{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T22:00:33Z","timestamp":1775167233170,"version":"3.50.1"},"reference-count":30,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"1","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Clin Cancer Inform"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>To assess the ability of GPT-4o in adjuvant treatment decision making in hormone receptor\u2013positive (HR+)\/human epidermal growth factor receptor 2\u2013negative (HER2\u2212) early breast cancer by comparing its recommendations with those of clinicians including Oncotype DX data, and to explore its potential as a decision-support tool in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We compared clinician and GPT-4o recommendations in patients tested with Oncotype DX in routine practice at the University of Naples Federico II (n = 607, cohort 1 [C1]) and within the prospective, multicenter PRO BONO study (n = 237, cohort 2 [C2]). Pre\u2013 and post\u2013Oncotype DX treatment recommendations were categorized as chemotherapy (CT) + endocrine therapy (ET) or ET alone. Concordance between clinician and GPT-4o recommendations was assessed using agreement rates and Cohen's kappa. The accuracy of Oncotype DX results was evaluated using the AUC metric.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The agreement between clinicians and GPT-4o in pretest recommendations was 68% (kappa, 0.381 [95% CI, 0.31 to 0.45],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) in C1 and 70% (0.401 [95% CI, 0.29 to 0.52],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) in C2. Before Oncotype DX, clinicians recommended CT more frequently than GPT-4o for C1 (58%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      38%) and C2 (53%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      43%). Post-test agreement increased to 93% (0.814 [95% CI, 0.76 to 0.87],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) in C1 and 90% (0.741 [95% CI, 0.64 to 0.84],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) in C2. The agreement between pre\u2013 and post\u2013Oncotype DX treatment recommendations for clinicians was 56% and 63% versus 68% and 60% for GPT-4o in C1 and C2, respectively. GPT-4o showed higher accuracy in predicting low than high genomic risk in postmenopausal patients (87%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      43% in C1; 85%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      45% in C2,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and low versus intermediate and high risk in premenopausal patients in both cohorts (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The agreement between clinicians and GPT-4o in pretest recommendations was modest but improved post-test, highlighting the importance of multigene testing and the potential of large language models in clinical decision making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/cci-25-00230","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T21:00:12Z","timestamp":1772830812000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of Large Language Model Decision Making in Hormone Receptor\u2013Positive\/Human Epidermal Growth Factor Receptor 2\u2013Negative Early Breast Cancer"],"prefix":"10.1200","volume":"10","author":[{"given":"Roberto","family":"Buonaiuto","sequence":"first","affiliation":[{"name":"Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS \u201cFondazione G. Pascale,\u201d Naples, Italy"},{"name":"Clinical and Translational Oncology, Scuola Superiore Meridionale (SSM), Naples, Italy"},{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5952-4333","authenticated-orcid":true,"given":"Aldo","family":"Caltavituro","sequence":"additional","affiliation":[{"name":"Clinical and Translational Oncology, Scuola Superiore Meridionale (SSM), Naples, Italy"},{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6649-293X","authenticated-orcid":true,"given":"Rossana","family":"Di Rienzo","sequence":"additional","affiliation":[{"name":"Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS \u201cFondazione G. Pascale,\u201d Naples, Italy"},{"name":"Clinical and Translational Oncology, Scuola Superiore Meridionale (SSM), Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Grieco","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica P.","family":"Mangiacotti","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Longobardi","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenza","family":"Cantile","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittoria","family":"Molinaro","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8114-2577","authenticated-orcid":true,"given":"Martina","family":"Pagliuca","sequence":"additional","affiliation":[{"name":"Clinical and Translational Oncology, Scuola Superiore Meridionale (SSM), Naples, Italy"},{"name":"Universit\u00e9 Paris-Saclay, Gustave Roussy, INSERM U981, Molecular Predictors and New Targets in Oncology, Villejuif, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2829-1455","authenticated-orcid":true,"given":"Giuseppe","family":"Buono","sequence":"additional","affiliation":[{"name":"Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS \u201cFondazione G. Pascale,\u201d Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro","family":"De Placido","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy"},{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Pietroluongo","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"},{"name":"Department of Medicine, Section of Hematology Oncology, Thoracic Oncology Program, The University of Chicago Medicine, Chicago, IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Forestieri","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS \u201cFondazione G. Pascale,\u201d Naples, Italy"},{"name":"Clinical and Translational Oncology, Scuola Superiore Meridionale (SSM), Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-7534","authenticated-orcid":true,"given":"Vincenzo","family":"di Lauro","sequence":"additional","affiliation":[{"name":"Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS \u201cFondazione G. Pascale,\u201d Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6978-6975","authenticated-orcid":true,"given":"Luigi","family":"Leo","sequence":"additional","affiliation":[{"name":"Oncology Unit, ASL Napoli 3 Sud, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimiliano","family":"D'Aiuto","sequence":"additional","affiliation":[{"name":"Breast Surgery Unit, ASL Napoli 3 Sud, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giampaolo","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy"},{"name":"University Vita-Salute San Raffaele, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Criscitiello","sequence":"additional","affiliation":[{"name":"Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy"},{"name":"Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Bianco","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9546-5841","authenticated-orcid":true,"given":"Lucia","family":"Del Mastro","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy"},{"name":"Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelino","family":"De Laurentiis","sequence":"additional","affiliation":[{"name":"Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS \u201cFondazione G. 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