ASCO, equity and the future of cancer care: a Q&A with Dr. Everett Vokes

Image of Dr. Everett Vokes talking at ASCO meeting

Dr. Everett Vokes served as president of ASCO during the 2021-2022 term and presided over the annual meeting.

Everett E. Vokes, MD, John E. Ultmann Professor of Medicine, chair of the Department of Medicine and physician-in-chief at the University of Chicago Medicine and Biological Sciences, served as the president of the American Society of Clinical Oncology (ASCO) for the 2021-2022 term.

As part of his responsibilities, the internationally renowned expert in head and neck and lung cancer treatment selected the theme for the 2022 ASCO Annual Meeting, held June 3-7 in Chicago. Vokes chose the theme “Advancing Equitable Cancer Care Through Innovation.” We talked with him about what that means for cancer treatment, recent advances in care, and the next potential breakthroughs in cancer therapy. Read on to find out his thoughts on the future of oncology and patient care.

This year, the ASCO Annual Meeting focused on equity in cancer care. Why is this important?

Research breakthroughs over the past 50 years have led to major advances in treatment options and care for our patients. Yet, we also see huge disparities in outcomes based on regions, economies and populations. Rooting out and addressing the causes of this inequity is critical to providing everyone with the highest-quality care.

During the COVID-19 pandemic, for example, people who are poor, people of color, people living in low- and middle-income regions, and people with serious underlying health conditions such as cancer were disproportionately affected by the disease. A recent CancerLinQ study showed that in the U.S., Black people with cancer were twice as likely to be infected with COVID-19 disease as white people with cancer and Hispanic people were five times as likely to get COVID-19 disease.

However, the pandemic also resulted in extraordinary innovations in medical care – from the speed at which mRNA vaccines and therapies were developed to advances in telemedicine and other ways to deliver care. I hope our healthcare system maintains this adaptability and continues to optimize these strategies to improve care for all our populations.

What are some specific challenges that cancer patients face in terms of equity, and how are medical professionals addressing those issues?

In the United States, we know that patients with cancer living in rural areas and under-resourced urban locations frequently have less access to care. This puts them at higher risk for later-stage diagnosis, less timely treatment and worse outcomes.

In Montana, one of the most rural states, ASCO has a new pilot project that uses telehealth and team building to expand access to care. We believe this could become a model for other isolated patient populations. Closer to home, the UChicago Medicine Comprehensive Cancer Center launched the Office of Community Engagement and Cancer Health Equity in 2010 to improve the health of local communities in terms of cancer treatment and prevention, and to work to eliminate disparities in cancer care, research and education.

Through these and similar initiatives across the U.S., organizations like ASCO and institutions like the University of Chicago are working to improve equity in healthcare.

The ASCO Annual Meeting featured nearly 3,000 abstracts on the latest advances in clinical cancer treatment from all areas of cancer research. What do you think were the most notable scientific innovations or trends at the conference?

First, it was exciting to me to see how well our own institution was represented at the conference, from all levels of faculty and across multiple departments (Editor’s note: nearly 90 abstracts from UChicago were presented at the meeting).

These advances give world-class oncologists like those found at UChicago Medicine new tools in the fight against breast and GI cancers, which they can apply and build on to provide patients with the best possible care.

If you look at scientific innovation, there was a standing ovation during the plenary session for a drug that targets HER2 breast cancer. The study, called DESTINY-4, was presented by Dr. Shanu Modi (Memorial Sloan Kettering Cancer Center) and investigated the use of trastuzumab deruxtecan, a novel antibody-drug conjugate, in patients with low HER2 expression. Traditionally, patients with low HER2 expression were not considered likely to benefit from the drug, which binds to the HER2 protein and has been shown to work very well in patients with high HER2 expression. The study found that the drug nearly doubled progression-free survival and overall survival rates compared to chemotherapy. This holds a lot of promise for patients who previously would have had only months to live using the current standard of care.

Another trial that I found exciting looked at liquid biopsies to monitor circulating tumor DNA (ctDNA) in patients with colon cancer. Presented by Dr. Jeanne Tie (Peter MacCallum Cancer Centre, Melbourne, Australia), the double-armed study investigated the need for post-surgical chemotherapy in stage 2 colon cancer patients. Patients in the experimental arm were given a very sensitive test to monitor the amount of ctDNA in the blood. If no residual disease was detected, no chemotherapy was given. The control arm received chemotherapy based on standard measurements. The ctDNA tests resulted in 15% of patients receiving chemo versus 28% in the control arm, yet the rate of recurrence was the same in both arms. This suggests that liquid biopsies could be a useful tool for guiding treatment decisions for patients with stage 2 colon cancer and could help save more patients from undergoing chemotherapy. This type of test could be similarly applied to other diseases, where you can monitor the residual disease and base treatment on the results, which I think is very promising.

Another abstract that received a lot of attention was presented by Dr. Andrea Cercek (Memorial Sloan Kettering Cancer Center) and investigated immunotherapy for patients with recently diagnosed advanced mismatch repair–deficient (dMMR) rectal cancer. Currently, the standard of care for these patients includes a combination of surgery, radiation and chemotherapy. In this trial, 14 patients were given the immunotherapy agent dostarlimab-gxly without any other treatments. Results showed a 100% complete clinical response for all patients at an average of 6.8 months from treatment. While larger and longer trials will be needed, this is still a big leap forward. It holds the promise that some patients with this disease can be cured without the need for invasive and aggressive treatments.

These advances give world-class oncologists like those found at UChicago Medicine new tools in the fight against breast and GI cancers, which they can apply and build on to provide patients with the best possible care.

Looking five years into the future, what do you think will be the biggest breakthroughs in cancer care?

One area that I think holds exceptional promise is metabolomics. The metabolome consists of all the substances used and created during metabolism. In cancer cells, the mechanisms used to metabolize glucose are corrupted, meaning they use energy differently and sometimes less effectively than other cells. Currently, medical professionals use metabolomics as a diagnostic tool to identify biomarkers of cancer. Researchers are also looking at how we can exploit the metabolome to develop personalized treatments for cancer patients. The University of Chicago has invested greatly into metabolomics, and it’s an area I really see growing.

UChicago also has a world-class program in the study of the microbiome – all the millions of different microorganisms such as bacteria, viruses and fungi that live in the human body, mainly in the intestines and on the skin. Strains of bacteria differ from person to person and have been shown to play a role in modulating the effects of cancer treatment, resulting in different patient outcomes. There’s also an association with the microbiome and the development of certain cancers. Further studies into the microbiome could illuminate the relationship between the organism and different cancers, and lead to discoveries into how we could harness it to fight disease.

Finally, I foresee advances in the technology used to diagnose and treat cancer. For example, the University of Chicago in partnership with Argonne National Laboratory has launched a study that combines artificial intelligence (AI), genomics and pathology in an effort to develop more effective, personalized cancer therapies. AI has also been used effectively in drug screening and development, and will increasingly become a way to determine the genetic makeup of tumors, removing the need to send samples out for genetic analysis. This, like the other advances mentioned, will allow us to significantly improve care for our patients.

Everett E. Vokes, MD

Everett E. Vokes, MD

Everett E. Vokes, MD is an internationally renowned expert in the treatment of head and neck and lung cancers. He is the John E. Ultmann Professor, chair of the Department of Medicine, and physician-in-chief at the University of Chicago Medicine and Biological Sciences.

Learn More About Dr. Vokes
Medical oncologist Sonali Smith, MD, and lymphoma patient Clayton Harris

UChicago Medicine Comprehensive Cancer Center

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