Complex in vitro 3D models of digestive system tumors to advance precision medicine and drug testing: Progress, challenges, and trends

Digestive system cancers account for nearly half of all cancers around the world and have a high mortality rate. Cell culture and animal models represent cornerstones of digestive cancer research. However, their ability to en- able cancer precision medicine is limited. Cell culture models cannot retain the genetic and phenotypic heteroge- neity of tumors and lack tumor microenvironment (TME). Patient-derived xenograft mouse models are not suitable for immune-oncology research. While humanized mouse models are time- and cost-consuming. Suitable preclinical models, which can facilitate the understanding of mechanisms of tumor progression and develop new therapeutic strategies, are in high demand. This review article summarizes the recent progress on the establish- ment of TME by using tumor organoid models and microfluidic systems. The main challenges regarding the translation of organoid models from bench to bedside are discussed. The integration of organoids and a microflu- idic platform is the emerging trend in drug screening and precision medicine. A future prospective on this field is also provided.