搜索结果：NPJ precision oncology

Cancer remains a leading cause of death worldwide, necessitating personalized treatment approaches to improve outcomes. Theranostics, combining molecular-level imaging with targeted therapy, offers potential for precision oncology but requires optimized, patient-specific care plans. This paper investigates state-of-the-art data-driven decision support applications with a reinforcement learning focus in precision oncology. We review current applications, training environments, state-space representation, performance evaluation criteria, and measurement of risk and reward, highlighting key challenges. We propose a framework integrating data-driven modeling with reinforcement learning-based decision support to optimize radiopharmaceutical therapy dosing, addressing identified challenges and setting directions for future research. The framework leverages Neural Ordinary Differential Equations and Physics-Informed Neural Networks to enhance Physiologically Based Pharmacokinetic models while applying reinforcement learning algorithms to iteratively refine treatment policies based on patient-specific data.

The essence of precision oncology lies in its commitment to tailor targeted treatments and care measures to each patient based on the individual characteristics of the tumor. The inherent heterogeneity of tumors necessitates gathering information from diverse data sources to provide valuable insights from various perspectives, fostering a holistic comprehension of the tumor. Over the past decade, multimodal data integration technology for precision oncology has made significant strides, showcasing remarkable progress in understanding the intricate details within heterogeneous data modalities. These strides have exhibited tremendous potential for improving clinical decision-making and model interpretation, contributing to the advancement of cancer care and treatment. Given the rapid progress that has been achieved, we provide a comprehensive overview of about 300 papers detailing cutting-edge multimodal data integration techniques in precision oncology. In addition, we conclude the primary clinical applications that have reaped significant benefits, including early assessment, diagnosis, prognosis, and biomarker discovery. Finally, derived from the findings of this survey, we presen

Phase I oncology trials aim to identify a safe dose - often the maximum tolerated dose (MTD) - for subsequent studies. Conventional designs focus on population-level toxicity modeling, with recent attention on leveraging pharmacokinetic (PK) data to improve dose selection. We propose the Precision Dose-Finding (PDF) design, a novel Bayesian phase I framework that integrates individual patient PK profiles into the dose-finding process. By incorporating patient-specific PK parameters (such as volume of distribution and elimination rate), PDF models toxicity risk at the individual level, in contrast to traditional methods that ignore inter-patient variability. The trial is structured in two stages: an initial training stage to update model parameters using cohort-based dose escalation, and a subsequent test stage in which doses for new patients are chosen based on each patient's own PK-predicted toxicity probability. This two-stage approach enables truly personalized dose assignment while maintaining rigorous safety oversight. Extensive simulation studies demonstrate the feasibility of PDF and suggest that it provides improved safety and dosing precision relative to the continual reas

Cancer evolves continuously over time through a complex interplay of genetic, epigenetic, microenvironmental, and phenotypic changes. This dynamic behavior drives uncontrolled cell growth, metastasis, immune evasion, and therapy resistance, posing challenges for effective monitoring and treatment. However, today's data-driven research in oncology has primarily focused on cross-sectional analysis using data from a single modality, limiting the ability to fully characterize and interpret the disease's dynamic heterogeneity. Advances in multiscale data collection and computational methods now enable the discovery of longitudinal multimodal biomarkers for precision oncology. Longitudinal data reveal patterns of disease progression and treatment response that are not evident from single-timepoint data, enabling timely abnormality detection and dynamic treatment adaptation. Multimodal data integration offers complementary information from diverse sources for more precise risk assessment and targeting of cancer therapy. In this review, we survey methods of longitudinal and multimodal modeling, highlighting their synergy in providing multifaceted insights for personalized care tailored to

The non-invasive assessment of increasingly incidentally discovered renal masses is a critical challenge in urologic oncology, where diagnostic uncertainty frequently leads to the overtreatment of benign or indolent tumors. In this study, we developed and validated RenalCLIP using a dataset of 27,866 CT scans from 8,809 patients across nine Chinese medical centers and the public TCIA cohort, a visual-language foundation model for characterization, diagnosis and prognosis of renal mass. The model was developed via a two-stage pre-training strategy that first enhances the image and text encoders with domain-specific knowledge before aligning them through a contrastive learning objective, to create robust representations for superior generalization and diagnostic precision. RenalCLIP achieved better performance and superior generalizability across 10 core tasks spanning the full clinical workflow of kidney cancer, including anatomical assessment, diagnostic classification, and survival prediction, compared with other state-of-the-art general-purpose CT foundation models. Especially, for complicated task like recurrence-free survival prediction in the TCIA cohort, RenalCLIP achieved a

