TumorBoard: Evidence-Grounded Multi-Agent Decision Support for Longitudinal Neuro-Oncology

Clinically relevant oncology information is distributed across heterogeneous, longitudinal documentation, creating substantial abstraction burden and requiring accurate attribution across specimens, tumors, biomarkers, and time points, while manual cancer-registry abstraction can require 27.2 minutes per case, highlighting the need for scalable methods that preserve clinical context while converting documentation into structured data. We evaluate an oncology information-extraction workflow in which OncoLens supplies multi-source, oncology-aware document selection, aggregation, and normalization from integrated EHRs, while the NimbleMind Multi-Agent System (nMAS) is a configurable oncology information-extraction workflow that extracts clinically relevant structured fields from fragmented oncology documentation. The extraction task uses a clinician-informed schema of 328 attributes spanning report metadata, diagnosis, staging, and cancer-type-specific information. nMAS separates clinician-defined field specifications from model execution and combines complexity-aware extraction, report-level consolidation, and source-grounded validation. The retrospective evaluation included 230 de-identified oncology documents from 40 patients and 418 clinician-reviewed document-field pairs containing 1,126 non-empty reference values. Evaluation focused on fields identified by clinicians as present in the source documents rather than exhaustively annotating all 328 schema fields. nMAS achieved a rank-weighted value-level precision of 82.6%, recall of 87.5%, and F1 of 85.0%, compared with an F1 of 66.4% for an independently implemented UMA-style MiniMax M2.5 comparator. These findings support the feasibility of using a configurable, source-grounded extraction workflow to convert fragmented oncology documentation into reusable structured data.

Large language models (LLMs) are increasingly being explored for clinical decision support, but their reliability in complex oncology treatment planning remains unclear. We evaluated agentic LLM systems for breast cancer treatment recommendation generation using 72 real clinical cases across stages I to IV and 1,147 case-specific rubrics generated through Asymmetric Information Rubric Generation (AIRG), in which the rubric generator had access to real clinical decisions unavailable to the evaluated models. Seven pipelines were compared, including single-LLM baselines, tool-augmented systems, and multi-agent architectures with fact checking and autonomous subagent spawning. The best-performing configuration, Claude Opus 4.8 with the D&C+SA pipeline, achieved a global score of 0.594 $\pm$ 0.025. Tool use and increased agent autonomy had mixed effects, improving performance in some settings but degrading it in others. Performance varied by clinical domain and disease stage, and oncologist-led error analysis revealed persistent clinically relevant failures, including incorrect or missing recommendations, flawed justifications, citation errors, outdated claims, and overconfidence. These findings suggest that agentic LLM systems can generate clinically relevant breast cancer recommendations, but remain insufficient for unsupervised clinical use.

Orchestra composes two independently built bioinformatics MCP servers -- RegNetAgents, which infers gene regulatory network topology from ARACNe networks, and CASCADE, which supplies four independent evidence sources (LINCS knockdown, DepMap essentiality, super-enhancer status, DoRothEA transcription-factor confidence) -- into one multi-agent workflow exposed via the Model Context Protocol. Its central architectural claim is that requiring RegNetAgents' topology evidence and CASCADE's experimental evidence to agree on a candidate regulator yields a more trustworthy candidate than either alone -- not previously tested directly, since RegNetAgents' own validation asked only whether its candidate lists beat chance. We test this on the TCGA tumor-acquired regulator tier (regulators in a gene's tumor ARACNe network but absent from the GREmLN population-averaged baseline), selecting candidates by ARACNe mutual-information (MI) edge weight. On RegNetAgents' published BRCA/COAD focal-gene panel plus matched negative controls, agreement among at least 2 of the 4 CASCADE sources predicts OncoKB cancer-gene status among focal genes (odds ratio 2.89, Benjamini-Hochberg-adjusted p=0.0166) but not among negative controls (p=0.0721); a single source is not diagnostic for either group. The pattern replicates and strengthens in a third cancer type, STAD, on a separately constructed panel (odds ratio 5.82), and against an independently curated ground truth (the Sanger COSMIC Cancer Gene Census). MI edge weight is the strongest single predictor overall (p=0.0003); a logistic-regression likelihood-ratio test confirms corroboration adds value beyond it in both panels (p=0.0234; p=0.0001). Every experiment invokes Orchestra's real agentic entry point.