Bill Doyle: Treating cancer with electric fields

Prevodilac: Jelena Nedjic Lektor: Ivana Korom

Everybody in our society's life is touched by cancer --

Rak utiče na život svih ljudi u našem društvu,

if not personally,

ako ne baš lično,

then through a loved one, a family member,

onda je deo priče naših voljenih, članova porodice,

colleague, friend.

kolega, prijatelja.

And once our lives are touched by cancer,

U momentu kada rak prodre u naše živote,

we quickly learn

veoma brzo naučimo

that there are basically

da postoje u osnovi

three weapons, or three tools, that are available

tri tipa oružja, tri alata, kojima se

to fight the disease:

borimo protiv ove bolesti:

surgery, radiation and chemotherapy.

operacija, zračenje i hemoterapija.

And once we get involved

U momentu kada postanemo deo

in the therapeutic decisions,

donošenja odluka o terapiji

again either personally

bilo baš lično

or with our loved ones and family members,

ili preko naših voljenih i članova porodice,

we also very quickly learn

veoma brzo shvatimo

the benefits, the trade-offs and the limitations

prednosti, sporedne efekte i ograničenja

of these tools.

ovih alata.

I'm very thankful to Jay and to Mark

Veoma sam zahvalan Džeju i Marku

and the TEDMED team

i ekipi TEDMED-a

for inviting me today

na pozivu da vam danas

to describe a fourth tool, a new tool,

opišem četvrto oruđe, novo oruđe,

that we call Tumor Treating Fields.

koje nazivamo "Polja za tretiranje tumora".

Tumor Treating Fields

Polja za tretiranje tumora

were invented by Dr. Yoram Palti,

je izumeo dr Joram Palti,

professor emeritus at the Technion in Israel.

počasni profesor na Tehnionu u Izraelu.

And they use low-intensity

Oni koriste električna polja

electric fields

slabe jačine

to fight cancer.

u borbi protiv raka.

To understand how Tumor Treating Fields work,

Da bismo razumeli kako ova polja rade,

we first need to understand

moramo prvo shvatiti

what are electric fields.

šta su električna polja.

Let me first address

Prvo bih obrazložio

a few popular misconceptions.

nekoliko opštih pogrešaka.

First of all, electric fields

Pre svega, električna polja

are not an electric current

nisu električna struja

that is coursing through the tissue.

koja prolazi kroz tkivo.

Electric fields

Električna polja

are not ionizing radiation,

nisu jonizujuće zračenje

like X-rays or proton beams,

kao što su X-zraci ili snopovi protona,

that bombard tissue

koji bombarduju tkivo

to disrupt DNA.

kako bi uništili DNK.

And electric fields

Električna polja nisu

are not magnetism.

ni magnetizam.

What electric fields are

Električna polja

are a field of forces.

su polje sila.

And these forces

Ove sile ispoljavaju

act on, attract, bodies

svoje dejstvo, deluju protiv tela

that have an electrical charge.

koja imaju električnu maržu.

The best way to visualize an electric field

Najbojli način da predstavite električno polje

is to think of gravity.

je da zamislite gravitaciju.

Gravity is also a field of forces

Gravitacija je takođe polje sila

that act on masses.

koje deluje na masu.

We can all picture astronauts in space.

Svi možemo da zamislimo astronaute u svemiru.

They float freely in three dimensions

Oni slobodno plutaju u trodimenzionalnom prostoru

without any forces acting on them.

bez ikakve sile koja deluje na njih.

But as that space shuttle

Ali kada se svemirska letelica

returns to Earth,

vrati na Zemlju,

and as the astronauts enter the Earth's gravitational field,

i kada astronauti uđu u gravitacioni prostor Zemlje,

they begin to see the effects of gravity.

oni počnu da osećaju uticaj gravitacije.

They begin to be attracted towards Earth.

Zemlja počinje da ih privlači.

And as they land,

U momentu prizemljenja

they're fully aligned in the gravitational field.

su u potpunosti pod dejstvom gravitacionog polja.

