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Lee JJ, Zepeda A, Arbour G, Isaac KV, Ng RT, Nichol AM. Automated Identification of Breast Cancer Relapse in Computed Tomography Reports Using Natural Language Processing. JCO Clin Cancer Inform 2024; 8:e2400107. [PMID: 39705642 DOI: 10.1200/cci.24.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/15/2024] [Accepted: 10/18/2024] [Indexed: 12/22/2024] Open
Abstract
PURPOSE Breast cancer relapses are rarely collected by cancer registries because of logistical and financial constraints. Hence, we investigated natural language processing (NLP), enhanced with state-of-the-art deep learning transformer tools and large language models, to automate relapse identification in the text of computed tomography (CT) reports. METHODS We analyzed follow-up CT reports from patients diagnosed with breast cancer between January 1, 2005, and December 31, 2014. The reports were curated and annotated for the presence or absence of local, regional, and distant breast cancer relapses. We performed 10-fold cross-validation to evaluate models identifying different types of relapses in CT reports. Model performance was assessed with classification metrics, reported with 95% confidence intervals. RESULTS In our data set of 1,445 CT reports, 799 (55.3%) described any relapse, 72 (5.0%) local relapses, 97 (6.7%) regional relapses, and 743 (51.4%) distant relapses. The any-relapse model achieved an accuracy of 89.6% (87.8-91.1), with a sensitivity of 93.2% (91.4-94.9) and a specificity of 84.2% (80.9-87.1). The local relapse model achieved an accuracy of 94.6% (93.3-95.7), a sensitivity of 44.4% (32.8-56.3), and a specificity of 97.2% (96.2-98.0). The regional relapse model showed an accuracy of 93.6% (92.3-94.9), a sensitivity of 70.1% (60.0-79.1), and a specificity of 95.3% (94.2-96.5). Finally, the distant relapse model demonstrated an accuracy of 88.1% (86.2-89.7), a sensitivity of 91.8% (89.9-93.8), and a specificity of 83.7% (80.5-86.4). CONCLUSION We developed NLP models to identify local, regional, and distant breast cancer relapses from CT reports. Automating the identification of breast cancer relapses can enhance data collection about patient outcomes.
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Affiliation(s)
- Jaimie J Lee
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Andres Zepeda
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Gregory Arbour
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Kathryn V Isaac
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Raymond T Ng
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Alan M Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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2
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Jee J, Fong C, Pichotta K, Tran TN, Luthra A, Waters M, Fu C, Altoe M, Liu SY, Maron SB, Ahmed M, Kim S, Pirun M, Chatila WK, de Bruijn I, Pasha A, Kundra R, Gross B, Mastrogiacomo B, Aprati TJ, Liu D, Gao J, Capelletti M, Pekala K, Loudon L, Perry M, Bandlamudi C, Donoghue M, Satravada BA, Martin A, Shen R, Chen Y, Brannon AR, Chang J, Braunstein L, Li A, Safonov A, Stonestrom A, Sanchez-Vela P, Wilhelm C, Robson M, Scher H, Ladanyi M, Reis-Filho JS, Solit DB, Jones DR, Gomez D, Yu H, Chakravarty D, Yaeger R, Abida W, Park W, O'Reilly EM, Garcia-Aguilar J, Socci N, Sanchez-Vega F, Carrot-Zhang J, Stetson PD, Levine R, Rudin CM, Berger MF, Shah SP, Schrag D, Razavi P, Kehl KL, Li BT, Riely GJ, Schultz N. Automated real-world data integration improves cancer outcome prediction. Nature 2024; 636:728-736. [PMID: 39506116 DOI: 10.1038/s41586-024-08167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 10/08/2024] [Indexed: 11/08/2024]
Abstract
The digitization of health records and growing availability of tumour DNA sequencing provide an opportunity to study the determinants of cancer outcomes with unprecedented richness. Patient data are often stored in unstructured text and siloed datasets. Here we combine natural language processing annotations1,2 with structured medication, patient-reported demographic, tumour registry and tumour genomic data from 24,950 patients at Memorial Sloan Kettering Cancer Center to generate a clinicogenomic, harmonized oncologic real-world dataset (MSK-CHORD). MSK-CHORD includes data for non-small-cell lung (n = 7,809), breast (n = 5,368), colorectal (n = 5,543), prostate (n = 3,211) and pancreatic (n = 3,109) cancers and enables discovery of clinicogenomic relationships not apparent in smaller datasets. Leveraging MSK-CHORD to train machine learning models to predict overall survival, we find that models including features derived from natural language processing, such as sites of disease, outperform those based on genomic data or stage alone as tested by cross-validation and an external, multi-institution dataset. By annotating 705,241 radiology reports, MSK-CHORD also uncovers predictors of metastasis to specific organ sites, including a relationship between SETD2 mutation and lower metastatic potential in immunotherapy-treated lung adenocarcinoma corroborated in independent datasets. We demonstrate the feasibility of automated annotation from unstructured notes and its utility in predicting patient outcomes. The resulting data are provided as a public resource for real-world oncologic research.
