Jun 06, 2022
Excerpt From the 2022 ASCO Annual Meeting Opening Session Presentation
By 2021-2022 ASCO President Everett E. Vokes, MD, FASCO
“Advancing Equitable Cancer Care Through Innovation" is my presidential theme, and today that is more critical than ever. While the past half century of research has transformed the care and treatment of our patients, deep-seated disparities remain between regions, economies, and populations.
Catastrophic events like war, epidemics, and natural disasters can compound these disparities. The COVID-19 pandemic for example, has officially killed 6 million people, but that number is suspected to be as much as 12 to 18 million—and rising. It has also has disproportionately affected 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. A recent CancerLinQ study revealed that in the United States, Black people with cancer were twice as likely to be infected with COVID as white people with cancer, and Hispanic people were five times as likely to get COVID.
However, cataclysmic events are also historically known to spark innovation. We've seen exponential advances during COVID, from the record-breaking speed of developing vaccines and therapeutics to innovations in telemedicine and other novel ways to deliver care. In another example of COVID-inspired innovation, ASCO introduced a data visualization tool to highlight cancer care inequities during the pandemic. Using the new Interactive Map of Oncology, we can view U.S. oncology data by state and county, parallel with COVID-specific data. Let's keep this innovation momentum going.
My passion for the power of innovation is what first drew me into oncology. As a student, and later as an intern and resident at Ravenswood Hospital in Chicago, I saw cancer being treated systemically with chemotherapy, a then still new but sometimes curative therapeutic strategy.
As a fellow at the University of Chicago, where I currently serve as professor and chair of the Department of Medicine, I was exposed to a culture of inquiry and had wonderful mentors who further nurtured my passion for innovation. Among them were Dr. Harvey M. Golomb (who first hired me) and Dr. Richard L. Schilsky, both of whom later became ASCO presidents, and Dr. Ralph R. Weichselbaum, chair of radiation oncology and recipient of ASCO’s David A. Karnofsky Memorial Award, who remains a close collaborator, as well as external mentors, such as internationally known leader in head and neck cancer Dr. Waun Ki Hong. They and other mentors guided me and provided opportunities to lead investigations in head and neck and lung cancer.
Dr. Janet D. Rowley was another important source of inspiration in my early years at U of Chicago. Dr. Rowley defined the Philadelphia chromosome of chronic myeloid leukemia as a translocation of chromosomes 9 and 22, which was later recognized as leading to the fusion of BCR::ABL. This was revolutionary and eventually led into modern treatment with tyrosine kinase inhibitors (TKIs) for this disease, as shown in studies led by Dr. Brian Druker and others, with high remission rates that can be maintained even after discontinuing therapy in 50% of patients. Dr. Rowley later received the Presidential Medal of Freedom from Barack Obama for her pioneering work, which paved the way for development of other new, targeted drugs, and vastly increased treatment options for many cancers.
For example, lung cancer, where after many decades we have finally made real progress in mortality. Its incidence and mortality are declining at accelerating speeds because of increased screening and improved treatments, based on an evolved understanding of its biology. Whereas we used to see lung cancer as simply either small cell or non-small cell lung cancer (NSCLC), with NSCLC divided into squamous or adenocarcinoma, we have now defined multiple subsets driven by specific mutations, which we can target with TKIs across all disease stages. When there are no driver mutations, the introduction of immunotherapy has led to greatly improved outcomes.
Encouraging progression-free survival rates have been achieved with TKIs in a variety of subsets of lung cancer and in the case of EGFR or ALK increasing activity with second- or third-generation drugs; particularly exciting is that a common subset of KRAS has also finally become targetable, with sotorasib currently approved and other drugs under investigation.
For the first time, we see encouraging longer-term survival rates in patients with metastatic disease treated with immunotherapy, especially for patients with high PD-L1 expression. Most importantly, the introduction of TKIs and immunotherapy into the curative-intent early-stage adjuvant settings for osimertinib or atezolizumab, or the neo-adjuvant setting for nivolumab, has improved disease-free or event-free survival, with promise for better overall survival. Given the high mortality from lung cancer worldwide, we must make these latest diagnostic and treatment strategies available to all patients, everywhere.
And, of course, not just lung cancer—for patients with other cancers, treatment for organ preservation with combined modality therapy represents another great opportunity in improving treatment.
Imagine a chef being told he needed to have most of his tongue removed because of cancer. Chicago chef Grant Achatz, of the restaurant Alinea, diagnosed with advanced oral tongue cancer, would have lost the ability to taste, swallow, and talk if treated surgically! Instead, our team treated him with combination radiation and chemotherapy, reserving surgery for salvage. We were able to save his tongue, his career, and his life. Chef Achatz and his team have generously supported our ongoing research, which shows that non-surgical treatments for tongue cancer might be more widely useful.
Another patient who benefitted from this strategy is here today, helping to make this very meeting run smoothly! Patrick Allen, senior director of operations here at McCormick Place in Chicago, had an advanced supraglottic laryngeal cancer, which we also treated for organ preservation. A special thanks to Patrick and his team for all they do for the ASCO community.
In addition to making innovative treatments more widely available, we must make new diagnostic testing accessible, too. Research from Dr. Maximilian Diehn shows tumor growth measured radiologically and by very sensitive ctDNA measurements (liquid biopsy) in a patient with stage III lung cancer, from pretreatment to post-chemoradiotherapy and while on consolidation immunotherapy. The liquid biopsy identified residual disease more effectively than the CT scan, which measured what was felt to be residual fibrosis. Tests like this will increasingly enhance, and maybe someday replace, more invasive diagnostic methods.