We're, of course, all stuck in the Earth's gravitational field right now.

Naravno, svi smo sada privezani gravitacionom silom za Zemlju.

That's why you're all in your chairs.

Usled toga ste svi u svojim stolicama.

And that's why we have to use our muscle energy

Zato moramo da koristimo energiju u mišićima

to stand up, to walk around

kako bismo ustali, šetali okolo

and to lift things.

i kako bismo podigli stvari.

In cancer,

U slučaju raka,

cells rapidly divide

ćelije se brzo umnožavaju

and lead to uncontrolled tumor growth.

što dovodi do nekontrolisanog rasta tumora.

We can think of a cell

Ćeliju možemo zamisliti

from an electrical perspective

sa stanovišta elekricizma

as if it's a mini space station.

kao mini kosmičku stanicu.

And in that space station

U toj stanici

we have the genetic material, the chromosomes,

se nalazi genetički materijal, hromozomi,

within a nucleus.

u jedru.

And out in the cytoplasmic soup

A izvan toga, u citoplazmi

we have special proteins

se nalaze posebni proteini,

that are required for cell division

koji su neophodni kako bi se ćelije delile,

that float freely in this soup

koji slobodno plutaju u tom buljonu

in three dimensions.

u sve tri dimenzije.

Importantly, those special proteins

Značajno je da su ti posebni proteini

are among the most highly charged objects

među najelektrisanijim objektima

in our body.

u našem telu.

As cell division begins

Kada počne ćelijska deoba

the nucleus disintegrates,

dolazi do dezintegracije jedra,

the chromosomes line up

hromozomi se poređaju u ravan

in the middle of the cell

na sredini ćelije

and those special proteins

i ovi posebni proteini

undergo a three-dimensional sequence

prolaze kroz seriju događaja

whereby they attach

pri čemu se prikače

and they literally click into place end-on-end

i bukvalno se uklope jedan za drugog

to form chains.

kako bi formirali lanac.

These chains

Ovi lanci se potom

then progress and attach

izdužuju kako bi se prikačili

to the genetic material

za genetički materijal

and pull the genetic material

i razdvojili taj genetički materijal

from one cell into two cells.

iz jedne u dve ćelije.

And this is exactly how

Upravo na ovaj način

one cancer cell becomes two cancer cells,

od jedne ćelije raka nastanu dve,

two cancer cells become four cancer cells,

od dve ćelije raka nastanu četiri,

and we have ultimately

i na kraju dođe do

uncontrolled tumor growth.

nekontrolisanog rasta tumora.

Tumor Treating Fields

Ova tehnologija

use externally placed transducers

koristi spoljašnje transduktore

attached to a field generator

koji su povezani za generatorom polja

to create an artificial electric field

kako bi stvorile veštačko električno polje

on that space station.

u toj kosmičkoj stanici.

And when that cellular space station

Kada je ćelijska kosmička stanica

is within the electric field,

u okviru tog električnog polja

it acts on those highly charged proteins

ona deluje na te visoko naelektrisane proteine

and aligns them.

i poređa ih u red.

And it prevents them from forming those chains,

To ih sprečava da naprave te lance,

those mitotic spindles,

to deobno vreteno,

that are necessary to pull the genetic material

koje je neophodno da bi se genetički materijal razdvojio

into the daughter cells.

u dve ćerke ćelije.

What we see is that the cells will attempt to divide

Uočili smo da ćelije pokušavaju da se podele

for several hours.

po nekoliko sati.

And they will either enter into

Ili će doći do

this so-called cellular suicide,

takozvanog samoubistva ćelije,

programmed cell death,

to je programirana ćelijska smrt,

or they will form unhealthy daughter cells

ili će od njih nastati nezdrave ćerke ćelije

and enter into apoptosis

koje će ući u proces apoptoze

once they have divided.

nakon ćelijske deobe.

And we can observe this.

Možemo to uočiti.

What I'm going to show you next

Ono što ću vam sada pokazati

are two in vitro experiments.

su dva in vitro eksperimenta.

This is cultures, identical cultures,

Ovo su kulture, identične kulture,

of cervical cancer cells.