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Affiliation(s)
- Justin Jee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Karl Pichotta
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anisha Luthra
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michele Waters
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chenlian Fu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mirella Altoe
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Si-Yang Liu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven B Maron
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mehnaj Ahmed
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susie Kim
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mono Pirun
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ino de Bruijn
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arfath Pasha
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ritika Kundra
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin Gross
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - David Liu
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | - Kelly Pekala
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa Loudon
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Perry
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mark Donoghue
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Axel Martin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronglai Shen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuan Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Rose Brannon
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason Chang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lior Braunstein
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Anyi Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anton Safonov
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Clare Wilhelm
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Howard Scher
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Marc Ladanyi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David B Solit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Gomez
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helena Yu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rona Yaeger
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wassim Abida
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wungki Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Eileen M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Julio Garcia-Aguilar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Nicholas Socci
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Ross Levine
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Charles M Rudin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | - Sohrab P Shah
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Pedram Razavi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | - Bob T Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Gregory J Riely
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, Cornell University, New York, NY, USA
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Kehl KL, Jee J, Pichotta K, Paul MA, Trukhanov P, Fong C, Waters M, Bakouny Z, Xu W, Choueiri TK, Nichols C, Schrag D, Schultz N. Shareable artificial intelligence to extract cancer outcomes from electronic health records for precision oncology research. Nat Commun 2024; 15:9787. [PMID: 39532885 PMCID: PMC11557593 DOI: 10.1038/s41467-024-54071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024] Open
Abstract
Databases that link molecular data to clinical outcomes can inform precision cancer research into novel prognostic and predictive biomarkers. However, outside of clinical trials, cancer outcomes are typically recorded only in text form within electronic health records (EHRs). Artificial intelligence (AI) models have been trained to extract outcomes from individual EHRs. However, patient privacy restrictions have historically precluded dissemination of these models beyond the centers at which they were trained. In this study, the vulnerability of text classification models trained directly on protected health information to membership inference attacks is confirmed. A teacher-student distillation approach is applied to develop shareable models for annotating outcomes from imaging reports and medical oncologist notes. 'Teacher' models trained on EHR data from Dana-Farber Cancer Institute (DFCI) are used to label imaging reports and discharge summaries from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset. 'Student' models are trained to use these MIMIC documents to predict the labels assigned by teacher models and sent to Memorial Sloan Kettering (MSK) for evaluation. The student models exhibit high discrimination across outcomes in both the DFCI and MSK test sets. Leveraging private labeling of public datasets to distill publishable clinical AI models from academic centers could facilitate deployment of machine learning to accelerate precision oncology research.
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Affiliation(s)
- Kenneth L Kehl
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA.
| | - Justin Jee
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Karl Pichotta
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Morgan A Paul
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Pavel Trukhanov
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Christopher Fong
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Michele Waters
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Ziad Bakouny
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Wenxin Xu
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Chelsea Nichols
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Deborah Schrag
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Nikolaus Schultz
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
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Mai N, Dos Anjos CH, Razavi P, Safonov A, Patil S, Chen Y, Drago JZ, Modi S, Bromberg JF, Dang CT, Liu D, Norton L, Robson M, Chandarlapaty S, Jhaveri K. Predictors of response to CDK4/6i retrial after prior CDK4/6i failure in ER+ metastatic breast cancer. NPJ Breast Cancer 2024; 10:92. [PMID: 39424631 PMCID: PMC11489574 DOI: 10.1038/s41523-024-00699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 09/22/2024] [Indexed: 10/21/2024] Open
Abstract
After disease progression on endocrine therapy (ET) plus a CDK4/6 inhibitor, there is no standardized sequence for subsequent treatment lines for estrogen receptor positive (ER+) metastatic breast cancer (MBC). CDK4/6i retrial as a treatment strategy is commonplace in modern clinical practice; however, the available prospective data investigating this strategy have had inconclusive results. To frame this data in a real-world context, we performed a retrospective analysis assessing the efficacy of CDK4/6is in 195 patients who had previous exposure to CDK4/6i in a prior treatment line at our institution. Among patients who had stopped a CDK4/6i due to toxicity, CDK4/6i retrial either immediately after with a different CDK4/6i or in a further treatment line with the same initial CDK4/6i was both safe and effective, with a median time to treatment failure (TTF) of 10.1 months (95%CI, 4.8-16.9). For patients whose disease progressed on a prior CDK4/6i, we demonstrated comparable median TTFs for patients rechallenged with the same CDK4/6i (4.3 months, 95%CI 3.2-5.5) and with a different CDK4/6i (4.7 months, 95%CI 3.7-6.0) when compared to the recent PACE, PALMIRA, and MAINTAIN trials. Exploratory genomic analysis suggested that the presence of mutations known to confer CDK4/6i resistance, such as TP53 mutations, CDK4 amplifications, and RB1 or FAT1 loss of function mutations may be molecular biomarkers predictive of CDK4/6i retrial failure.
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Affiliation(s)
- Nicholas Mai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlos H Dos Anjos
- Oncology Service, Department of Medicine, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Pedram Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anton Safonov
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Quantitative Health Sciences, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Yuan Chen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Z Drago
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shanu Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Chau T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dazhi Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarat Chandarlapaty
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Komal Jhaveri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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5
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Hu J, Fu J, Zhao W, Lou P, Feng M, Ren H, Feng S, Li Y, Fang A. Characterizing pituitary adenomas in clinical notes: Corpus construction and its application in LLMs. Health Informatics J 2024; 30:14604582241291442. [PMID: 39379071 DOI: 10.1177/14604582241291442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Objective: Faced with the challenges of differential diagnosis caused by the complex clinical manifestations and high pathological heterogeneity of pituitary adenomas, this study aims to construct a high-quality annotated corpus to characterize pituitary adenomas in clinical notes containing rich diagnosis and treatment information. Methods: A dataset from a pituitary adenomas neurosurgery treatment center of a tertiary first-class hospital in China was retrospectively collected. A semi-automatic corpus construction framework was designed. A total of 2000 documents containing 9430 sentences and 524,232 words were annotated, and the text corpus of pituitary adenomas (TCPA) was constructed and analyzed. Its potential application in large language models (LLMs) was explored through fine-tuning and prompting experiments. Results: TCPA had 4782 medical entities and 28,998 tokens, achieving good quality with the inter-annotator agreement value of 0.862-0.986. The LLMs experiments showed that TCPA can be used to automatically identify clinical information from free texts, and introducing instances with clinical characteristics can effectively reduce the need for training data, thereby reducing labor costs. Conclusion: This study characterized pituitary adenomas in clinical notes, and the proposed method were able to serve as references for relevant research in medical natural language scenarios with highly specialized language structure and terminology.
