Abstract
Background: Digital twin (DT) technology, integrated with artificial intelligence (AI) and machine learning (ML), holds significant potential to transform oncology care. By creating dynamic virtual replicas of patients, DTs allow clinicians to simulate disease progression and treatment responses, offering a personalized approach to cancer treatment. Aim: This narrative review aimed to synthesize existing review studies on the application of digital twins in oncology, focusing on their potential benefits, challenges, and ethical considerations. Methods: The narrative review of reviews (NRR) followed a structured selection process using a standardized checklist. Searches were conducted in PubMed and Scopus with a predefined query on digital twins in oncology. Reviews were prioritized based on their synthesis of prior studies, with a focus on digital twins in oncology. Studies were evaluated using quality parameters (clear rationale, research design, methodology, results, conclusions, and conflict disclosure). Only studies with scores above a prefixed threshold and disclosed conflicts of interest were included in the final synthesis; seventeen studies were selected. Results and Discussion: DTs in oncology offer advantages such as enhanced decision-making, optimized treatment regimens, and improved clinical trial design. Moreover, economic forecasts suggest that the integration of digital twins into healthcare systems may significantly reduce treatment costs and drive growth in the precision medicine market. However, challenges include data integration issues, the complexity of biological modeling, and the need for robust computational resources. A comparison to cutting-edge research studies contributes to this direction and confirms also that ethical and legal considerations, particularly concerning AI, data privacy, and accountability, remain significant barriers. Conclusions: The integration of digital twins in oncology holds great promise, but requires careful attention to ethical, legal, and operational challenges. Multidisciplinary efforts, supported by evolving regulatory frameworks like those in the EU, are essential for ensuring responsible and effective implementation to improve patient outcomes.