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Personalised Cancer Medicine: Humans Make Better Treatment Decisions Than AI

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Treating cancer is becoming increasingly complex, but more and more possibilities are being presented. After all, the better a tumour’s biology and genetic features are understood, the more treatment approaches there are. To be able to offer patients personalised therapies tailored to their disease, laborious, time-consuming analysis and interpretation of various data are required. Researchers at Charité – Berlin University Medicine and Humboldt University of Berlin have now studied whether generative artificial intelligence (AI) tools such as ChatGPT can help with this step. This is one of many projects at Charité analysing the opportunities unlocked by AI in patient care.

If the body can no longer repair certain genetic mutations itself, cells begin to grow unchecked, producing a tumour. The crucial factor in this phenomenon is an imbalance of growth-inducing and growth-inhibiting factors, which can result from changes in oncogenes – genes with the potential to cause cancer – for example. Precision oncology, a specialised field of personalised medicine, leverages this knowledge by using specific treatments such as low-molecular weight inhibitors and antibodies to target and disable hyperactive oncogenes.

The first step in identifying which genetic mutations are potential targets for treatment is to analyse the genetic makeup of the tumour tissue. The molecular variants of the tumour DNA that are necessary for precision diagnosis and treatment are determined. Then the doctors use this information to craft individual treatment recommendations. In especially complex cases, this requires knowledge from various fields of medicine. At Charité, this is when the “molecular tumour board” (MTB) meets: Experts from the fields of pathology, molecular pathology, oncology, human genetics, and bioinformatics work together to analyse which treatments seem most promising based on the latest studies. It is a very involved process, ultimately culminating in a personalised treatment recommendation.

Dr Damian Rieke of Charité, Ulf Leser and Xing David Wang of Humboldt University of Berlin, and Dr Manuela Benary, a bioinformatics specialist at Charité, wondered whether artificial intelligence might be able to help at this juncture. In a study recently published in the journal JAMA Network Open, they worked with other researchers to examine the possibilities and limitations of large language models such as ChatGPT in automatically scanning scientific literature with an eye to selecting personalised treatments.

“We prompted the models to identify personalised treatment options for fictitious cancer patients and then compared the results with the recommendations made by experts,” Rieke explained. His conclusion: “AI models were able to identify personalised treatment options in principle – but they weren’t even close to the abilities of human experts.”

The team created ten molecular tumour profiles of fictitious patients for the experiment. A human physician specialist and four large language models were then tasked with identifying a personalised treatment option. These results were presented to the members of the MTB for assessment, without them knowing where which recommendation came from.

“There were some surprisingly good treatment options identified by AI in isolated cases,” Benary reports. “But large language models perform much worse than human experts.” Beyond that, data protection, privacy, and reproducibility pose particular challenges in relation to the use of artificial intelligence with real-world patients, she noted.

Still, Rieke is fundamentally optimistic about the potential uses of AI in medicine: “In the study, we also showed that the performance of AI models is continuing to improve as the models advance. This could mean that AI can provide more support for even complex diagnostic and treatment processes in the future – as long as humans are the ones to check the results generated by AI and have the final say about treatment.”

Professor Felix Balzer, the director of the Institute of Medical Informatics, is also certain medicine will benefit from AI. In his role as chief medical information officer (CMIO) within IT, he is responsible for the digital transformation of patient care at Charité. “One special area of focus when it comes to greater efficiency in patient care is digitalisation, which also means the use of automation and artificial intelligence,” Balzer explained.

His institute is working on AI models to help with fall prevention in long-term care, for example. Other areas at Charité are also conducting extensive research on AI: The Charité Lab for Artificial Intelligence in Medicine is working to develop tools for AI-based prognosis following strokes, and the TEF-Health project, led by professor Petra Ritter of the Berlin Institute of Health at Charité (BIH), is working to facilitate the validation and certification of AI and robotics in medical devices.

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