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Affiliation(s)
- Jiahui Hu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jin Fu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wanqing Zhao
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Pei Lou
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming Feng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huiling Ren
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shanshan Feng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yansheng Li
- DHC Mediway Technology Co., Ltd., Beijing, China
| | - An Fang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Szymaszek P, Tyszka-Czochara M, Ortyl J. Application of Photoactive Compounds in Cancer Theranostics: Review on Recent Trends from Photoactive Chemistry to Artificial Intelligence. Molecules 2024; 29:3164. [PMID: 38999115 PMCID: PMC11243723 DOI: 10.3390/molecules29133164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
According to the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), the number of cancer cases and deaths worldwide is predicted to nearly double by 2030, reaching 21.7 million cases and 13 million fatalities. The increase in cancer mortality is due to limitations in the diagnosis and treatment options that are currently available. The close relationship between diagnostics and medicine has made it possible for cancer patients to receive precise diagnoses and individualized care. This article discusses newly developed compounds with potential for photodynamic therapy and diagnostic applications, as well as those already in use. In addition, it discusses the use of artificial intelligence in the analysis of diagnostic images obtained using, among other things, theranostic agents.
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Affiliation(s)
- Patryk Szymaszek
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, Warszawska 24, 31-155 Kraków, Poland
| | | | - Joanna Ortyl
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, Warszawska 24, 31-155 Kraków, Poland
- Photo HiTech Ltd., Bobrzyńskiego 14, 30-348 Kraków, Poland
- Photo4Chem Ltd., Juliusza Lea 114/416A-B, 31-133 Cracow, Poland
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7
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Riaz IB, Harmon S, Chen Z, Naqvi SAA, Cheng L. Applications of Artificial Intelligence in Prostate Cancer Care: A Path to Enhanced Efficiency and Outcomes. Am Soc Clin Oncol Educ Book 2024; 44:e438516. [PMID: 38935882 DOI: 10.1200/edbk_438516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
The landscape of prostate cancer care has rapidly evolved. We have transitioned from the use of conventional imaging, radical surgeries, and single-agent androgen deprivation therapy to an era of advanced imaging, precision diagnostics, genomics, and targeted treatment options. Concurrently, the emergence of large language models (LLMs) has dramatically transformed the paradigm for artificial intelligence (AI). This convergence of advancements in prostate cancer management and AI provides a compelling rationale to comprehensively review the current state of AI applications in prostate cancer care. Here, we review the advancements in AI-driven applications across the continuum of the journey of a patient with prostate cancer from early interception to survivorship care. We subsequently discuss the role of AI in prostate cancer drug discovery, clinical trials, and clinical practice guidelines. In the localized disease setting, deep learning models demonstrated impressive performance in detecting and grading prostate cancer using imaging and pathology data. For biochemically recurrent diseases, machine learning approaches are being tested for improved risk stratification and treatment decisions. In advanced prostate cancer, deep learning can potentially improve prognostication and assist in clinical decision making. Furthermore, LLMs are poised to revolutionize information summarization and extraction, clinical trial design and operations, drug development, evidence synthesis, and clinical practice guidelines. Synergistic integration of multimodal data integration and human-AI integration are emerging as a key strategy to unlock the full potential of AI in prostate cancer care.
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Affiliation(s)
- Irbaz Bin Riaz
- Division of Hematology and Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
- Department of AI and Informatics, Mayo Clinic, Rochester, MN
| | - Stephanie Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Zhijun Chen
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Department of Surgery (Urology), Brown University Warren Alpert Medical School, Lifespan Health, and the Legorreta Cancer Center at Brown University, Providence, RI
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8
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Mai N, Dos Anjos CH, Razavi P, Safonov A, Patil S, Chen Y, Drago JZ, Modi S, Bromberg JF, Dang CT, Liu D, Norton L, Robson M, Chandarlapaty S, Jhaveri K. Predictors of Response to CDK4/6i Retrial After Prior CDK4/6i Failure in ER+ Metastatic Breast Cancer. RESEARCH SQUARE 2024:rs.3.rs-4237867. [PMID: 38746324 PMCID: PMC11092820 DOI: 10.21203/rs.3.rs-4237867/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
After disease progression on endocrine therapy (ET) plus a CDK4/6 inhibitor, there is no standardized sequence for subsequent treatment lines for estrogen receptor positive (ER+) metastatic breast cancer (MBC). CDK4/6i retrial as a treatment strategy is commonplace in modern clinical practice; however, the available prospective data investigating this strategy have had inconclusive results. To frame this data in a real-world context, we performed a retrospective analysis assessing the efficacy of CDK4/6is in 195 patients who had previous exposure to CDK4/6i in a prior treatment line at our institution. Among patients who had stopped a CDK4/6i due to toxicity, CDK4/6i retrial either immediately after with a different CDK4/6i or in a further treatment line with the same initial CDK4/6i was both safe and effective, with a median time to treatment failure (TTF) of 10.1 months (95%CI, 4.8-16.9). For patients whose disease progressed on a prior CDK4/6i, we demonstrated comparable median TTFs for patients rechallenged with the same CDK4/6i (4.3 months, 95%CI 3.2-5.5) and with a different CDK4/6i (4.7 months, 95%CI 3.7-6.0) when compared to the recent PACE, PALMIRA, and MAINTAIN trials. Exploratory genomic analysis suggested that the presence of mutations known to confer CDK4/6i resistance, such as TP53 mutations, CDK4 amplifications, and RB1 or FAT1 loss of function mutations may be molecular biomarkers predictive of CDK4/6i retrial failure.
