MatchMiner-AI: Open-source, Privacy-preserving Cancer Clinical Trial Matching using Artificial Intelligence
Background: Clinical trials are essential to advancing cancer treatments, but fewer than 10% of adults with cancer enroll in therapeutic trials. Open-source AI trial matching tools could democratize access to trial options. Methods: We created MatchMiner-AI, co-developed with practicing clinical oncologists and trained on synthetic electronic health record (EHR) data. It uses open-weight LLMs to summarize patient histories from unstructured EHR text and extract target populations from trial eligibility documents. Embedding and re-ranking models were distilled to retrieve and rank trial and patient suggestions. Multifaceted evaluation was performed, including retrospective quantification of distillation fidelity; applying a closed-source LLM as judge of patient summarization and matching; and evaluation of candidate matches by oncologists. Results: Across retrospective evaluations of distillation fidelity, the pipeline outperformed a baseline text-embedding model, improving mean average precision (MAP) at 20 from 0.44 (95% CI 0.44-0.45) to 0.95 (95% CI 0.95-0.96) for trial-enrolled patients and from 0.38 (95% CI 0.37-0.38) to 0.94 (95% CI 0.93-0.94) for patients who received standard of care therapies. In a 50-patient sample selected for comparison between MatchMiner-AI and a rules-based tumor genomic trial matching algorithm, MatchMiner-AI retrieved trials for all patients, as opposed to 19 patients (38%) who had tumor genomic data available. Among those 19 patients, 80% of 256 trial suggestions retrieved by MatchMiner-AI were deemed reasonable considerations by a frontier LLM, vs 53% of 113 suggestions retrieved by the rules-based approach. Conclusion: MatchMiner-AI is an open-source, open-weights, clinical trial matching AI pipeline for oncology. Synthetic training data, model weights, inference tools, and demonstration frontends are publicly available.