VITAL-3D: Volumetric Single-Cell Quantification Reveals Microenvironment-Dependent Drug Responses in Breast Cancer

Preclinical drug evaluation relies heavily on two-dimensional (2D) monolayer assays, which fail to recapitulate the structural and functional complexity of the tumor microenvironment and may therefore misrepresent therapeutic efficacy. Here, we present VITAL (Volumetric Imaging-based Toxicity and Live Analysis), a high-throughput imaging platform that enables direct single-cell quantification of proliferation and cell death in both 2D and three-dimensional (3D) extracellular matrix (ECM) cultures using a 96-well format. By combining volumetric imaging with automated single-cell analysis, VITAL enables dynamic assessment of drug responses beyond conventional viability assays and EC measurements. Using breast cancer cell lines treated with anticancer agents, we systematically compared drug responses between 2D and 3D microenvironments. Although EC values were often comparable between culture formats, growth kinetics and concentrations required to induce complete growth arrest or net cell loss differed substantially in 3D cultures. In particular, drug concentrations required to induce net cell loss were consistently higher in 3D, revealing microenvironment-dependent survival responses that were not captured by EC alone. Furthermore, clinically expected subtype-specific responses, including tamoxifen sensitivity in ER-positive cells and olaparib sensitivity in BRCA1-mutant cells, were more accurately resolved under 3D culture conditions and extended treatment durations. Together, these findings demonstrate that growth-based, single-cell quantification provides a more comprehensive assessment of therapeutic efficacy than conventional endpoint measurements and establish VITAL as a scalable platform for physiologically relevant preclinical drug screening.