Impact of a real-time updated evidence library in addressing lag in guideline updates to aide physicians.

Abstract

e13684 Background: Across oncology, practice-changing data emerges daily from peer-reviewed publications, major congresses, or FDA announcements. Physicians must identify, review, and interpret this changing treatment landscape, creating substantial burden. Delays in clinical guideline integration may further impact treatment decisions. This study evaluates the lag between evidence emergence and guideline incorporation, physician burden, and the use of a REal-time AI-assisted Living SLR (REAL-SLR) clinical decision support tool to address these gaps. Methods: REAL-SLRs were implemented using protocol-driven, PRISMA-aligned searches for non-small cell lung cancer (NSCLC), breast and prostate cancers with daily updates. Evidence from interventional clinical trials meeting predefined criteria was selected, mapped to U.S. regulatory and guideline recommendations, and integrated into an interactive platform. Regulatory and clinical guidelines were manually reviewed. As the National Comprehensive Cancer Network (NCCN) updates more frequently than other major guidelines (ASCO, ESMO), time evaluations are specific to NCCN. Results: In 2025, 20 FDA approvals across NSCLC (11), breast (5), and prostate (4) cancer were granted. Publication of primary data occurred a median 168 days before FDA approval. Supporting evidence came from a median of 5 (1-8) publications and 3 (1-6) distinct sources, highlighting the need for multiple searches. Time from FDA approval to NCCN update ranged from 12 days in NSCLC to 73 days in prostate cancer. As of January 20 th , the REAL-SLRs included 1540, 930, 740 clinical trials in NSCLC, breast, and prostate cancers, respectively. All guideline-cited phase 3 trials were captured, with platform integration occurring within 1–13 days of publication or approval, representing an 11–72 day lead time over guidelines. Compared to guideline incorporation, evidence on a REAL-SLR platform represents a 11-72 day lead-time. Since launch, 4,294 physicians across 20 European countries and 48 U.S. states accessed the platform. Conclusions: Significant delays exist between evidence emergence and guideline incorporation, requiring physicians to consult multiple sources to stay current. Use of a REAL-SLR clinical decision support tool reduced physician burden while maintaining rigorous research standards. Days from Publication to FDA approval, Median (Range) Days from FDA approval to REAL-SLR Platform Days from FDA approval to guideline, Median (Range) REAL-SLR lead-time (days), Median (Range) Breast 167 (127-288) 1 22 (4-32) 21 (3-31) NSCLC 135 (0-1143) 1 12 (7-48) 11 (6-47) Prostate 260 (56-307) 1 73 (4-76) 72 (3-75) Overall 168 (0-1143) 1 16 (4-75) 15 (3-75)