Multidisciplinary

Triple-negative breast cancer, the benefits of multidisciplinarity

The interest of a multidisciplinary approach for the management of cancers is not new. As early as the 1950s, centers dedicated to cancer patients held consultation meetings in which surgeons, radiotherapists and chemotherapists took part in order to propose the most suitable approach for patients. However, this approach was not the most common and in the case of breast cancer, an article from 2010, to which several members of the Bordet Institute extensively contributed, underlined the wide disparities between geographical regions.

In oncology, multidisciplinarity is perceived as the collaboration of professionals from different backgrounds and with diversified expertise to achieve optimal care for each patient. In practice, it is a question of optimizing the course of care via the implementation of adequate preventive or therapeutic approaches vis-à-vis all the factors likely to alter the objective pursued.

This multidisciplinary approach is particularly valuable for the most problematic cases of cancer, which is indisputably the case of triple negative breast cancers whose median survival after metastases still remains dramatically lower than that of HR+/HER2+ breast cancers, despite undeniable therapeutic progress,

Nowadays, multidisciplinarity obviously includes the various traditional disciplines (anatomo-pathologists, radiologists, medical oncologists, surgeons and radiotherapists), but also all the people who, by virtue of their talent and/or their expertise in specific niches, can contribute to perfecting the achievement of the set objective (plastic surgeons, physiotherapists, specialized nurses, psychologists, nutritionists, social workers). Are particularly concerned in view of recent developments, molecular biologists, geneticists, onco-immunologists, cardiologists, clinical pharmacologists, specialists in supportive care, stereotactic radiotherapy, laparoscopic and robotic surgery ..., this is a non-exhaustive list which needs to be adjusted realistically, considering the specific characteristics of each patient's cancer and the resources available in Belgium.

Several papers on triple-negative breast cancer presented at the last ASCO Annual Meeting indicate that the time for defeatism is over. The results obtained following the implementation of trials, whose rationale owes a great deal to multidisciplinarity, show that it is indeed possible to positively influence the prognosis and even to have curative ambitions.

This is evidenced by trials testing pure immunological approaches, vectorised chemotherapies in the form of antibody-drug conjugates, targeted therapies aimed at new signalling pathways (like what is already being done in lung cancer), combinations in search of synergistic activity, and chemotherapy-free regimens. These are all initiatives seeking to jointly improve performance without increasing or even reducing toxicities.

Still within the framework of multidisciplinarity, this edition of ASCO also highlighted various additional approaches, more or less conventional, with the common goal of ensuring that progress in survival corresponds to additional years of qualitative well-being for patients (acupuncture, stress management, correction of alopecia, reduction of fatigue, cognitive preservation in the case of cerebral metastases, prevention of neuropathies).

For many types of breast cancer, it is already possible to speak of a cure or at least a chronic condition that is manageable over time. Will multidisciplinarity make this possible for triple negatives?

In any case, let's give ourselves all the means to solve that question!

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