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Affiliation(s)
- Nicholas Mai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carlos H Dos Anjos
- Oncology Service, Department of Medicine, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Pedram Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anton Safonov
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sujata Patil
- Department of Quantitative Health Sciences, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Yuan Chen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joshua Z Drago
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shanu Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Chau T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dazhi Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarat Chandarlapaty
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Komal Jhaveri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Xu W, Gu B, Lotter WE, Kehl KL. Extraction and Imputation of Eastern Cooperative Oncology Group Performance Status From Unstructured Oncology Notes Using Language Models. JCO Clin Cancer Inform 2024; 8:e2300269. [PMID: 38810206 PMCID: PMC11492207 DOI: 10.1200/cci.23.00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/08/2024] [Accepted: 04/11/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a key clinical variable for cancer treatment and research, but it is usually only recorded in unstructured form in the electronic health record. We investigated whether natural language processing (NLP) models can impute ECOG PS using unstructured note text. MATERIALS AND METHODS Medical oncology notes were identified from all patients with cancer at our center from 1997 to 2023 and divided at the patient level into training (approximately 80%), tuning/validation (approximately 10%), and test (approximately 10%) sets. Regular expressions were used to extract explicitly documented PS. Extracted PS labels were used to train NLP models to impute ECOG PS (0-1 v 2-4) from the remainder of the notes (with regular expression-extracted PS documentation removed). We assessed associations between imputed PS and overall survival (OS). RESULTS ECOG PS was extracted using regular expressions from 495,862 notes, corresponding to 79,698 patients. A Transformer-based Longformer model imputed PS with high discrimination (test set area under the receiver operating characteristic curve 0.95, area under the precision-recall curve 0.73). Imputed poor PS was associated with worse OS, including among notes with no explicit documentation of PS detected (OS hazard ratio, 11.9; 95% CI, 11.1 to 12.8). CONCLUSION NLP models can be used to impute performance status from unstructured oncologist notes at scale. This may aid the annotation of oncology data sets for clinical outcomes research and cancer care delivery.
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Affiliation(s)
- Wenxin Xu
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Bowen Gu
- Dana-Farber Cancer Institute, Boston, MA
| | - William E. Lotter
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kenneth L. Kehl
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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10
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Wang H, Wu Y, Sun M, Cui X. Enhancing diagnosis of benign lesions and lung cancer through ensemble text and breath analysis: a retrospective cohort study. Sci Rep 2024; 14:8731. [PMID: 38627587 PMCID: PMC11021445 DOI: 10.1038/s41598-024-59474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Early diagnosis of lung cancer (LC) can significantly reduce its mortality rate. Considering the limitations of the high false positive rate and reliance on radiologists' experience in computed tomography (CT)-based diagnosis, a multi-modal early LC screening model that combines radiology with other non-invasive, rapid detection methods is warranted. A high-resolution, multi-modal, and low-differentiation LC screening strategy named ensemble text and breath analysis (ETBA) is proposed that ensembles radiology report text analysis and breath analysis. In total, 231 samples (140 LC patients and 91 benign lesions [BL] patients) were screened using proton transfer reaction-time of flight-mass spectrometry and CT screening. Participants were randomly assigned to a training set and a validation set (4:1) with stratification. The report section of the radiology reports was used to train a text analysis (TA) model with a natural language processing algorithm. Twenty-two volatile organic compounds (VOCs) in the exhaled breath and the prediction results of the TA model were used as predictors to develop the ETBA model using an extreme gradient boosting algorithm. A breath analysis model was developed based on the 22 VOCs. The BA and TA models were compared with the ETBA model. The ETBA model achieved a sensitivity of 94.3%, a specificity of 77.3%, and an accuracy of 87.7% with the validation set. The radiologist diagnosis performance with the validation set had a sensitivity of 74.3%, a specificity of 59.1%, and an accuracy of 68.1%. High sensitivity and specificity were obtained by the ETBA model compared with radiologist diagnosis. The ETBA model has the potential to provide sensitivity and specificity in CT screening of LC. This approach is rapid, non-invasive, multi-dimensional, and accurate for LC and BL diagnosis.
