Systems and methods for predicting a patient response to various agents and/or combinations of agents using ex vivo dosing and imaging are disclosed. In one example, a method of determining treatment efficacy includes analyzing a solid cell culture over time, e.g., first and second responses to a solid cell culture to respective treatments may be compared to determine a treatment efficacy of each treatment. Systems and methods for applying the treatments to the cell culture and analyzing the cell culture and efficacy are disclosed.