ćelija raka grlića materice.

And we've stained these cultures

Obeležili smo ove ćelije

with a green florescent dye

zelenom fluorescentnom bojom

so that we can look at these proteins

kako bismo mogli da posmatramo proteine

that form these chains.

koji formiraju te lance.

The first clip shows

Prvi snimak prikazuje

a normal cell division

normalnu ćelijsku deobu

without the Tumor Treating Fields.

bez primene "Polja za tretiranje tumora".

What we see

Možemo uočiti

are, first of all, a very active culture,

pre svega veoma aktivnu kulturu,

a lot of divisions,

mnogo deoba,

and then very clear nuclei

a potom veoma jasno definisana jedra

once the cells have separated.

nakon razdvajanja ćelija.

And we can see them dividing throughout.

Možemo uočiti ceo proces ćelijske deobe.

When we apply the fields --

Kada primenimo polja,

again, in the identical time-scale

ponovo, u istom vremenskom periodu

to the identical culture --

na istovetnu kulturu,

you're going to see something different.

videćete nešto drukčije.

The cells round up for division,

Ćelije se spreme za deobu,

but they're very static in that position.

ali su veoma statične u tom momentu.

We'll see two cells

Možemo uočiti dve ćelije

in the upper part of the screen

u pokušaju ćelijske deobe

attempting to divide.

u gornjem delu ekrana.

The one within the circle manages.

Ćeliji u okviru kruga to i uspeva.

But see how much of the protein

Ali uočite koliko je proteina

is still throughout the nucleus,

ostalo u jedru

even in the dividing cell.

čak i u ćeliji koja se deli.

The one up there can't divide at all.

Ova gore ne može da se podeli uopšte.

And then this bubbling, this membrane bubbling,

Ovo bubrenje, bubrenje membrane,

is the hallmark

je zaštitni znak

of apoptosis in this cell.

apoptoze kod ćelija.

Formation of healthy mitotic spindles

Formiranje funkcionalnog deobnog vretena

is necessary for division

je neophodno za deobu

in all cell types.

svih tipova ćelija.

We've applied Tumor Treating Fields

Primenili smo "Polja za tretman tumora"

to over 20 different cancers in the lab,

na oko 20 različitih tipova raka u laboratoriji,

and we see this effect

i uočavamo isti efekat

in all of them.

kod svih tipova.

Now importantly,

Značajno je to

these Tumor Treating Fields have no effect

da ova "Polja za tretman tumora" nemaju nikakav efekat

on normal undividing cells.

na ćelije koje nisu u procesu deobe.

10 years ago,

Dr. Palti je pre 10 godina

Dr. Palti founded a company called Novocure

osnovao kompaniju "Novocure"

to develop his discovery

kako bi svoje otkriće

into a practical therapy for patients.

razvio do nivoa primene u lečenju pacijenata.

In that time, Novocure's developed two systems --

U tu svrhu "Novocure" je razvio dva sistema -

one system for cancers in the head

jedan za primenu u slučaju raka mozga,

and another system for cancers in the trunk of the body.

i drugi za lečenja raka trupa tela.

The first cancer that we have focused on

Prvi tip raka na koji smo se skoncentrisali

is the deadly brain cancer, GBM.

je smrtonosni rak mozga, glioblastoma (GBM).

GBM affects about 10,000 people

Od GBM-a oboli oko 10.000 osoba

in the U.S. each year.

u SAD-u svake godine.

It's a death sentence.

To je smrtna kazna.

The expected five year survival

Verovatnoća za petogodišnje preživljanje

is less than five percent.

je manja od 5 odsto.

And the typical patient

Tipičan pacijent

with optimal therapy

koji prima optimalnu terapiju

survives just a little over a year,

će živeti malo duže od godinu dana,

and only about seven months

i samo sedam meseci

from the time that the cancer is first treated

od perioda kada je lečenje raka počelo

and then comes back and starts growing again.

i kada dođe do relapsiranja tumora.