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Affiliation(s)
- Hao Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yinghua Wu
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Meixiu Sun
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
- Engineering Research Center of Pulmonary and Critical Care Medicine Technology and Device Ministry of Education, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
| | - Xiaonan Cui
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
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11
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Kehl KL, Mazor T, Trukhanov P, Lindsay J, Galvin MR, Farhat KS, McClure E, Giordano A, Gandhi L, Schrag D, Hassett MJ, Cerami E. Identifying Oncology Clinical Trial Candidates Using Artificial Intelligence Predictions of Treatment Change: A Pilot Implementation Study. JCO Precis Oncol 2024; 8:e2300507. [PMID: 38513166 PMCID: PMC10965204 DOI: 10.1200/po.23.00507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/25/2023] [Accepted: 01/23/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Precision oncology clinical trials often struggle to accrue, partly because it is difficult to find potentially eligible patients at moments when they need new treatment. We piloted deployment of artificial intelligence tools to identify such patients at a large academic cancer center. PATIENTS AND METHODS Neural networks that process radiology reports to identify patients likely to start new systemic therapy were applied prospectively for patients with solid tumors that had undergone next-generation sequencing at our center. Model output was linked to the MatchMiner tool, which matches patients to trials using tumor genomics. Reports listing genomically matched patients, sorted by probability of treatment change, were provided weekly to an oncology nurse navigator (ONN) coordinating recruitment to nine early-phase trials. The ONN contacted treating oncologists when patients likely to change treatment appeared potentially trial-eligible. RESULTS Within weekly reports to the ONN, 60,199 patient-trial matches were generated for 2,150 patients on the basis of genomics alone. Of these, 3,168 patient-trial matches (5%) corresponding to 525 patients were flagged for ONN review by our model, representing a 95% reduction in review compared with manual review of all patient-trial matches weekly. After ONN review for potential eligibility, treating oncologists for 74 patients were contacted. Common reasons for not contacting treating oncologists included cases where patients had already decided to continue current treatment (21%); the trial had no slots (14%); or the patient was ineligible on ONN review (12%). Of 74 patients whose oncologists were contacted, 10 (14%) had a consult regarding a trial and five (7%) enrolled. CONCLUSION This approach facilitated identification of potential patients for clinical trials in real time, but further work to improve accrual must address the many other barriers to trial enrollment in precision oncology research.
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Affiliation(s)
| | - Tali Mazor
- Dana-Farber Cancer Institute, Boston, MA
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12
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Amorrortu R, Garcia M, Zhao Y, El Naqa I, Balagurunathan Y, Chen DT, Thieu T, Schabath MB, Rollison DE. Overview of approaches to estimate real-world disease progression in lung cancer. JNCI Cancer Spectr 2023; 7:pkad074. [PMID: 37738580 PMCID: PMC10637832 DOI: 10.1093/jncics/pkad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Randomized clinical trials of novel treatments for solid tumors normally measure disease progression using the Response Evaluation Criteria in Solid Tumors. However, novel, scalable approaches to estimate disease progression using real-world data are needed to advance cancer outcomes research. The purpose of this narrative review is to summarize examples from the existing literature on approaches to estimate real-world disease progression and their relative strengths and limitations, using lung cancer as a case study. METHODS A narrative literature review was conducted in PubMed to identify articles that used approaches to estimate real-world disease progression in lung cancer patients. Data abstracted included data source, approach used to estimate real-world progression, and comparison to a selected gold standard (if applicable). RESULTS A total of 40 articles were identified from 2008 to 2022. Five approaches to estimate real-world disease progression were identified including manual abstraction of medical records, natural language processing of clinical notes and/or radiology reports, treatment-based algorithms, changes in tumor volume, and delta radiomics-based approaches. The accuracy of these progression approaches were assessed using different methods, including correlations between real-world endpoints and overall survival for manual abstraction (Spearman rank ρ = 0.61-0.84) and area under the curve for natural language processing approaches (area under the curve = 0.86-0.96). CONCLUSIONS Real-world disease progression has been measured in several observational studies of lung cancer. However, comparing the accuracy of methods across studies is challenging, in part, because of the lack of a gold standard and the different methods used to evaluate accuracy. Concerted efforts are needed to define a gold standard and quality metrics for real-world data.
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Affiliation(s)
| | - Melany Garcia
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Yayi Zhao
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Dung-Tsa Chen
- Department of Biostatistics and Bionformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Thanh Thieu
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
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13
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Tan RSYC, Lin Q, Low GH, Lin R, Goh TC, Chang CCE, Lee FF, Chan WY, Tan WC, Tey HJ, Leong FL, Tan HQ, Nei WL, Chay WY, Tai DWM, Lai GGY, Cheng LTE, Wong FY, Chua MCH, Chua MLK, Tan DSW, Thng CH, Tan IBH, Ng HT. Inferring cancer disease response from radiology reports using large language models with data augmentation and prompting. J Am Med Inform Assoc 2023; 30:1657-1664. [PMID: 37451682 PMCID: PMC10531105 DOI: 10.1093/jamia/ocad133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To assess large language models on their ability to accurately infer cancer disease response from free-text radiology reports. MATERIALS AND METHODS We assembled 10 602 computed tomography reports from cancer patients seen at a single institution. All reports were classified into: no evidence of disease, partial response, stable disease, or progressive disease. We applied transformer models, a bidirectional long short-term memory model, a convolutional neural network model, and conventional machine learning methods to this task. Data augmentation using sentence permutation with consistency loss as well as prompt-based fine-tuning were used on the best-performing models. Models were validated on a hold-out test set and an external validation set based on Response Evaluation Criteria in Solid Tumors (RECIST) classifications. RESULTS The best-performing model was the GatorTron transformer which achieved an accuracy of 0.8916 on the test set and 0.8919 on the RECIST validation set. Data augmentation further improved the accuracy to 0.8976. Prompt-based fine-tuning did not further improve accuracy but was able to reduce the number of training reports to 500 while still achieving good performance. DISCUSSION These models could be used by researchers to derive progression-free survival in large datasets. It may also serve as a decision support tool by providing clinicians an automated second opinion of disease response. CONCLUSIONS Large clinical language models demonstrate potential to infer cancer disease response from radiology reports at scale. Data augmentation techniques are useful to further improve performance. Prompt-based fine-tuning can significantly reduce the size of the training dataset.
