A simple new blood test that can catch cancer early | Jimmy Lin

Prevoditelj: Ivan Stamenković Recezent: Sanda L

Cancer.

Rak.

Many of us have lost family, friends or loved ones

Mnogi od nas izgubili su obitelj, prijatelje ili voljene osobe

to this horrible disease.

od ove užasne bolesti.

I know there are some of you in the audience

Znam da su neki od vas u publici

who are cancer survivors,

preživjeli rak,

or who are fighting cancer at this moment.

ili se bore s rakom u ovom trenutku.

My heart goes out to you.

Suosjećam s vama.

While this word often conjures up emotions of sadness and anger and fear,

Iako ova riječ često priziva osjećaje tuge, ljutnje i straha,

I bring you good news from the front lines of cancer research.

donosim vam dobre vijesti s prve crte istraživanja raka.

The fact is, we are starting to win the war on cancer.

Činjenica je da počinjemo pobjeđivati u ratu protiv raka.

In fact, we lie at the intersection

Zapravo, na raskrižju smo

of the three of the most exciting developments within cancer research.

tri najuzbudljivija razvoja unutar istraživanja raka.

The first is cancer genomics.

Prvi je genomika raka.

The genome is a composition

Genom je sklop

of all the genetic information encoded by DNA

svih genetskih informacija kodiranih od strane DNK

in an organism.

u organizmu.

In cancers, changes in the DNA called mutations

Kod raka, mutacije u DNK

are what drive these cancers to go out of control.

su ono što tjera rak da nekontrolirano raste.

Around 10 years ago, I was part of the team at Johns Hopkins

Prije 10 godina bio sam dio tima u bolnici Johns Hopkins

that first mapped the mutations of cancers.

koji je prvi mapirao mutacije raka.

We did this first for colorectal,

Radili smo prvo s rektalnim,

breast, pancreatic and brain cancers.

rakom dojke, gušterače i mozga.

And since then, there have been over 90 projects in 70 countries

I od onda bilo je preko 90 projekata u sedamdeset zemalja

all over the world,

diljem svijeta,

working to understand the genetic basis of these diseases.

koji rade na tome da razumiju genetske osnove ovih bolesti.

Today, tens of thousands of cancers are understood

Danas razumijemo desetke tisuća pojava raka

down to exquisite molecular detail.

do nevjerojatnih molekularnih detalja.

The second revolution is precision medicine,

Druga revolucija je precizna medicina,

also known as "personalized medicine."

poznata i kao "personalizirana medicina."

Instead of one-size-fits-all methods to be able to treat cancers,

Umjesto jedne metode liječenja za sve tipove raka,

there is a whole new class of drugs that are able to target cancers

postoji potpuno nova serija lijekova kojom možemo ciljano liječiti rak,

based on their unique genetic profile.

na temelju jedinstvenog genetskog profila.

Today, there are a host of these tailor-made drugs,

Danas, postoji mnoštvo ovih specijaliziranih lijekova

called targeted therapies,

nazvanih ciljane terapije,

available to physicians even today

dostupne liječnicima već danas,

to be able to personalize their therapy for their patients,

kako bi mogli stvoriti osobnu terapiju za svoje pacijente,

and many others are in development.

a mnoge druge se još razvijaju.

The third exciting revolution is immunotherapy,

Treća uzbudljiva revolucija je imunoterapija,

and this is really exciting.

i to je zaista uzbudljivo.

Scientists have been able to leverage the immune system

Znanstvenici su uspjeli iskoristiti imunosni sustav

in the fight against cancer.

u borbi protiv raka.

For example, there have been ways where we find the off switches of cancer,

Na primjer, postojali su slučajevi gdje smo našli prekidače za gašenje raka,

and new drugs have been able to turn the immune system back on,

a novi lijekovi mogli su ponovno aktivirati imunosni sustav,

to be able to fight cancer.

kako bi se borio protiv raka.

In addition, there are ways where you can take away immune cells

Kao dodatak, postoje metode kojima možete uzeti imunosne stanice

from the body,

iz tijela,

train them, engineer them and put them back into the body

trenirati ih, podesiti i vratiti u tijelo

to fight cancer.

kako bi se borile protiv raka.