Novocure conducted

"Novocure" je sproveo

its first phase three randomized trial

prvu studiju treće faze uz nasumičan izbor pacijenata

in patients with recurrent GBM.

sa relapsirajućim GBM-om.

So these are patients

To su pacijenti koji

who had received surgery,

su bili podvrgnuti operacijama,

high dose radiation to the head

visokoj dozi zračenja glave

and first-line chemotherapy,

i inicijalnoj hemoterapiji,

and that had failed and their tumors had grown back.

sve to je bilo bezuspešno i tumor je relapsirao.

We divided the patients into two groups.

Podelili smo pacijente u dve grupe.

The first group received second-line chemotherapy,

Prva grupa pacijenata je tretirana sekundarnim režimom hemoterapije,

which is expected to double the life expectancy,

koja bi trebalo da udvostruči period preživljavanja,

versus no treatment at all.

u poređenju sa periodom preživljavanja bez ikakvog tretmana.

And then the second group

Druga grupa pacijenata

received only Tumor Treating Field therapy.

je bila podvrgnuta lečenju "Poljima za tretiranje tumora".

What we saw in that trial

Ono što smo uočili u studiji je

is that that the life expectancies of both groups --

da je period preživljavanja u slučaju obe grupe,

so the chemotherapy treated group

dakle i onih koji su tretirani hemoterapijom,

and the Tumor Treating Field group --

i onih koji su tretirani "Poljima za tretiranje tumora",

was the same.

bio jednak.

But importantly,

Međutim,

the Tumor Treating Field group

ljudi koji su tretirani poljima koja leče tumor

suffered none of the side effects

nisu patili ni od jedne kontraindikacije

typical of chemotherapy patients.

koje su tipične za hemoterapiju.

They had no pain,

Nisu bili u bolovima,

suffered none of the infections.

nije došlo do infekcija.

They had no nausea, diarrhea,

Nije bilo mučnine, dijareje,

constipation, fatigue

zatvora, zamora

that would be expected.

što bi bilo očekivano.

Based on this trial,

Na osnovu ove studije,

in April of this year,

iz aprila ove godine, Administracija

the FDA approved Tumor Treating Fields

za hranu i lekove je odobrila upotrebu "Polja za tretiranje

for the treatment of patients

tumora" za lečenje bolesnika

with recurrent GBM.

koji pate od relapsirajuće forme GBM-a.

Importantly, it was the first time ever

Ono što je važno je da je Administracija po prvi put

that the FDA included

u svojim formularima za odobrenje

in their approval of an oncology treatment

primene onkološkog tretmana

a quality of life claim.

navela kvalitet života kao prednost.

So I'm going to show you now

Pokazaću vam sada

one of the patients

jednog pacijenta

from this trial.

iz studije.

Robert Dill-Bundi

Robert Dil-Bandi

is a famous Swiss cycling champion.

je poznati švajcarski šampion u biciklizmu.

He won the gold medal in Moscow

Osvojio je zlatnu medalju u Moskvi

in the 4,000 meter pursuit.

u trci na 4.000 metara.

And five years ago,

Pre pet godina,

Robert was diagnosed with GBM.

Robertu je dijagnostikovan GBM.

He received the standard treatments.

Lečen je standardnim protokolima.

He received surgery.

Podvrgnut je operaciji.

He received high dose radiation to the head.

Primio je visoku dozu zračenja glave.

And he received first-line chemotherapy.

I dobio je inicijalnu hemoterapiju.

A year after this treatment --

Godinu dana nakon tog tretmana,

in fact, this is his baseline MRI.

ovo je ustvari njegov osnovni MR snimak.

You can see that the black regions

Ovi crni delovi koje možete videti

in the upper right quadrant

u gornjem desnom kvadrantu

are the areas where he had surgery.

su delovi koji su bili podvrgnuti operaciji.

And a year after that treatment,

Godinu dana nakon tretmana,

his tumor grew back with a vengeance.

tumor se povratio u još agresivnijoj formi.

That cloudy white mass that you see

Ova magličasta bela masa koju možete videti

is the recurrence of the tumor.

je tumor koji se ponovo stvorio.

