medRxiv PreprintsInternational14 October 2026
Human-Guided Agentic AI for End-to-End EHR Research: Sequential Antibody-Drug Conjugate Pathways in Breast Cancer
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PURPOSE: To demonstrate an end-to-end research workflow combining a large electronic health record (EHR) resource and a multi-agent artificial intelligence (AI) system governed by Human-Guided Orchestration (HGO), using sequential sacituzumab govitecan (SG) and trastuzumab deruxtecan (T-DXd) orders in breast cancer as the clinical use case. METHODS: A June 2026 EHR release contained 4.95 million patients, including 156,051 with breast cancer codes. Muse Spark supported cohort construction, executable statistical analysis, data-quality checks, literature retrieval, and reporting executed throug
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