures tumor-cell killing and growth inhibition. Patients also seeking an experienced oncologist prepared to implement the result may prefer Dr. Nagourney, despite the older technology. Patients prioritizing the strongest published randomized outcome evidence and mainly considering standard cytotoxic therapies may consider ChemoID, despite its longer turnaround and narrower drug scope.
References
1. Haslam A, Kim MS, Prasad V. Updated estimates of eligibility for and response to genome-targeted oncology drugs among US cancer patients, 2006-2020. Ann Oncol. 2021;32:926-932. doi:10.1016/j.annonc.2021.04.003.
2. Herzog TJ, Krivak TC, Bush S II, et al. ChemoID-guided therapy improves objective response rate in recurrent platinum-resistant ovarian cancer randomized clinical trial. NPJ Precis Oncol. 2025;9:86. doi:10.1038/s41698-025-00874-0.
3. Ranjan T, Sengupta S, Glantz MJ, et al. Cancer stem cell assay-guided chemotherapy improves survival of patients with recurrent glioblastoma in a randomized trial. Cell Rep Med. 2023;4:101025. doi:10.1016/j.xcrm.2023.101025.
4. American Society of Clinical Oncology. ASCO Clinical Notice: ASCO clarification on the status of functional precision medicine. July 14, 2026.
5. Nagourney Cancer Institute. Functional Profiling and Physician Information. Accessed August 2026.
6. Gray HJ, Chatterjee P, Rosati R, et al. Extraordinary clinical response to ibrutinib in low-grade ovarian cancer guided by organoid drug testing. NPJ Precis Oncol. 2023;7:45. doi:10.1038/s41698-023-00379-8.
7. Cure First. PARIS Test: How to Order and Frequently Asked Questions. Accessed August 2026.
8. Acanda De La Rocha AM, et al. Feasibility of functional precision medicine for guiding treatment of relapsed or refractory pediatric cancers. Nat Med. 2024;30:990-1000. doi:10.1038/s41591-024-02848-4.
9. Travera. Rapid Therapy Selection Technology and Clinical Workflow. Accessed August 2026.