Evaluating Current Breast Cancer Care, Treatments: Lakshminarayanan Nandagopal, MD

Breast cancer care innovations, like surgical techniques, circulating tumor DNA testing, and antibody-drug conjugates, can have a significant impact on patient outcomes, quality of life, and treatment sequencing.

At the Institute for Value-Based Medicine® event in Richmond, Virginia, Lakshminarayanan Nandagopal, MD, physician of medical oncology at the Hematology Oncology Associates of Fredericksburg, discussed the current state of breast cancer care innovations. Nandagopal specializes in cancers of the reproductive and urinary systems, as well as precision medicine, and he is involved with a high level of customization for treatments and care. In an interview with The American Journal of Managed Care®, Nandagopal elaborated on the progression of breast cancer treatments, impacting patient outcomes, how he navigates difficult conversations with patients about their treatments, and how multidisciplinary collaboration between physicians has the potential to significantly improve patient care, monitoring, and treatment.

There have been numerous advancements in breast cancer care, especially in adjuvant and monotherapies, and treatment tools that help guide physicians and patients to make the best decisions on their course of treatment. From recent FDA drug approvals of oral estrogen-receptor degraders to treat estrogen receptor (ER)–positive and HER2-negative breast cancer to the use of the Breast Cancer Index, breast cancer care continues to improve through the aid of health care providers, oncologists, and scientists to improve patient outcomes.1-3

As the field of breast cancer care evolves, the integration of novel therapies and diagnostic tools highlights the importance of ongoing research and multidisciplinary teamwork. These innovations not only provide patients with more targeted, personalized options but also offer clinicians improved guidance in tailoring care. With rapid progress in precision medicine and supportive technologies, the future of breast cancer treatment holds the promise of more effective interventions, reduced side effects, and ultimately, better survival and quality of life outcomes.

Transcript

This transcript was lightly edited. Captions are auto-generated.

Which innovations in breast cancer care had the most transformative impact on patient outcomes, and which areas are still lagging behind?

In terms of innovations in the past decade in breast cancer, specifically, I think the major changes we have moved towards are biology-driven in the treatment decision process. As we all know, there are 3 broad subtypes: the ER-driven, the HER2-driven, and the triple-negative breast cancers. We treat each one of them by very different means using different agents, and I think there's been tremendous progress in improving pathological responses to some of these treatments. And that translates to improved chances of a cure and building on those biology-driven treatment pathways.

I think the treatments have become more and more complex and more sequential. By adding some of the newer treatments to the perioperative setting, I think this has improved not just immediate responses but also long-term outcomes, delayed recurrence events, and also improved survival.

I think we are still making a lot of progress. We are curing a lot more people than we used to, but still, there is more work that needs to be done.

How do you approach conversations with patients who are overwhelmed by the growing number of treatment choices?

With any patient discussion, I think it's important to make sure that you understand what they understand about the disease and where they're coming from, and also try to understand how their cultural background influences how they make their decision.

Each person thinks differently based on their different life experiences. It's always important that we make an effort to help them understand why we would recommend a certain treatment at a certain point in time. I always try to provide some information about the drug, whether that be the data behind it. I sometimes even pull up the trial and show them the graphical representation of why this drug should benefit them and why I would choose this particular drug over another for them.

It's always spending the time, at the end of the day, in the clinic to invest in these types of discussions. Usually when patients have had a detailed discussion, they're much more satisfied [with their decisions after] picking their choice of treatment.

How has multidisciplinary collaboration evolved in your practice with the introduction of more advanced therapies?

I have been fortunate to be in different kinds of systems where multidisciplinary care is implemented in different ways. However, let's say, in academic practices, they sometimes have the luxury of having all the doctors in one place, physically. That's a big advantage to patients, because in 1 visit or 1 day, they could see the medical oncologist, the surgeon, and the radiation doctor, and sometimes you can see all of them at the same time. That would be an ideal scenario for a lot of our breast cancer patients, but in the community, it’s not as feasible unless you have a dedicated breast cancer program, and each community is made up in a different way.

I think that would be an ideal scenario for a lot of our patients, but outside of that, ensuring that we have a good, robust tumor board for breast cancer and that we meet regularly to discuss our patients, even if the patients are very straightforward [is important for treatment]. Making sure that we discuss each and every patient with a breast cancer diagnosis in a multidisciplinary setting, in a tumor board, I think that's one of our most effective tools to ensure that these treatments are being sequenced in the right manner for the maximum chance of cure.

This also ensures that we're all on the same page as physicians and care teams and the patient is also communicated with in the right manner, ensuring that she's not confused about what decisions are being made. I think making sure that there’s a tumor board, that we get timely tests done, and making sure that we are working as a team. I think those are the important things.

References

1. McCrear S. FDA approves imlunestrant for ER+ and HER2-negative breast cancer. AJMC®. September 25, 2025. Accessed September 29, 2025. https://www.ajmc.com/view/fda-approves-imlunestrant-for-er-and-her2-negative-breast-cancer.

2. Miller DG, Boe LA, Wen HY, et al. Adjuvant radiation and endocrine therapy in early-stage breast cancer with low genomic risk. JAMA Netw Open. 2025;8(9):e2532305. doi:10.1001/jamanetworkopen.2025.32305

3. McCrear S, Adriana Olivo N. The future of survivorship care: precision tools for women after breast cancer. AJMC. September 26, 2025. Accessed September 26, 2025. https://www.ajmc.com/view/the-future-of-survivorship-care-precision-tools-for-women-after-breast-cancer