Adapting Cancer Treatment for Survivorship and Precision Care

In this discussion with Karen Winkfield, MD, PhD, from our October Institute for Value-Based Medicine® event in Nashville, she addresses the rapid advancement she and others in oncology are seeing that is helping to propel forward care and clinical discovery in the field. It’s crucial, she emphasized, to drive home the message of the importance of using technological advances to help improve how patients receive care, receive radiation treatments, and their survivorship.

Winkfield is the Ingram Professor of Cancer Research at Vanderbilt Ingram Cancer Center, professor of medicine at Meharry Medical College, and executive director of the Meharry-Vanderbilt Alliance.

This transcript has been edited for clarity.

Transcript

How are emerging technologies like adaptive radiation therapy and AI shaping the future of cancer treatment?

Well, one of the things I loved about radiation oncology is the fact that we can actually leverage technology to treat patients with cancer. And I've watched the field change dramatically, both in terms of techniques that are used, but also the technological advances with respect to software, etc. You mentioned the kind of adaptive radiation therapy, and the ability that we can actually be able to adapt radiation fields as a tumor is shrinking, getting smaller, allows us to actually improve the therapeutic ratio.

We know that all of our therapies, whether it be radiation or systemic therapies, they have side effects. And so, while we do want to do everything we can to cure cancer, we want to make sure that when we cure those cancers that the survivors are surviving well—that they have limited toxicities and side effects. I think that it's really important to maintain that ability to be on the cutting edge, even in terms of surgical techniques.

This is not unique to radiation therapy, but certainly, I've watched the field of radiation grow and expand and really drive home the message, the importance of using technological advances to help improve the way that patients receive the care, receive the radiation treatments, but then also their survivorship afterward.

Are there any other advancements in oncology that you believe have potential to take cancer care to the next level?

I have been very impressed by how quickly we're able to discover now. I'm a basic scientist as well; I'm a biochemist, and I remember when I was in the lab back in the ‘90s, it just took forever, sometimes even just to sequence a protein or even DNA. It was just at the time we were learning how to sequence DNA. Now, we can do those things at a drop of a hat, and it allows for the scientific discoveries about how cancer works, how cancer bypasses normal systems within our body that are intended to ward off cancer. Our discoveries are now allowing us to understand how cancer functions. Because of that, we're able to have many more targeted agents, things that specifically go after a particular protein or a gene. And that allows us to then, again, make sure that we're increasing the therapeutic ratio.

If we can target something versus it being a poison—a lot of the old chemotherapeutics were literally poisons you're putting in people's bodies, and they destroy both normal tissues and also the cancer—now, we can target and send drugs, even drug delivery with nanoparticles. Not just the systemic therapies themselves, but really even targeting ways that we can deliver chemotherapy, deliver that poison, but deliver it right to the tumor cells. These advances are really important in terms of the discovery phase of cancer.

But I also want to make it clear that cancer is a continuum. It starts with prevention. And I do think that it's really important to understand that we are now learning how to screen cancers better, differently, and thinking differently about screening. And we really need to make sure that we're getting our colorectal cancer screening rates up. Some folks are afraid of colonoscopy; they don't have access to it. But this is why [it’s important to even think] about how to improve the way that we screen.

We're doing stool-based tests. We have blood tests now for colorectal cancer, right, as an example, this is important. But also thinking about the advances we have in terms of lung cancer screening, low-dose CT scans, and thinking about discovery, not just in terms of technologies but also implementation of programs that can actually shift not only just the stage at which people are diagnosed with cancer but ultimately the outcomes.