Head and neck squamous cell carcinoma (HNSCC) presents significant challenges in clinical oncology due to its heterogeneity and high mortality rates. This study aims to leverage clinical data and machine learning (ML) principles to predict key outcomes for HNSCC patients: mortality, and relapse-free survival. Utilizing data sourced from the Cancer Imaging Archive, an extensive pipeline was implemented to ensure robust model training and evaluation. Ensemble and individual classifiers, including XGBoost, Random Forest, and Support Vectors, were employed to develop predictive models. The study identified key clinical features influencing HNSCC mortality outcomes and achieved predictive accuracy and ROC-AUC values exceeding 90\% across tasks. Support Vector Machine strongly excelled in relapse-free survival, with an recall value of 0.99 and precision of 0.97. Key clinical features including loco-regional control, smoking and treatment type, were identified as critical predictors of patient outcomes. This study underscores the medical impact of using ML-driven insights to refine prognostic accuracy and optimize personalized treatment strategies in HNSCC.

Chromosome analysis is vital for diagnosing genetic disorders and guiding cancer therapy decisions through the identification of somatic clonal aberrations. However, developing an AI model are hindered by the overwhelming complexity and diversity of chromosomal abnormalities, requiring extensive annotation efforts, while automated methods remain task-specific and lack generalizability due to the scarcity of comprehensive datasets spanning diverse resource conditions. Here, we introduce CHROMA, a foundation model for cytogenomics, designed to overcome these challenges by learning generalizable representations of chromosomal abnormalities. Pre-trained on over 84,000 specimens (~4 million chromosomal images) via self-supervised learning, CHROMA outperforms other methods across all types of abnormalities, even when trained on fewer labelled data and more imbalanced datasets. By facilitating comprehensive mapping of instability and clonal leisons across various aberration types, CHROMA offers a scalable and generalizable solution for reliable and automated clinical analysis, reducing the annotation workload for experts and advancing precision oncology through the early detection of rare

Multimodal learning, integrating histology images and genomics, promises to enhance precision oncology with comprehensive views at microscopic and molecular levels. However, existing methods may not sufficiently model the shared or complementary information for more effective integration. In this study, we introduce a Unified Modeling Enhanced Multimodal Learning (UMEML) framework that employs a hierarchical attention structure to effectively leverage shared and complementary features of both modalities of histology and genomics. Specifically, to mitigate unimodal bias from modality imbalance, we utilize a query-based cross-attention mechanism for prototype clustering in the pathology encoder. Our prototype assignment and modularity strategy are designed to align shared features and minimizes modality gaps. An additional registration mechanism with learnable tokens is introduced to enhance cross-modal feature integration and robustness in multimodal unified modeling. Our experiments demonstrate that our method surpasses previous state-of-the-art approaches in glioma diagnosis and prognosis tasks, underscoring its superiority in precision neuro-Oncology.

Thanks to the rapidly evolving integration of LLMs into decision-support tools, a significant transformation is happening across large-scale systems. Like other medical fields, the use of LLMs such as GPT-4 is gaining increasing interest in radiation oncology as well. An attempt to assess GPT-4's performance in radiation oncology was made via a dedicated 100-question examination on the highly specialized topic of radiation oncology physics, revealing GPT-4's superiority over other LLMs. GPT-4's performance on a broader field of clinical radiation oncology is further benchmarked by the ACR Radiation Oncology In-Training (TXIT) exam where GPT-4 achieved a high accuracy of 74.57%. Its performance on re-labelling structure names in accordance with the AAPM TG-263 report has also been benchmarked, achieving above 96% accuracies. Such studies shed light on the potential of LLMs in radiation oncology. As interest in the potential and constraints of LLMs in general healthcare applications continues to rise5, the capabilities and limitations of LLMs in radiation oncology decision support have not yet been fully explored.

