PHAROS: turning single-cell perturbation models into target-directed drug-combination screens.

Combination therapies are central to cancer treatment, but exhaustive screening is impractical. We introduce PHAROS, a framework that turns a pretrained single-cell perturbation model into a target-directed search engine for drug combinations. PHAROS predicts how a cell population changes under a drug, one drug at a time, then chains these predictions together to simulate drug combinations. It scores each simulated outcome against the desired target state and uses a search algorithm to find the most promising combinations, all without retraining the underlying model. Across two independent combinatorial perturbation datasets, PHAROS recovered exact or mechanism-matched two-drug responses in cell lines, both seen and unseen during model training. Its rankings were specific to the requested conversion and were not explained by single-drug effects, additive effects, or shared mechanism of action. In exploratory analyses of patient-derived metastatic HR+/HER2 breast tumors and basal cell carcinoma (BCC), PHAROS prioritized FDA-approved regimens, distinguished combinations by their predicted tumor-versus-immune objective profiles, and nominated pathway-level hypotheses, while explicitly identifying both tumor cohorts as outside the model's supported distribution. PHAROS provides a modular route from pretrained virtual-cell models to inverse, single-cell combination-screening platforms.