Optimizing Multidisciplinary Care and Novel Therapies in Early Breast Cancer
Foluso Ademuyiwa, MD, MPH, MSCI
In this interview, Foluso Ademuyiwa, MD, MPH, MSCI, discusses the evolving role of ctDNA assays in clinical pathways for early-stage triple-negative breast cancer, the personalization of treatment strategies, the challenges of coordinating multidisciplinary care, and emerging therapeutic approaches, including non-anthracycline regimens, antibody-drug conjugates, and biomarker-guided treatments.
Please introduce yourself by stating your name, title, and any clinical experience you’d like to share.
Foluso Ademuyiwa, MD, MPH, MSCI: My name is Foluso Ademuyiwa, MD, MPH, MSCI. I am a professor of medicine at Washington University. My clinical expertise is in breast cancer management.
How do you envision the integration of ctDNA assays into existing clinical pathways for early-stage triple-negative breast cancer?
Ademuyiwa: The integration of ctDNA assays into existing pathways will likely occur once we have more data demonstrating their clinical utility.
How has the approach to treatment personalization in early breast cancer evolved in recent years, particularly for triple-negative subtypes?
Ademuyiwa: The approach to treatment personalization in early breast cancer, particularly for triple-negative subtypes, has evolved significantly over the years. For early-stage triple-negative breast cancer (eTNBC), we now utilize tumor stage in order to determine whether to administer preoperative chemotherapy versus adjuvant chemotherapy.
Additionally, we utilize this information to assess the potential role of immunotherapy in the treatment regimen. We also consider patient comorbidities to guide the selection of the most appropriate chemotherapy, tailoring the approach to optimize outcomes based on the individual patient’s health overall.
What are the key challenges in coordinating care for early-stage breast cancer patients across different treatment modalities (surgery, radiation, systemic therapy)?
Ademuyiwa: Coordinating care for early-stage breast cancer across various treatment modalities—such as surgery, radiation, and systemic therapy—can present significant challenges, particularly in community or lower-volume practices. For example, typically the breast surgeon is the first to evaluate the patient and, ideally, will refer to medical oncology if the patient is a candidate for pre-operative systemic therapy.
Once chemotherapy is completed, the medical oncologist then needs to refer the patient back for surgery, and following surgery, a referral needs to be made to a radiation oncologist. Managing these transitions effectively can be difficult in single-specialty groups where streamlined communication and timely referrals may not always be in place.
What novel therapeutic strategies are you most excited about in the treatment of early-stage breast cancer?
Ademuyiwa: There are several emerging therapeutic strategies in early-stage breast cancer that hold significant promise. Newer non-anthracycline based regimens, antibody-drug conjugates, and image- or biomarker-guided personalized approaches are currently in development for early-stage breast cancer, aiming to refine treatment selection and potentially improve patient outcomes.
