Foluso (Bisi) O. Ademuyiwa, MD, MPH, MSCI

• Breast cancer

• Triple negative breast cancer
• Immunotherapy

My clinical and research interests focus on the treatment of patients with breast cancer. I am particularly interested in developing novel treatments for patients with triple negative breast cancer (TNBC). Compared with non-TNBC, these tumors generally occur in younger or black women, are of a higher grade, have a higher propensity to spread to distant organs, and have a worse outcome with a high rate of recurrences after adjuvant treatments. Thus, there is a dire need to develop novel treatment strategies in an attempt to improve the outcome for patients with TNBC.

I am the Principal Investigator on a clinical trial investigating a unique chemotherapy combination in the pre-operative setting in patients with triple negative breast cancer. This is an innovative co-clinical trial, in which we simultaneously develop patient-derived xenografts (PDX) in immunodeficient mice. The ultimate goal of this project is to determine if we can increase the pathologic complete response rate at time of surgery by utilizing this chemotherapy combination. In addition, we will investigate molecular mechanisms of chemotherapy resistance using genomic and proteomic analysis from both the patients’ tumors and the PDX.

Another main focus of my translational research program is to develop tools to identify TNBC patients at high-risk for disease recurrence, and ultimately use this information to enable early and clinically meaningful intervention. Our preliminary results show that circulating tumor DNA (ctDNA) is detectable in patients with early-stage TNBC, and can accurately predict clinical outcomes. We are validating these results in a larger multi-institutional cohort of TNBC patients. We hypothesize that TNBC patients’ genomic architecture predicts response to chemotherapy, and that high-risk patients may be identified before clinical recurrence by ctDNA. If patients who will recur due to chemotherapy resistance can be identified earlier, clinical trials with agents other than chemotherapy may be developed, with a view to changing the natural history of recurrent TNBC. Early intervention improves survival in early stage patients as neo(adjuvant) chemotherapy effectively eradicates disease. Although, this strategy has not been tested clinically with minimal residual disease identified by ctDNA during the observation period, preclinical studies suggest improved outcome with early intervention in metastatic disease. Currently, there is no proven strategy for early detection of disease recurrence.

I also collaborate actively with several scientists on clinical protocols in which immune therapies are used to harness the immune system to fight against breast cancer. In the largest and most rigorous investigation on NY-ESO-1 cancer testis antigen in patients with TNBC, we have shown that NY-ESO-1 is expressed in a subset of TNBC patients and leads to a relatively high spontaneous humoral immune response rate in these individuals. Progress continues to be made in understanding the interactions between the immune system and patients with breast cancer. It is through careful characterization of the different subtypes of TNBC through analysis of its genomic features and other indices detectable by IHC that progress will be made in using these differences for the development of personalized therapies.

I have also been actively involved in cancer disparities research, especially as related to racial inequities and disparities in breast cancer. We recently reported that less than 60% of Black patients with breast cancer receive guideline-concordant genetic counseling and testing. The long-term goal of our ongoing project is to develop strategies to improve genetic counseling and testing utilization and guideline concordant care for Blacks with breast cancer and in doing so, reduce cancer health disparities. We also recently showed that Blacks were more likely to no-show for scheduled screening mammograms. Our ongoing research also aims at improving the uptake of life-saving breast cancer screening for eligible Black women through family partnership programs.

I take care of patients with all types of breast cancer at the Siteman Cancer Center Main Campus and South County Campus. I am particularly interested in patients with TNBC and young women with breast cancer and provide them information on the latest research findings and clinical trials available. I am passionate about the patients and families I care for and I am honored to be part of their journeys.