At this point, he was told by his doctors

U tom momentu lekari su mu rekli

that he had about 3 months to live.

da mu je ostalo još oko tri meseca života.

He entered our trial.

Uključili smo ga u našu studiju.

And here we can see him getting the therapy.

Ovde ga možemo videti u fazi lečenja.

First of all, these electrodes are noninvasive.

Pre svega, ovo su neinvazivne elektrode.

They're attached to the skin

Prikačene su za kožu

in the area of the tumor.

u predelu tumora.

Here you can see

Možete videti ovde

that a technician is placing them on there much like bandages.

tehničara kako ih postavlja na sličan način kao i zavoj.

The patients learn to do this themselves

Pacijenti nauče da sami ovo rade.

And then the patients

Nakon toga pacijenti

can undergo all the activities of their daily life.

mogu nastaviti sa uobičajenim dnevnim aktivnostima.

There's none of the tiredness.

Ne dolazi do zamora.

There's none of what is called the "chemo head."

Ne dolazi do sindroma nazvanog "hemo-glava".

There's no sensation.

Ništa se ne oseća.

It doesn't interfere

To ne interferira

with computers or electrical equipment.

sa računarima ili električnom opremom.

And the therapy is delivered continuously

Terapija se kontinuirano primenjuje

at home,

kod kuće

without having to go into the hospital

i nije potrebno odlaziti u bolnicu,

either periodically or continually.

bilo periodično ili stalno.

These are Robert's MRIs,

Ovo su Robertovi MR snimci,

again, under only TTField treatment.

ponovo, pri isključivoj primeni terapije polja koja leče tumor.

This is a therapy that takes time to work.

Neophodno je vreme da bi ova terapija delovala.

It's a medical device;

To je medicinski uređaj,

it works when it's on.

radi kada je uključen.

But what we can see is, by month six,

Ali možemo da vidimo da već u šestom mesecu

the tumor has responded

dolazi do delovanja na tumor

and it's begun to melt away.

koji počinje lagano da nestaje.

It's still there.

Još uvek je tamo.

By month 12,

Ovde, u dvanaestom mesecu

we could argue whether

možemo polemisati da li je

there's a little bit of material around the edges,

preostalo nešto tkiva tumora oko samih ivica

but it's essentially completely gone.

ali je u principu nestao potpuno.

It's now five years

Prošlo je pet godina

since Robert's diagnosis,

od uspostavljanja Robertove dijagnoze

and he's alive,

i on je živ,

but importantly, he's healthy

i što je važno, on je zdrav

and he's at work.

i radi.

I'm going to let him, in this very short clip,

U ovom kratkom filmu će vam on

describe his impressions of the therapy

opisati svojim rečima

in his own words.

utiske o terapiji.

(Video) Robert Dill-Bundi: My quality of life,

(Snimak) Robert Dil-Bandi: Kvalitet mog života,

I rate what I have today

ja ocenjujem ono što danas posedujem

a bit different than what most people would assume.

malo drukčije u odnosu na ono što bi većina ljudi pretpostavila.

I am the happiest, the happiest person in the world.

Ja sam najsrećnija, najsrećnija osoba na svetu.

And every single morning I appreciate life.

Svakog jutra ja slavim život.

Every night I fall asleep very well,

Svake noći lako zaspim,

and I am, I repeat,

i ja sam, ponavljam,

the happiest man in the world,

najsrećniji čovek na zemlji,

and I'm thankful I am alive.

i zahvalan sam što sam živ.

BD: Novocure's also working on lung cancer

BD: "Novocure" takođe radi na raku pluća,

as the second target.

to je novi cilj.

We've run a phase two trial

Sprovodimo drugu fazu studije

in Switzerland

u Švajcarskoj

on, again, recurrent patients --

i to ponovo na pacijentima sa relapsirajućim tumorom,

patients who have received standard therapy

to su pacijenti koji su bili podrvgnuti standardnim tretmanima

and whose cancer has come back.

a rak se ponovo javio.