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Affiliation(s)
- Ryan Shea Ying Cong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Qian Lin
- Department of Computer Science, National University of Singapore, Singapore
| | - Guat Hwa Low
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Ruixi Lin
- Department of Computer Science, National University of Singapore, Singapore
| | - Tzer Chew Goh
- Institute of Systems Science, National University of Singapore, Singapore
| | | | - Fung Fung Lee
- Institute of Systems Science, National University of Singapore, Singapore
| | - Wei Yin Chan
- Institute of Systems Science, National University of Singapore, Singapore
| | - Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Han Jieh Tey
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Fun Loon Leong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Wen Long Nei
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - David Wai Meng Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Gillianne Geet Yi Lai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Lionel Tim-Ee Cheng
- Duke-NUS Medical School, Singapore
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Melvin Lee Kiang Chua
- Duke-NUS Medical School, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Data and Computational Science Core, National Cancer Centre Singapore, Singapore
| | - Daniel Shao Weng Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Choon Hua Thng
- Duke-NUS Medical School, Singapore
- Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore
| | - Iain Bee Huat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Data and Computational Science Core, National Cancer Centre Singapore, Singapore
| | - Hwee Tou Ng
- Department of Computer Science, National University of Singapore, Singapore
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14
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Elmarakeby HA, Trukhanov PS, Arroyo VM, Riaz IB, Schrag D, Van Allen EM, Kehl KL. Empirical evaluation of language modeling to ascertain cancer outcomes from clinical text reports. BMC Bioinformatics 2023; 24:328. [PMID: 37658330 PMCID: PMC10474750 DOI: 10.1186/s12859-023-05439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Longitudinal data on key cancer outcomes for clinical research, such as response to treatment and disease progression, are not captured in standard cancer registry reporting. Manual extraction of such outcomes from unstructured electronic health records is a slow, resource-intensive process. Natural language processing (NLP) methods can accelerate outcome annotation, but they require substantial labeled data. Transfer learning based on language modeling, particularly using the Transformer architecture, has achieved improvements in NLP performance. However, there has been no systematic evaluation of NLP model training strategies on the extraction of cancer outcomes from unstructured text. RESULTS We evaluated the performance of nine NLP models at the two tasks of identifying cancer response and cancer progression within imaging reports at a single academic center among patients with non-small cell lung cancer. We trained the classification models under different conditions, including training sample size, classification architecture, and language model pre-training. The training involved a labeled dataset of 14,218 imaging reports for 1112 patients with lung cancer. A subset of models was based on a pre-trained language model, DFCI-ImagingBERT, created by further pre-training a BERT-based model using an unlabeled dataset of 662,579 reports from 27,483 patients with cancer from our center. A classifier based on our DFCI-ImagingBERT, trained on more than 200 patients, achieved the best results in most experiments; however, these results were marginally better than simpler "bag of words" or convolutional neural network models. CONCLUSION When developing AI models to extract outcomes from imaging reports for clinical cancer research, if computational resources are plentiful but labeled training data are limited, large language models can be used for zero- or few-shot learning to achieve reasonable performance. When computational resources are more limited but labeled training data are readily available, even simple machine learning architectures can achieve good performance for such tasks.
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Affiliation(s)
- Haitham A Elmarakeby
- Dana-Farber Cancer Institute, Boston, MA, USA.
- Al-Azhar University, Cairo, Egypt.
- Harvard Medical School, Boston, MA, USA.
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | | | | | - Irbaz Bin Riaz
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mayo Clinic, Rochester, MN, USA
| | - Deborah Schrag
- Memorial-Sloan Kettering Cancer Center, New York, NY, USA
| | - Eliezer M Van Allen
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kenneth L Kehl
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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15
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Flores-Toro JA, Jagu S, Armstrong GT, Arons DF, Aune GJ, Chanock SJ, Hawkins DS, Heath A, Helman LJ, Janeway KA, Levine JE, Miller E, Penberthy L, Roberts CWM, Shalley ER, Shern JF, Smith MA, Staudt LM, Volchenboum SL, Zhang J, Zenklusen JC, Lowy DR, Sharpless NE, Guidry Auvil JM, Kerlavage AR, Widemann BC, Reaman GH, Kibbe WA, Doroshow JH. The Childhood Cancer Data Initiative: Using the Power of Data to Learn From and Improve Outcomes for Every Child and Young Adult With Pediatric Cancer. J Clin Oncol 2023; 41:4045-4053. [PMID: 37267580 PMCID: PMC10461939 DOI: 10.1200/jco.22.02208] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/31/2023] [Accepted: 03/28/2023] [Indexed: 06/04/2023] Open
Abstract
Data-driven basic, translational, and clinical research has resulted in improved outcomes for children, adolescents, and young adults (AYAs) with pediatric cancers. However, challenges in sharing data between institutions, particularly in research, prevent addressing substantial unmet needs in children and AYA patients diagnosed with certain pediatric cancers. Systematically collecting and sharing data from every child and AYA can enable greater understanding of pediatric cancers, improve survivorship, and accelerate development of new and more effective therapies. To accomplish this goal, the Childhood Cancer Data Initiative (CCDI) was launched in 2019 at the National Cancer Institute. CCDI is a collaborative community endeavor supported by a 10-year, $50-million (in US dollars) annual federal investment. CCDI aims to learn from every patient diagnosed with a pediatric cancer by designing and building a data ecosystem that facilitates data collection, sharing, and analysis for researchers, clinicians, and patients across the cancer community. For example, CCDI's Molecular Characterization Initiative provides comprehensive clinical molecular characterization for children and AYAs with newly diagnosed cancers. Through these efforts, the CCDI strives to provide clinical benefit to patients and improvements in diagnosis and care through data-focused research support and to build expandable, sustainable data resources and workflows to advance research well past the planned 10 years of the initiative. Importantly, if CCDI demonstrates the success of this model for pediatric cancers, similar approaches can be applied to adults, transforming both clinical research and treatment to improve outcomes for all patients with cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Allison Heath
