# Human-Guided Orchestration

A multi-agent workflow under investigator direction carried a large electronic health record study from cohort construction and executable statistics through data-quality checks, literature retrieval and reporting, using sequential sacituzumab govitecan (SG) and trastuzumab deruxtecan (T-DXd) orders in breast cancer as the clinical case. From 4.95 million patients, 106 had orders for both drugs, 73 with T-DXd first and 33 with SG first; median second-drug record spans were 63 and 49 days, a median difference of −14 days (95% CI, −41 to 21), descriptive and unadjusted.

A multi-agent workflow under investigator direction carried a large electronic health record study from cohort construction and executable statistics through data-quality checks, literature retrieval and reporting, using sequential sacituzumab govitecan (SG) and trastuzumab deruxtecan (T-DXd) orders in breast cancer as the clinical case. From 4.95 million patients, 106 had orders for both drugs, 73 with T-DXd first and 33 with SG first; median second-drug record spans were 63 and 49 days, a median difference of −14 days (95% CI, −41 to 21), descriptive and unadjusted.