Advancing cancer care through artificial intelligence: from innovative models to clinical decision-making and regulatory integration

Abstract Artificial intelligence (AI) and machine learning (ML) have emerged as transformative tools across the oncology drug development pipeline, spanning from early discovery and compound screening to clinical trial optimization and regulatory oversight. With the growing complexity of cancer biology and the rising demand for precision medicine, AI technologies offer new strategies to accelerate therapeutic innovation, reduce development costs, and improve clinical outcomes. This review synthesizes recent advancements in AI-driven oncology, integrating perspectives from computational modeling, predictive analytics, clinical decision-making, and evolving regulatory frameworks. We highlight how AI-enabled platforms are being employed to identify druggable targets, optimize molecular design, predict drug target interactions, and support preclinical and clinical decision-making. Special attention is given to advanced architectures such as cascade deep forest models, deep learning networks, and the transformative impact of large language models and multimodal AI, including AlphaFold 3, which have demonstrated superior performance in drug target interaction prediction and de novo compound generation. Beyond technical accuracy, we emphasize the importance of “model actionability,” a concept rooted in the ability of AI models to reduce diagnostic and therapeutic uncertainty, thus enhancing their practical value in clinical oncology. Furthermore, we discuss the U.S. Food and Drug Administration’s (FDA) proactive engagement with AI/ML applications, particularly in the context of clinical trials, safety monitoring, and real-world evidence generation. The integration of AI into regulatory science underscores the need for transparency, contextual validation, and risk-based oversight. By bridging scientific innovation with clinical utility and regulatory expectations, this review underscores the pivotal role of AI in advancing oncology drug development and shaping the future of cancer care.