Benchmarking Large Language Models Against Tumour Boards for Oncology Treatment Recommendations

Artifical Intelligence, Breast Neoplasms, Decision Making, Decision Support Systems, Clinical, Digestive System Neoplasms, Genital Neoplasms, Kidney Neoplasms, Large Language Models, Lung Neoplasms, Prostatic Neoplasms, Urinary Bladder Neoplasms, Urologic Neoplasms

Large Language Models, Artificial Intelligence, Clinical Decision support, Decision Support Systems, Clinical, Multidisciplinary tumour board (RCP), Patient Care Team, Medical oncology, Neoplasms, Benchmark, Benchmarking, Concordance, Weighted kappa, Synthetic data, Patient safety, Reproductibility

BEACON (Benchmarking AI for Clinical Oncology decisioNmaking) is a prospective, multicentre, comparative, blinded, non-interventional benchmark evaluating the treatment recommendations of five frontier large language models (LLMs) against the recommendations of multidisciplinary tumour boards (RCP) in oncology treatment planning. One hundred standardised synthetic cases (20 per localisation, across breast, lung, urological, digestive and gynaecological cancers) are submitted as identical structured input to two independent tumour boards per localisation and to five frontier LLMs. Each recommendation - human or model - is decomposed into five predefined decision domains (intent, surgery, radiotherapy, systemic therapy, work-up and biomarkers) and scored 0/1/2 for concordance against a two-tier reference: the consensus of the two tumour boards, complemented by an a priori locked guideline matrix (ESMO, NCCN). The primary endpoint is domain-level concordance between LLM and RCP consensus, expressed as a linearly weighted Cohen's kappa. A co-primary safety endpoint captures the proportion of recommendations carrying serious harm potential, because concordance alone can conceal dangerous errors. Because expert boards may disagree with one another on identical cases, model performance is always interpreted against the human consensus. BEACON is designed as reusable, openly licensed, pre-registered infrastructure: all synthetic cases, evaluation rubrics, the locked guideline matrix, scoring algorithms and verbatim prompts are released for full reproducibility.

BEACON is a prospective, multicentre, blinded benchmark using automated, criteria-based scoring. It is built on three design decisions that distinguish it from the existing literature: (i) synthetic, standardised cases remove the record-completeness variability that confounds retrospective comparisons and allow the identical input to be given to every board and every model; (ii) two independent tumour boards per localisation let human-human agreement be measured rather than assumed; and (iii) a guideline matrix, locked a priori, provides an objective anchor applied identically to human and model recommendations. Reference standard. For each case-domain, a guideline matrix (guideline-recommended / acceptable / unsupported options per case-domain; ESMO, NCCN), locked and time-stamped before data collection, is applied identically to boards and models. Five decision domains. Every recommendation is decomposed into D1 Intent, D2 Surgery, D3 Radiotherapy, D4 Systemic therapy (class + line), and D5 Work-up & biomarkers before any comparison.

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