FIG 1.

Functional precision medicine in the management of recurrent childhood cancers. Illustration of our functional precision medicine program depicting the workflow, beginning with the sample collection, and processing, continuing with the establishment of patient-derived tumor cells that are subjected to single drug testing. In parallel, DNA is sent for targeted gene sequencing (UCSF500). The DSS are reported back to the MTB within 5-10 days, whereas the sequencing data take up to 3 weeks. The MTB reviews the data, likely off-label availability for candidate drugs, prior experience with candidate drugs, and treatment history of each patient. A final list of therapeutic options (ranked in order of preference together with suggested doses and schedules) is issued, and patients are treated with the best recommendations whenever possible. DSS, drug sensitivity score; MTB, Molecular Tumor Board.