In addition to testing and treatment, we are also developing novel tools to better communicate with our patients. For example, research by Dr. Ethan Basch and colleagues demonstrated that flagging symptoms early with electronic patient-reported outcomes improves overall survival. Data presented in 2017 and updated for ASCO's Monthly Plenary Series in 2021 show that the digital communication approach improved patient quality of life and physical functioning. This is just one of many techniques being studied to enhance communication with our patients.
Assuring that the patient is front of mind in everything we do has become part of the fabric of cancer research, and we must leverage these innovations to improve cancer care for all patients. During my presidency, I had the opportunity to work with ASCO staff and volunteers on a number of innovative equity initiatives. In December 2021, ASCO released its Equity, Diversity, and Inclusion Action Plan. Building on the critical work of 2020-2021 ASCO president Dr. Lori J. Pierce, the plan aims to infuse equity into all activities at ASCO, both here in the United States and internationally.
In the U.S., 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 our most rural states, ASCO has a new pilot project that uses telehealth and team building to expand access to care, led by Montana oncologist Dr. Jack O. Hensold and the ASCO Clinical Practice Committee. We believe this could become a model for other isolated patient populations.
ASCO continues to advocate for more diversity in clinical trials. One bill pending in the U.S. Congress now would allow companies to reimburse participants for transportation, childcare, and other expenses associated with being in a trial. Recognizing cost as a barrier and being proactive in removing that barrier is important, and I am proud that ASCO is advocating for this legislation.
Turning to the international front, ASCO members Dr. Jackson Orem in Uganda and Dr. Roberto Jerez in Honduras are studying the feasibility of applying ASCO’s longstanding quality initiative, QOPI, in their countries. Their insights and input will help us measure and improve care in other lower-resourced settings around the world.
Many of you are familiar with ASCO’s Leadership Development Program, now in its 12th year, which successfully mentors up-and-coming clinicians to become leaders in ASCO and oncology. ASCO’s Asia Pacific Regional Council worked with ASCO staff to adapt this program to the particular leadership needs and relevant cultural considerations of the region. The Asia Pacific Regional Council is one of three new regional councils; another is in Latin America and a third is planned for sub-Saharan Africa later this year. Founded on the premise that local oncologists know best what their patients need, the councils are working with ASCO to advance quality care in their regions.
Equitable cancer care worldwide is one central goal of ASCO's Strategic Plan. In March 2022, the Board dedicated a retreat to the topic. We heard from Dr. André Ilbawi, of the World Health Organization (WHO), about WHO's plans for enhanced global cancer care. I’m pleased to announce that we have just signed a Memorandum of Understanding with WHO to collaborate on this critical objective.
Consistent with our strategic goal, Conquer Cancer, the ASCO Foundation, has increased support for research on cancer health disparities and for researchers from underrepresented populations. This past year, Dr. Rebecca Shulman received the first Young Investigator Award specifically designed to encourage Latina women to enter medicine and cancer research. Dr. Shulman is using the grant to study mutations of the BRCA1 gene which are largely responsible for the familial form of breast cancer that disproportionately affects young Latinas and people of color.
Growing the Conquer Cancer donor base will fund more innovative, lifesaving research like this. That’s why I support our Foundation, and I hope you will, too. Every donor makes a difference.
Before I close, I’d like to recognize the heroic work of ASCO members and other clinicians caring for patients with cancer affected by the war in Ukraine and other humanitarian crises around the world. ASCO is part of a network of more than 300 organizations working to connect caregivers and patients to the help they need. They include WHO, the European Cancer Organisation, and the American Cancer Society. If you would like to get involved, please visit asco.org/ukraine. We are all learning from these experiences to inform our future efforts to support cancer care during times of humanitarian crisis worldwide.
In closing, I am sure to echo thoughts of the 57 ASCO presidents who preceded me: It has been an incredible honor to serve as president of this impactful, visionary, and generous Society. I’d like to extend a special thanks to all of the ASCO staff who have gone above and beyond to put together this outstanding program and do such meaningful work throughout the year. It has been gratifying to work with them, and the Board, and overall, an extremely rewarding year.
A special thank you to Dr. Howard A. “Skip” Burris III and Dr. Pierce for your leadership as ASCO presidents during two extremely difficult years of COVID-19. As I turn the baton over to Dr. Eric P. Winer, and the following year to Dr. Lynn Mara Schuchter, I feel confident that they will continue to advance ASCO priorities in meaningful ways.
I am grateful for the unwavering support of my family, including my wife of nearly 40 years, Tamara, who is an endocrinologist here in Chicago, and my daughters Natalie and Katherine. Natalie was interested in oncology at an early age and accompanied me to several meetings, including some ASCO meetings, and is now a medical oncologist on the faculty at MD Anderson. Her husband, Dr. Derek Erstad, is a surgical oncologist, and they have two daughters, Vivienne and Elaina. Katherine also accompanied me to oncology meetings, but her passion is in music; she is on the faculty at NYU pursuing a career in film scoring. Her partner of many years, Nitzan Gavrieli, is a jazz pianist.
My mother, Gisela Richter, also a pianist, still lives in Germany where I grew up; at 93, she is still a wizard on the keys, but now they’re on the computer and she is following this event online.
Finally, we must all thank our patients who inspire us with their strength and determination, allow us to guide them through some of the most difficult times in their lives, and participate in the trials that make it possible for us to advance the field.
Editor’s note: Excerpt has been edited for length, style, and clarity. Watch Dr. Vokes' full presentation.