- Children's Hospital of Philadelphia, Philadelphia, PA
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16
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Ascierto PA, Avallone A, Bifulco C, Bracarda S, Brody JD, Emens LA, Ferris RL, Formenti SC, Hamid O, Johnson DB, Kirchhoff T, Klebanoff CA, Lesinski GB, Monette A, Neyns B, Odunsi K, Paulos CM, Powell DJ, Rezvani K, Segal BH, Singh N, Sullivan RJ, Fox BA, Puzanov I. Perspectives in Immunotherapy: meeting report from Immunotherapy Bridge (Naples, November 30th-December 1st, 2022). J Transl Med 2023; 21:488. [PMID: 37475035 PMCID: PMC10360352 DOI: 10.1186/s12967-023-04329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
The discovery and development of novel treatments that harness the patient's immune system and prevent immune escape has dramatically improved outcomes for patients across cancer types. However, not all patients respond to immunotherapy, acquired resistance remains a challenge, and responses are poor in certain tumors which are considered to be immunologically cold. This has led to the need for new immunotherapy-based approaches, including adoptive cell transfer (ACT), therapeutic vaccines, and novel immune checkpoint inhibitors. These new approaches are focused on patients with an inadequate response to current treatments, with emerging evidence of improved responses in various cancers with new immunotherapy agents, often in combinations with existing agents. The use of cell therapies, drivers of immune response, and trends in immunotherapy were the focus of the Immunotherapy Bridge (November 30th-December 1st, 2022), organized by the Fondazione Melanoma Onlus, Naples, Italy, in collaboration with the Society for Immunotherapy of Cancer.
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Affiliation(s)
- Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumor IRCCS "Fondazione G. Pascale", Naples, Italy.
| | - Antonio Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Carlo Bifulco
- Translational Molecular Pathology and Molecular Genomics, Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
| | - Sergio Bracarda
- Department of Oncology, Medical and Translational Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Joshua D Brody
- Tisch Cancer Institute, Marc and Jennifer Lipschultz Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leisha A Emens
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Ankyra Therapeutics, Cambridge, MA, USA
| | - Robert L Ferris
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Omid Hamid
- The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, CA, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tomas Kirchhoff
- Laura and Isaac Perlmutter Cancer Center, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Christopher A Klebanoff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Gregory B Lesinski
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne Monette
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Bart Neyns
- Department of Medical Oncology, University Hospital Brussel, Brussels, Belgium
| | - Kunle Odunsi
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, IL, USA
| | - Chrystal M Paulos
- Department of Surgery and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
- Translational Research for Cutaneous Malignancies, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Daniel J Powell
- Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brahm H Segal
- Department of Internal Medicine and Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nathan Singh
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan J Sullivan
- Melanoma Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Bernard A Fox
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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17
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Xu M, Chen Z, Zheng J, Zhao Q, Yuan Z. Artificial Intelligence-Aided Optical Imaging for Cancer Theranostics. Semin Cancer Biol 2023:S1044-579X(23)00094-9. [PMID: 37302519 DOI: 10.1016/j.semcancer.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
The use of artificial intelligence (AI) to assist biomedical imaging have demonstrated its high accuracy and high efficiency in medical decision-making for individualized cancer medicine. In particular, optical imaging methods are able to visualize both the structural and functional information of tumors tissues with high contrast, low cost, and noninvasive property. However, no systematic work has been performed to inspect the recent advances on AI-aided optical imaging for cancer theranostics. In this review, we demonstrated how AI can guide optical imaging methods to improve the accuracy on tumor detection, automated analysis and prediction of its histopathological section, its monitoring during treatment, and its prognosis by using computer vision, deep learning and natural language processing. By contrast, the optical imaging techniques involved mainly consisted of various tomography and microscopy imaging methods such as optical endoscopy imaging, optical coherence tomography, photoacoustic imaging, diffuse optical tomography, optical microscopy imaging, Raman imaging, and fluorescent imaging. Meanwhile, existing problems, possible challenges and future prospects for AI-aided optical imaging protocol for cancer theranostics were also discussed. It is expected that the present work can open a new avenue for precision oncology by using AI and optical imaging tools.
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Affiliation(s)
- Mengze Xu
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Zhuhai, China; Cancer Center, Faculty of Health Sciences, University of Macau, Macau SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China
| | - Zhiyi Chen
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
| | - Junxiao Zheng
- Cancer Center, Faculty of Health Sciences, University of Macau, Macau SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China
| | - Qi Zhao
- Cancer Center, Faculty of Health Sciences, University of Macau, Macau SAR, China
| | - Zhen Yuan
- Cancer Center, Faculty of Health Sciences, University of Macau, Macau SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China.