Almost sounds like science fiction, doesn't it?

Gotovo zvuči kao znanstvena fantastika, zar ne?

While I was a researcher at the National Cancer Institute,

Dok sam istraživao pri Nacionalnom Institutu za rak,

I had the privilege of working with some of the pioneers of this field

imao sam čast raditi s nekima od pionira na ovom polju

and watched the development firsthand.

i gledao sam razvoj iz prve ruke.

It's been pretty amazing.

Bilo je zadivljujuće.

Today, over 600 clinical trials are open,

Danas je otvoreno preko 600 kliničkih testiranja

actively recruiting patients to explore all aspects in immunotherapy.

i aktivno traže pacijente za istraživanje svih vidova imunoterapije.

While these three exciting revolutions are ongoing,

Dok se ove tri uzbudljive revolucije događaju,

unfortunately, this is only the beginning,

nažalost, ovo je tek početak,

and there are still many, many challenges.

i još postoji puno, puno izazova.

Let me illustrate with a patient.

Predočit ću vam ovo s pacijentom.

Here is a patient with a skin cancer called melanoma.

Ovaj pacijent ima rak kože, melanom.

It's horrible; the cancer has gone everywhere.

Užasno je, rak se proširio posvuda.

However, scientists were able to map the mutations of this cancer

No ipak, znanstvenici su mapirali mutacije ovog raka

and give a specific treatment that targets one of the mutations.

i dali specifično liječenje koje cilja jednu od mutacija.

And the result is almost miraculous.

I rezultat je gotovo čudotvoran.

Tumors almost seem to melt away.

Tumori su gotovo nestali.

Unfortunately, this is not the end of the story.

Nažalost, ovo nije kraj priče.

A few months later, this picture is taken.

Nekoliko mjeseci kasnije, ponovo je slikano.

The tumor has come back.

Tumor se vratio.

The question is: Why?

Pitanje je: Zašto?

The answer is tumor heterogeneity.

Odgovor je u tumorskoj heterogenezi.

Let me explain.

Dozvolite da objasnim.

Even a cancer as small as one centimeter in diameter

Čak i rak promjera jednog centimetra

harbors over a hundred million different cells.

sadrži stotine milijuna različitih stanica.

While genetically similar,

Iako su genetski slične,

there are small differences in these different cancers

postoje male razlike u tim stanicama

that make them differently prone to different drugs.

koje ih čine različito podložnima na različite lijekove.

So even if you have a drug that's highly effective,

Čak i ako imate lijek koji je izrazito učinkovit

that kills almost all the cells,

i koji uništi gotovo sve stanice,

there is a chance that there's a small population

moguće je da postoji mala populacija

that's resistant to the drug.

koja je otporna na lijek.

This ultimately is the population

To je na kraju populacija

that comes back,

koja se vrati

and takes over the patient.

i preuzme pacijenta.

So then the question is: What do we do with this information?

Onda je pitanje sljedeće: Što radimo s ovim informacijama?

Well, the key, then,

Pa, tada je ključno

is to apply all these exciting advancements in cancer therapy earlier,

primjeniti sve ove uzbudljive napretke u terapiji raka ranije,

as soon as we can,

što je prije moguće,

before these resistance clones emerge.

prije nego se ovi otporni klonovi pojave.

The key to cancer and curing cancer is early detection.

Ključ raka i liječenja raka je u ranom otkrivanju.

And we intuitively know this.

I intuitivno znamo ovo.

Finding cancer early results in better outcomes,

Kada rak pronađemo ranije, dobijemo bolje rezultate

and the numbers show this as well.

i brojke to također pokazuju.

For example, in ovarian cancer, if you detect cancer in stage four,

Na primjer, rak jajnika, ako ga otkrijete u četvrtom stadiju,

only 17 percent of the women survive at five years.

samo 17 posto žena preživi pet godina.

However, if you are able to detect this cancer as early as stage one,

Ako ga otkrijete u prvom stadiju,

over 92 percent of women will survive.

oko 92 posto žena će preživjeti.