Histopathology is essential for disease diagnosis and treatment decision-making. Recent advances in artificial intelligence (AI) have enabled the development of pathology foundation models that learn rich visual representations from large-scale whole-slide images (WSIs). However, existing models are often trained on disparate datasets using varying strategies, leading to inconsistent performance and limited generalizability. Here, we introduce ELF (Ensemble Learning of Foundation models), a novel framework that integrates five state-of-the-art pathology foundation models to generate unified slide-level representations. Trained on 53,699 WSIs spanning 20 anatomical sites, ELF leverages ensemble learning to capture complementary information from diverse models while maintaining high data efficiency. Unlike traditional tile-level models, ELF's slide-level architecture is particularly advantageous in clinical contexts where data are limited, such as therapeutic response prediction. We evaluated ELF across a wide range of clinical applications, including disease classification, biomarker detection, and response prediction to major anticancer therapies, cytotoxic chemotherapy, targeted t

The overexpression of the human epidermal growth factor receptor 2 (HER2) in breast cells is a key driver of HER2-positive breast cancer, a highly aggressive subtype requiring precise diagnosis and targeted therapy. Immunohistochemistry (IHC) is the standard technique for HER2 assessment but is costly, labor-intensive, and highly dependent on antibody selection. In contrast, hematoxylin and eosin (H&E) staining, a routine histopathological procedure, offers broader accessibility but lacks HER2 specificity. This study proposes an advanced deep learning-based image translation framework to generate high-fidelity IHC images from H&E-stained tissue samples, enabling cost-effective and scalable HER2 assessment. By modifying the loss function of pyramid pix2pix, we mitigate mode collapse, a fundamental limitation in generative adversarial networks (GANs), and introduce a novel variance-based penalty that enforces structural diversity in generated images. Our model particularly excels in translating HER2-positive (IHC 3+) images, which have remained challenging for existing methods. Quantitative evaluations on the overall BCI dataset reveal that our approach outperforms baseline m

Randomized controlled trials (RCTs) in oncology often allow control group participants to crossover to experimental treatments, a practice that, while often ethically necessary, complicates the accurate estimation of long-term treatment effects. When crossover rates are high or sample sizes are limited, commonly used methods for crossover adjustment (such as the rank-preserving structural failure time model, inverse probability of censoring weights, and two-stage estimation (TSE)) may produce imprecise estimates. Real-world data (RWD) can be used to develop an external control arm for the RCT, although this approach ignores evidence from trial subjects who did not crossover and ignores evidence from the data obtained prior to crossover for those subjects who did. This paper introduces ''augmented two-stage estimation'' (ATSE), a method that combines data from non-switching participants in a RCT with an external dataset, forming a ''hybrid non-switching arm''. With a simulation study, we evaluate the ATSE method's performance compared to TSE crossover adjustment and an external control arm approach. Results indicate that performance is dependent on scenario characteristics, but when

We present a new unified graph-based representation of medical data, combining genetic information and medical records of patients with medical knowledge via a unique knowledge graph. This approach allows us to infer meaningful information and explanations that would be unavailable by looking at each data set separately. The systematic use of different databases, managed throughout the built knowledge graph, gives new insights toward a better understanding of oncology medicine. Indeed, we reduce some useful medical tasks to well-known problems in theoretical computer science for which efficient algorithms exist.

Human grasps can be roughly categorized into two types: power grasps and precision grasps. Precision grasping enables tool use and is believed to have influenced human evolution. Today's multi-fingered robotic hands are effective in power grasps, but for tasks requiring precision, parallel grippers are still more widely adopted. This contrast highlights a key limitation in current robotic hand design: the difficulty of achieving both stable power grasps and precise, fine-grained manipulation within a single, versatile system. In this work, we bridge this gap by jointly optimizing the control and hardware design of a multi-fingered dexterous hand, enabling both power and precision manipulation. Rather than redesigning the entire hand, we introduce a lightweight fingertip geometry modification, represent it as a contact plane, and jointly optimize its parameters along with the corresponding control. Our control strategy dynamically switches between power and precision manipulation and simplifies precision control into parallel thumb-index motions, which proves robust for sim-to-real transfer. On the design side, we leverage large-scale simulation to optimize the fingertip geometry us