I'm going to show you another clip

Pokazaću vam još jedan snimak,

of a woman named Lydia.

o ženi koja se zove Lidija.

Lydia's a 66 year-old farmer

Lidija ima 66 godina i ona je poljoprivrednik

in Switzerland.

u Švajcarskoj.

She was diagnosed with lung cancer

Dijagnostifikovan joj je rak pluća

five years ago.

pre pet godina.

She underwent four different regimes of chemotherapy

U toku lečenja primila je četiri različita režima hemoterapije

over two years,

u periodu od dve godine,

none of which had an effect.

ni jedan od njih nije pokazao efekat.

Her cancer continued to grow.

Njen rak je nastavljao da raste.

Three years ago,

Pre tri godine

she entered the Novocure lung cancer trial.

je pristupila studiji "Novocure"-a za lečenje raka pluća.

You can see, in her case,

Možete vidti da u njenom slučaju

she's wearing her transducer arrays,

ona nosi provodničke mreže,

one of the front of her chest, one on the back,

jednu na grudima, jednu na leđima,

and then the second pair side-to-side over the liver.

i još jedan par koji je postavljen jedan do drugog oko jetre.

You can see the Tumor Treating Field field generator,

Možete uočiti i punjač "Polja za tretiranje tumora"

but importantly you can also see that she is living her life.

ali još važnije možete videti da ona živi svoj život.

She is managing her farm.

Ona održava svoje imanje.

She's interacting with her kids and her grand kids.

Druži se sa svojom decom i unucima.

And when we talked to her,

U razgovoru nam je rekla

she said that when she was undergoing chemotherapy,

da je morala da ide u bolnicu svakog meseca kako bi primila svoju dozu,

she had to go to the hospital every month for her infusions.

dok se lečila hemoterapijom.

Her whole family suffered

Čitava njena porodica je patila

as her side effect profile came and went.

dok je posmatrala nuz-pojave lečenja kako se javljaju i nestaju.

Now she can run

Sada može da se bavi

all of the activities of her farm.

svim delatnostima na svom imanju.

It's only the beginning.

To je samo početak.

(Applause)

(aplauz)

In the lab, we've observed tremendous synergies

U laboratoriji smo uočili neverovatne sinergističke efekte

between chemotherapy and Tumor Treating Fields.

hemoterapije i polja koja leče rak.

There's research underway now at Harvard Medical School

U Školi medicine Harvarda je trenutno u toku istraživanje

to pick the optimum pairs

koje iznalazi najbolje parove terapija

to maximize that benefit.

koje bi pojačale prednosti tretmana.

We also believe that Tumor Treating Fields will work with radiation

Takođe verujemo da će "Polja za tretiranje raka" davati dobre rezultate

and interrupt the self-repair mechanisms that we have.

u sinergiji sa zračenjem pri onesposobljavanju mehanizama za reparaciju koje nosimo u sebi.

There's now a new research project underway

Novi istraživački projekat, koji treba da

at the Karolinska in Sweden

dokaže tu hipotezu, treba da počne

to prove that hypothesis.

na institutu Karolinska u Švedskoj.

We have more trials planned

Planirali smo još studija

for lung cancer,

za izučavanje raka pluća,

pancreatic cancer, ovarian cancer

raka gušterače, raka jajnika

and breast cancer.

i raka dojki.

And I firmly believe

Ja zaista verujem da će

that in the next 10 years

u narednih deset godina

Tumor Treating Fields

Polja za tretiranje tumora

will be a weapon available to doctors and patients

biti dostupno oruđe za lekare i pacijente

for all of these most-difficult-to-treat solid tumors.

za sve ove veoma teške forme tumora tvrdog tkiva.

I'm also very hopeful

Takođe se nadam

that in the next decades,

da ćemo u narednim decenijama

we will make big strides

učiniti velike pomake

on reducing that death rate

u smanjenju stope smrtnosti

that has been so challenging in this disease.

koja je već toliko dugo istinski izazov kod ove bolesti.

Thank you.

Hvala vam.

(Applause)

(aplauz)