Adverse drug reactions considerably impact patient outcomes and healthcare costs in cancer therapy. Using artificial intelligence to predict adverse drug reactions in real time could revolutionize oncology treatment. This study aims to assess the performance of artificial intelligence models in predicting adverse drug reactions in patients with cancer. This is the first systematic review and meta-analysis. Scopus, PubMed, IEEE Xplore, and ACM Digital Library databases were searched for studies in English, French, and Arabic from January 1, 2018, to August 20, 2023. The inclusion criteria were: (1) peer-reviewed research articles; (2) use of artificial intelligence algorithms (machine learning, deep learning, knowledge graphs); (3) study aimed to predict adverse drug reactions (cardiotoxicity, neutropenia, nephrotoxicity, hepatotoxicity); (4) study was on cancer patients. The data were extracted and evaluated by three reviewers for study quality. Of the 332 screened articles, 17 studies (5%) involving 93,248 oncology patients from 17 countries were included in the systematic review, of which ten studies synthesized the meta-analysis. A random-effects model was created to pool the sensitivity, specificity, and AUC of the included studies. The pooled results were 0.82 (95% CI:0.69, 0.9), 0.84 (95% CI:0.75, 0.9), and 0.83 (95% CI:0.77, 0.87) for sensitivity, specificity, and AUC, respectively, of ADR predictive models. Biomarkers proved their effectiveness in predicting ADRs, yet they were adopted by only half of the reviewed studies. The use of AI in cancer treatment shows great potential, with models demonstrating high specificity and sensitivity in predicting ADRs. However, standardized research and multicenter studies are needed to improve the quality of evidence. AI can enhance cancer patient care by bridging the gap between data-driven insights and clinical expertise.

Timely and accurate extraction of Adverse Drug Events (ADE) from biomedical literature is paramount for public safety, but involves slow and costly manual labor. We set out to improve drug safety monitoring (pharmacovigilance, PV) through the use of Natural Language Processing (NLP). We introduce BioDEX, a large-scale resource for Biomedical adverse Drug Event Extraction, rooted in the historical output of drug safety reporting in the U.S. BioDEX consists of 65k abstracts and 19k full-text biomedical papers with 256k associated document-level safety reports created by medical experts. The core features of these reports include the reported weight, age, and biological sex of a patient, a set of drugs taken by the patient, the drug dosages, the reactions experienced, and whether the reaction was life threatening. In this work, we consider the task of predicting the core information of the report given its originating paper. We estimate human performance to be 72.0% F1, whereas our best model achieves 62.3% F1, indicating significant headroom on this task. We also begin to explore ways in which these models could help professional PV reviewers. Our code and data are available: https://github.com/KarelDO/BioDEX.

Model-informed precision dosing (MIPD) using therapeutic drug/biomarker monitoring offers the opportunity to significantly improve the efficacy and safety of drug therapies. Current strategies comprise model-informed dosing tables or are based on maximum a-posteriori estimates. These approaches, however, lack a quantification of uncertainty and/or consider only part of the available patient-specific information. We propose three novel approaches for MIPD employing Bayesian data assimilation (DA) and/or reinforcement learning (RL) to control neutropenia, the major dose-limiting side effect in anticancer chemotherapy. These approaches have the potential to substantially reduce the incidence of life-threatening grade 4 and subtherapeutic grade 0 neutropenia compared to existing approaches. We further show that RL allows to gain further insights by identifying patient factors that drive dose decisions. Due to its flexibility, the proposed combined DA-RL approach can easily be extended to integrate multiple endpoints or patient-reported outcomes, thereby promising important benefits for future personalized therapies.

Febrile neutropenia (FN) has been associated with high mortality, especially among adults with cancer. Understanding the patient and provider level heterogeneity in FN hospital admissions has potential to inform personalized interventions focused on increasing survival of individuals with FN. We leverage machine learning techniques to disentangling the complex interactions among multi domain risk factors in a population with FN. Data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample and Nationwide Inpatient Sample (NIS) were used to build machine learning based models of mortality for adult cancer patients who were diagnosed with FN during a hospital admission. In particular, the importance of risk factors from different domains (including demographic, clinical, and hospital associated information) was studied. A set of more interpretable (decision tree, logistic regression) as well as more black box (random forest, gradient boosting, neural networks) models were analyzed and compared via multiple cross validation. Our results demonstrate that a linear prediction score of FN mortality among adults with cancer, based on admission information is effective in classifying high risk patients; clinical diagnoses is the domain with the highest predictive power. A number of the risk variables (e.g. sepsis, kidney failure, etc.) identified in this study are clinically actionable and may inform future studies looking at the patients prior medical history are warranted.