Artificial intelligence (AI) has potential to revolutionize the field of oncology by enhancing the precision of cancer diagnosis, optimizing treatment strategies, and personalizing therapies for a variety of cancers. This review examines the limitations of conventional diagnostic techniques and explores the transformative role of AI in diagnosing and treating cancers such as lung, breast, colorectal, liver, stomach, esophageal, cervical, thyroid, prostate, and skin cancers. The primary objective of this paper is to highlight the significant advancements that AI algorithms have brought to oncology within the medical industry. By enabling early cancer detection, improving diagnostic accuracy, and facilitating targeted treatment delivery, AI contributes to substantial improvements in patient outcomes. The integration of AI in medical imaging, genomic analysis, and pathology enhances diagnostic precision and introduces a novel, less invasive approach to cancer screening. This not only boosts the effectiveness of medical facilities but also reduces operational costs. The study delves into the application of AI in radiomics for detailed cancer characterization, predictive analytics for i

In the past year, there has been a growing trend in applying Large Language Models (LLMs) to the field of medicine, particularly with the advent of advanced language models such as ChatGPT developed by OpenAI. However, there is limited research on LLMs specifically addressing oncology-related queries. The primary aim of this research was to develop a specialized language model that demonstrates improved accuracy in providing advice related to oncology. We performed an extensive data collection of online question-answer interactions centered around oncology, sourced from reputable doctor-patient platforms. Following data cleaning and anonymization, a dataset comprising over 180K+ oncology-related conversations was established. The conversations were categorized and meticulously reviewed by field specialists and clinicians to ensure precision. Employing the LLaMA model and other selected open-source datasets, we conducted iterative fine-tuning to enhance the model's proficiency in basic medical conversation and specialized oncology knowledge. We observed a substantial enhancement in the model's understanding of genuine patient inquiries and its reliability in offering oncology-relate

Precision oncology tests that profile tumors to identify clinically actionable targets have rapidly entered clinical practice. Effective visual presentation of the results of these tests is crucial in accurate clinical decision-making. In current practice, these results are typically delivered to oncologists as static prints, who then incorporate them into their clinical decision-making process. However, due to a lack of guidelines for standardization, different vendors use different report formats. There is very little known on the effectiveness of these report formats or the criteria necessary to improve them. In this study, we have aimed to identify both the tasks and the needs of oncologists from precision oncology report design and then to improve the designs based on these findings. To this end, we report results from multiple interviews and a survey study (n=32) conducted with practicing oncologists. Based on these results, we compiled a set of design criteria for precision oncology reports and developed a prototype report design using these criteria, along with feedback from oncologists.

Mathematical oncology is an interdisciplinary research field where the mathematical sciences meet cancer research. Being situated at the intersection of these two fields makes mathematical oncology highly dynamic, as practicing researchers are incentivised to quickly adapt to both technical and medical research advances. Determining the scope of mathematical oncology is therefore not straightforward; however, it is important for purposes related to funding allocation, education, scientific communication, and community organisation. To address this issue, we here conduct a bibliometric analysis of mathematical oncology. We compare our results to the broader field of mathematical biology, and position our findings within theoretical science of science frameworks. Based on article metadata and citation flows, our results provide evidence that mathematical oncology has undergone a significant evolution since the 1960s marked by increased interactions with other disciplines, geographical expansion, larger research teams, and greater diversity in studied topics. The latter finding contributes to the greater discussion on which models different research communities consider to be valuable

In this manuscript, we draw on the insights from Kahneman, Sibony, and Sunsteins influential nonfiction book Noise: A Flaw in Human Judgment to explore the concept of unwanted variability in judgment (i.e., noise). We introduce key terms and connect these insights to the field of radiation oncology by illustrating how noise contributes to errors in clinically relevant areas such as contouring. Additionally, we propose practical strategies to reduce noise in radiation oncology, such as through judgment aggregation and the use of artificial intelligence tools, building on the principles outlined in the book.