But the sad fact is, only 15 percent of women are detected at stage one,

Ali tužna činjenica je da samo 15 posto žena dijagnosticiramo u prvom stadiju,

whereas the vast majority, 70 percent, are detected in stages three and four.

a većini, oko 70 posto, bude dijagnosticirano u trećem i četvrtom.

We desperately need better detection mechanisms for cancers.

Očajnički trebamo bolji mehanizam za otkrivanje raka.

The current best ways to screen cancer fall into one of three categories.

Najbolji načini za pronalazak raka spadaju u jednu od ove tri kategorije.

First is medical procedures,

Prvo su medicinski postupci,

which is like colonoscopy for colon cancer.

kao kolonoskopija za rak debelog crijeva.

Second is protein biomarkers, like PSA for prostate cancer.

Drugo su proteinski biomarkeri, kao za rak prostate.

Or third, imaging techniques,

Ili treće, tehnike snimanja,

such as mammography for breast cancer.

kao mamografija za rak dojke.

Medical procedures are the gold standard;

Medicinski postupci su zlatni standard;

however, they are highly invasive

no, oni su jako invazivni

and require a large infrastructure to implement.

i traže veliku infrastrukturu za primjenu.

Protein markers, while effective in some populations,

Proteinski markeri, iako učinkoviti kod nekih populacija,

are not very specific in some circumstances,

nisu dovoljno specifični u određenim okolnostima,

resulting in high numbers of false positives,

rezultirajući s mnogo lažnih pozitivnih rezultata,

which then results in unnecessary work-ups and unnecessary procedures.

koji potom rezultiraju nepotrebnim pretragama i liječenjima.

Imaging methods, while useful in some populations,

Metode snimanja, iako korisne kod nekih populacija,

expose patients to harmful radiation.

izlažu pacijente štetnom zračenju.

In addition, it is not applicable to all patients.

I dodatno, nisu primjenjive na sve pacijente.

For example, mammography has problems in women with dense breasts.

Na primjer, mamografija ima problema kod žena koje imaju gusto tkivo dojki.

So what we need is a method that is noninvasive,

Tako da trebamo metodu koja nije invazivna,

that is light in infrastructure,

koja nema veliku infrastrukturu,

that is highly specific,

koja je vrlo specifična,

that also does not have false positives,

da nema lažne pozitivne rezultate,

does not use any radiation

ne koristi zračenje

and is applicable to large populations.

i primjenjiva je na širokoj populaciji.

Even more importantly,

Još važnije,

we need a method to be able to detect cancers

trebamo metodu koja može uočiti rak

before they're 100 million cells in size.

prije nego zahvati sto milijuna stanica.

Does such a technology exist?

Postoji li takva tehnologija?

Well, I wouldn't be up here giving a talk if it didn't.

Pa, ne bih bio ovdje i pričao, da ne postoji.

I'm excited to tell you about this latest technology we've developed.

Uzbuđen sam s vama podijeliti informacije o najnovijoj tehnologiji.

Central to our technology is a simple blood test.

Osnova naše tehnologije je jednostavan test krvi.

The blood circulatory system, while seemingly mundane,

Sustav protoka krvi, iako se čini vrlo običan,

is essential for you to survive,

osnova je našeg preživljavanja,

providing oxygen and nutrients to your cells,

dajući kisik i hranjive tvari stanicama

and removing waste and carbon dioxide.

i uklanjajući otpad i ugljični dioksid.

Here's a key biological insight:

Ovo je ključna biološka stvar:

Cancer cells grow and die faster than normal cells,

Stanice raka rastu i umiru brže od normalnih stanica

and when they die,

i kada umru,

DNA is shed into the blood system.

DNK se odbacuje u krvotok.

Since we know the signatures of these cancer cells

Pošto znamo potpise ovih stanica raka,

from all the different cancer genome sequencing projects,

iz svih različitih projekata sekvenciranja genoma raka,

we can look for those signals in the blood

možemo tražiti ove signale u krvi

to be able to detect these cancers early.

kako bismo rano otkrili rak.

