Implementing generative artificial intelligence in precision oncology: safety, governance, and significance.

The paramount challenge in precision oncology lies in further improving quality of life and response rates for individual patients. Efforts toward these goals are steadily expanding the scope of clinical implementation, despite ongoing challenges such as standardization, cost-effectiveness, and data harmonization. Building upon this maturing foundation, generative AI-which has evolved dramatically in recent years-is particularly valuable at this stage of advancing efficiency and adoption as an auxiliary technology linking literature, guidelines, trial protocols, and patient data. Specifically, through mutation interpretation, trial eligibility matching, and tumor board support, it is expected to contribute to advancing standardization, improving cost-effectiveness, accelerating data harmonization, and further accelerating human-centered decision-making. Accordingly, this review surveys the development history of generative AI and its current healthcare applications, organizing its implementation potential for precision oncology along three axes: (1) generative AI-based interpretation of genetic mutations and estimation of their pathological significance; (2) generative AI-driven verification of clinical trial eligibility; and (3) multimodal foundation models for imaging and pathology that compute "tumor phenotypes" using real-world data, contributing to report drafting and molecular surrogate estimation. In response, we propose a strategy centered on retrieval-augmented generation (RAG) and human-in-the-loop (HITL) workflows, encompassing data preparation based on OMOP, mCODE, and FHIR; multicenter prospective evaluation; auditable logs and governance aligned with Good Manufacturing Practice (GMP) and the EU AI Act; and a synthetic data strategy including differential privacy. Ultimately, this approach validates value through real-world outcomes and charts a path toward "learning oncology," accelerating patient-centered decision-making and clinical trial development.