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18
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Vazquez-Levin MH, Reventos J, Zaki G. Editorial: Artificial intelligence: A step forward in biomarker discovery and integration towards improved cancer diagnosis and treatment. Front Oncol 2023; 13:1161118. [PMID: 37064106 PMCID: PMC10102612 DOI: 10.3389/fonc.2023.1161118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Mónica Hebe Vazquez-Levin
- Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET) Fundación IBYME (FIBYME), Buenos Aires, Argentina
- *Correspondence: Mónica Hebe Vazquez-Levin, ;
| | - Jaume Reventos
- Institut d’Investigacio Biomedica de Bellvitge (IDIBELL) and Universitat Internacional de Catalunya, Barcelona, Spain
| | - George Zaki
- Frederick National Laboratory for Cancer Research, National Cancer Institute at Frederick (NIH), Frederick, MD, United States
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Huang S, Yang J, Shen N, Xu Q, Zhao Q. Artificial intelligence in lung cancer diagnosis and prognosis: Current application and future perspective. Semin Cancer Biol 2023; 89:30-37. [PMID: 36682439 DOI: 10.1016/j.semcancer.2023.01.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Lung cancer is one of the malignant tumors with the highest incidence and mortality in the world. The overall five-year survival rate of lung cancer is relatively lower than many leading cancers. Early diagnosis and prognosis of lung cancer are essential to improve the patient's survival rate. With artificial intelligence (AI) approaches widely applied in lung cancer, early diagnosis and prediction have achieved excellent performance in recent years. This review summarizes various types of AI algorithm applications in lung cancer, including natural language processing (NLP), machine learning and deep learning, and reinforcement learning. In addition, we provides evidence regarding the application of AI in lung cancer diagnostic and clinical prognosis. This review aims to elucidate the value of AI in lung cancer diagnosis and prognosis as the novel screening decision-making for the precise treatment of lung cancer patients.
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Affiliation(s)
- Shigao Huang
- Department of Radiation Oncology, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Jie Yang
- Chongqing Industry&Trade Polytechnic, Chongqing, China
| | - Na Shen
- Hong Kong Shue Yan University, Hong Kong, China
| | - Qingsong Xu
- Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Qi Zhao
- Cancer Center, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China; MoE Frontiers Science Center for Precision Oncology, University of Macau, Taipa, Macau SAR, China.
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20
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Saha A, Burns L, Kulkarni AM. A scoping review of natural language processing of radiology reports in breast cancer. Front Oncol 2023; 13:1160167. [PMID: 37124523 PMCID: PMC10130381 DOI: 10.3389/fonc.2023.1160167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Various natural language processing (NLP) algorithms have been applied in the literature to analyze radiology reports pertaining to the diagnosis and subsequent care of cancer patients. Applications of this technology include cohort selection for clinical trials, population of large-scale data registries, and quality improvement in radiology workflows including mammography screening. This scoping review is the first to examine such applications in the specific context of breast cancer. Out of 210 identified articles initially, 44 met our inclusion criteria for this review. Extracted data elements included both clinical and technical details of studies that developed or evaluated NLP algorithms applied to free-text radiology reports of breast cancer. Our review illustrates an emphasis on applications in diagnostic and screening processes over treatment or therapeutic applications and describes growth in deep learning and transfer learning approaches in recent years, although rule-based approaches continue to be useful. Furthermore, we observe increased efforts in code and software sharing but not with data sharing.
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Affiliation(s)
- Ashirbani Saha
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences and McMaster University, Escarpment Cancer Research Institute, Hamilton, ON, Canada
- *Correspondence: Ashirbani Saha,
| | - Levi Burns
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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Pandiyan S, Wang L. A comprehensive review on recent approaches for cancer drug discovery associated with artificial intelligence. Comput Biol Med 2022; 150:106140. [PMID: 36179510 DOI: 10.1016/j.compbiomed.2022.106140] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/20/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
Through the revolutionization of artificial intelligence (AI) technologies in clinical research, significant improvement is observed in diagnosis of cancer. Utilization of these AI technologies, such as machine and deep learning, is imperative for the discovery of novel anticancer drugs and improves existing/ongoing cancer therapeutics. However, building a model for complicated cancers and their types remains a challenge due to lack of effective therapeutics that hinder the establishment of effective computational tools. In this review, we exploit recent approaches and state-of-the-art in implementing AI methods for anticancer drug discovery, and discussed how advances in these applications need to be considered in the current cancer therapeutics. Considering the immense potential of AI, we explore molecular docking and their interactions to recognize metabolic activities that support drug design. Finally, we highlight corresponding strategies in applying machine and deep learning methods to various types of cancer with their pros and cons.
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Affiliation(s)
- Sanjeevi Pandiyan
- Research Center for Intelligent Information Technology, Nantong University, Nantong, China; School of Information Science and Technology, Nantong University, Nantong, China; Nantong Research Institute for Advanced Communication Technologies, Nantong, China
| | - Li Wang
- Research Center for Intelligent Information Technology, Nantong University, Nantong, China; School of Information Science and Technology, Nantong University, Nantong, China; Nantong Research Institute for Advanced Communication Technologies, Nantong, China.
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Dlamini Z, Skepu A, Kim N, Mkhabele M, Khanyile R, Molefi T, Mbatha S, Setlai B, Mulaudzi T, Mabongo M, Bida M, Kgoebane-Maseko M, Mathabe K, Lockhat Z, Kgokolo M, Chauke-Malinga N, Ramagaga S, Hull R. AI and precision oncology in clinical cancer genomics: From prevention to targeted cancer therapies-an outcomes based patient care. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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