So instead of waiting for cancers to be large enough to cause symptoms,

Umjesto čekanja da rak bude dovoljno uznapredovao i izazove simptome,

or for them to be dense enough to show up on imaging,

ili da bude dovoljno gust kako bi se vidio na slikama,

or for them to be prominent enough

ili da bude dovoljno uznapredovao

for you to be able to visualize on medical procedures,

te ga možete vizualizirati medicinskim procedurama,

we can start looking for cancers while they are relatively pretty small,

možemo početi tražiti rak dok je još relativno malen,

by looking for these small amounts of DNA in the blood.

tražeći ove male količine DNK u krvi.

So let me tell you how we do this.

Dozvolite da vam kažem kako to činimo.

First, like I said, we start off with a simple blood test --

Prvo, kako sam rekao, počinjemo testiranjem krvi,

no radiation, no complicated equipment --

bez zračenja, bez složene opreme,

a simple blood test.

jednostavan test krvi.

Then the blood is shipped to us,

Onda nam dopreme krv

and what we do is extract the DNA out of it.

i iz nje izvlačimo DNK.

While your body is mostly healthy cells,

Dok su u vašem tijelu većinom zdrave stanice,

most of the DNA that's detected will be from healthy cells.

većina DNK će biti iz zdravih stanica.

However, there will be a small amount, less than one percent,

Ali, postojat će mala količina, manje od 1 posto,

that comes from the cancer cells.

koja dolazi iz stanica raka.

Then we use molecular biology methods to be able to enrich this DNA

Zatim, kako bismo obogatili DNK, koristimo metode molekularne biologije,

for areas of the genome which are known to be associated with cancer,

za područja genoma za koja se zna da su povezani s rakom,

based on the information from the cancer genomics projects.

prema informacijama iz projekata koji su se bavili genomikom raka.

We're able to then put this DNA into DNA-sequencing machines

Možemo onda uzeti tu DNK i staviti je u sekvencer

and are able to digitize the DNA into A's, C's, T's and G's

te možemo digitalizirati DNK u A, C, T i G

and have this final readout.

i dobiti iščitanje.

Ultimately, we have information of billions of letters

Na kraju, imamo informacije o milijardama slova

that output from this run.

koja proizlaze iz ovoga.

We then apply statistical and computational methods

Potom primjenjujemo statističke i računalne metode

to be able to find the small signal that's present,

kako bismo pronašli mali signal koji je prisutan,

indicative of the small amount of cancer DNA in the blood.

indicirajući malu količinu DNK raka u krvi.

So does this actually work in patients?

Radi li ovo zaista na pacijentima?

Well, because there's no way of really predicting right now

Pa, budući još ne postoji način da zaista predvidimo

which patients will get cancer,

koji pacijenti će dobiti rak,

we use the next best population:

koristimo sljedeću najbolju populaciju:

cancers in remission;

rak u remisiji;

specifically, lung cancer.

konkretno, rak pluća.

The sad fact is, even with the best drugs that we have today,

Tužna činjenica je, i uz najbolje lijekove danas,

most lung cancers come back.

većina raka pluća se vrati.

The key, then, is to see

Ključ je, onda, vidjeti

whether we're able to detect these recurrences of cancers

možemo li detektirati povratak raka

earlier than with standard methods.

ranije nego standardnim metodama.

We just finished a major trial

Upravo smo završili veliko testiranje

with Professor Charles Swanton at University College London,

s profesorom Charlesom Swantonom sa Sveučilišta u Londonu,

examining this.

proučavajući ovo.

Let me walk you through an example of one patient.

Proći ćemo zajedno primjer jednog pacijenta.

Here's an example of one patient who undergoes surgery

Ovo je primjer pacijenta koji odlazi na operaciju

at time point zero,

u nultoj vremenskoj točci,

and then undergoes chemotherapy.

potom ide na kemoterapiju.

Then the patient is under remission.

Zatim je pacijent u remisiji.

He is monitored using clinical exams and imaging methods.

Prati ga se koristeći klinička testiranja i metode vizualizacije, odnosno slikanja.

Around day 450, unfortunately, the cancer comes back.

