Vokes Charts a New Course in Head and Neck Cancer Treatment

Published: Thursday, May 22, 2014
Dr. Everett E. Vokes

The “Giants of Cancer Care” awards program, which OncLive launched last year, honors oncology specialists whose work has made a significant impact on the lives of patients with cancer. Everett E. Vokes, MD, was recognized for groundbreaking research into head and neck cancers, yet he also has helped advance the field of lung cancer therapies.

In 2007, when Everett E. Vokes, MD, first saw Grant Achatz, the 33-year-old patient already had stage IV squamous cell carcinoma of the tongue, and the assurance of two eminent doctors that amputation was his only hope to survive more than a few months.

That surgery would hinder speech and nearly eliminate all sense of taste–a hardship for anyone but a nightmare for this particular patient, who happened to be one of the world’s most celebrated chefs. Even if he was one of the “lucky” 31% of patients who was alive three years after the surgery, he’d have a life he couldn’t imagine wanting to live.

Luckily for Achatz–and the foodies who have circumnavigated the globe to visit his Chicago restaurant, Alinea–Vokes was then running a clinical trial, one based on previous work that had boosted survival rates to the 70% range and minimized the need for surgery with a combination of three drugs, and then two months later, chemoradiation.

Vokes was able to save both the patient and his tongue. It was another victory for the various combinations of chemotherapy and radiation that Vokes has helped to develop, test, and implement as standards of care for locally advanced head and neck cancer (HNC).

Discovering Medical Oncology

Vokes was born in New York City to parents who were both studying at The Juilliard School. His parents divorced when he was 4, and his mother took him to live in West Germany.

Vokes, though an American citizen, grew up entirely in West Germany and attended medical school in Bonn, which Vokes describes as a “small and fairly sedate city,” despite being the nation’s capital during his time there. One thing that Vokes did not encounter at medical school in Bonn was medical oncology. It was not common in Germany, even in the 1970s, and so Vokes had no experience with it until a three-month exchange rotation in Sydney, Australia.

“After graduating from medical school I ‘returned’ to the United States without knowing whether I’d stay,” Vokes said. “I started my postgraduate education at Ravenswood Hospital in Chicago–which was a small community hospital at the time but no longer exists–and where I again encountered medical oncology and became fascinated by the concept of treating malignancies with systemic therapy as opposed to surgery or radiation therapy. I had a feeling that there was much work to do in cancer care.”

Seeing the Need to Enhance Chemotherapy

“I was a first-year fellow the first time I saw chemotherapy used to treat a head and neck cancer tumor. It was part of a trial. The tumor shrank dramatically, but the study found no survival benefits,” Vokes said. “None of the early individual studies did, indicating cross-resistance with radiotherapy.”

Many doctors inferred that chemotherapy’s lackluster performance in those early trials indicated its irrelevance to HNC treatment. As a result, many forgot all about the tumor shrinkage and continued the status quo: surgery followed by radiation in most cases, or, sometimes, just one or the other.

Dr. Everett E. Vokes Career Highlights Vokes, on the other hand, remembered the dramatic shrinkage and wondered how to enhance chemotherapy’s obvious effect, how to augment something that was already strong enough to kill most of the cancer to the point that it could kill all of the cancer. By the mid-1980s, when he was working his way up the ladder at the oncology-hematology section at the University of Chicago Medical Center, Vokes believed the answer might lie in giving patients chemotherapy and radiation simultaneously.

He secured both permission and funding, and then began testing concomitant chemoradiation, along with several other protocols that used different timetables to combine chemotherapy with radiation and surgery. Concomitant chemoradiation therapy was the runaway winner. It produced highly encouraging results from the start, curing patients with many of the late-stage tumors that almost always eluded existing standards of care and killed patients.

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