Nažalost, oko 450. dana, rak se vraća.

The question is: Are we able to catch this earlier?

Pitanje je: Jesmo li ga mogli uočiti ranije?

During this whole time, we've been collecting blood serially

Cijelo ovo vrijeme serijski smo skupljali krv,

to be able to measure the amount of ctDNA in the blood.

kako bismo mjerili količinu ctDNK u krvi.

So at the initial time point, as expected,

Na početnoj vremenskoj točci, kako smo i očekivali,

there's a high level of cancer DNA in the blood.

postoji visoka razina DNK raka u krvi.

However, this goes away to zero in subsequent time points

No, to nestaje u kasnijim vremenskim točkama

and remains negligible after subsequent points.

i ostaje zanemarivo u budućnosti.

However, around day 340, we see the rise of cancer DNA in the blood,

No, 340. dana uočavamo skok DNK raka u krvi

and eventually, it goes up higher for days 400 and 450.

i s vremenom, penje se oko 400. i 450. dana.

Here's the key, if you've missed it:

Ovdje je ključ, ako ste ga propustili.

At day 340, we see the rise in the cancer DNA in the blood.

340. dana vidimo podizanje DNK raka u krvi.

That means we are catching this cancer over a hundred days earlier

To znači da smo primjetili rak stotinu dana ranije

than traditional methods.

od tradicionalnih metoda.

This is a hundred days earlier where we can give therapies,

Ovo je stotinu dana više u kojima možemo liječiti,

a hundred days earlier where we can do surgical interventions,

stotinu dana više gdje možemo obaviti operaciju,

or even a hundred days less for the cancer to grow

ili čak sto dana manje da rak raste,

or a hundred days less for resistance to occur.

ili stotinu dana manje da se stvori otpornost.

For some patients, this hundred days means the matter of life and death.

Za neke pacijente, stotinu dana znači razliku između života i smrti.

We're really excited about this information.

Zaista smo uzbuđeni zbog ovih informacija.

Because of this assignment, we've done additional studies now

Zbog ovog zadatka, odradili smo dodatne studije

in other cancers,

kod drugih tipova raka,

including breast cancer, lung cancer

uključujući rak dojke, rak pluća

and ovarian cancer,

i rak jajnika,

and I can't wait to see how much earlier we can find these cancers.

i ne mogu dočekati da vidim koliko ranije ćemo uočiti ove vrste raka.

Ultimately, I have a dream,

U konačnici imam san,

a dream of two vials of blood,

sanjam dvije epruvete krvi

and that, in the future, as part of all of our standard physical exams,

i da ćemo u budućnosti, kao dio svakog liječničkog pregleda,

we'll have two vials of blood drawn.

dati dvije epruvete krvi.

And from these two vials of blood we will be able to compare

I iz te dvije epruvete moći ćemo napraviti usporedbu

the DNA from all known signatures of cancer,

DNK za sve poznate vrste raka

and hopefully then detect cancers months to even years earlier.

i moći uočiti rak mjesecima, pa čak i godinama ranije.

Even with the therapies we have currently,

Čak i pomoću terapija koje imamo trenutno,

this could mean that millions of lives could be saved.

to znači da bi se milijuni života mogli spasiti.

And if you add on to that recent advancements in immunotherapy

I ako tome dodate nedavne napretke u imunoterapiji

and targeted therapies,

i ciljane terapije,

the end of cancer is in sight.

kraj raka se bliži.

The next time you hear the word "cancer,"

Sljedećeg puta kada čujete riječ "rak",

I want you to add to the emotions: hope.

želim da dodate emociju: nada.

Hold on.

Izdržite.

Cancer researchers all around the world are working feverishly

Istraživači raka diljem svijeta vrlo aktivno rade

to beat this disease,

da pobijede ovu bolest

and tremendous progress is being made.

i ogromni pomaci su napravljeni.

This is the beginning of the end.

Ovo je početak kraja.

We will win the war on cancer.

Pobijedit ćemo u ratu protiv raka.

And to me, this is amazing news.

A za mene, to su odlične vijesti.

Thank you.

Hvala vam.

(Applause)

(Pljesak)