Bill Doyle: Treating cancer with electric fields

翻译人员: Chunxiang Qian 校对人员: Zhenwei Huang

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

这个社会的每一个成员都会接触到癌症－

if not personally,

有的是本人不幸患病

then through a loved one, a family member,

有的是亲人

colleague, friend.

同事或者朋友得了癌症

And once our lives are touched by cancer,

一旦生命中接触到了癌症

we quickly learn

我们很快就了解到

that there are basically

治疗癌症的

three weapons, or three tools, that are available

三种常见治疗手段是：

to fight the disease:

手术

surgery, radiation and chemotherapy.

放疗和化疗

And once we get involved

一旦到了

in the therapeutic decisions,

选择治疗手段的时候

again either personally

不论是自己的治疗

or with our loved ones and family members,

还是亲人朋友的

we also very quickly learn

我们又很快了解到

the benefits, the trade-offs and the limitations

各种治疗手段的

of these tools.

优劣之处

I'm very thankful to Jay and to Mark

非常感谢杰和马克

and the TEDMED team

以及TEDMED小组

for inviting me today

邀请我

to describe a fourth tool, a new tool,

来介绍一种新的治疗手段

that we call Tumor Treating Fields.

我们称做肿瘤治疗电场

Tumor Treating Fields

肿瘤治疗电场这项技术的发明人是

were invented by Dr. Yoram Palti,

以色列理工学院的荣誉教授尤兰姆･帕耳提医生

professor emeritus at the Technion in Israel.

以色列理工学院的荣誉教授尤兰姆･帕耳提医生

And they use low-intensity

他们利用低强度电场

electric fields

来治疗癌症

to fight cancer.

来治疗癌症

To understand how Tumor Treating Fields work,

要理解肿瘤治疗电场的工作原理

we first need to understand

我们先来了解一下

what are electric fields.

什么是电场

Let me first address

首先澄清

a few popular misconceptions.

几个常见误区

First of all, electric fields

首先，电场

are not an electric current

并不是流经身体组织的电流

that is coursing through the tissue.

并不是流经身体组织的电流

Electric fields

其次，电场

are not ionizing radiation,

也不是电离辐射

like X-rays or proton beams,

比如X光或者质子光束

that bombard tissue

它们能攻击细胞组织

to disrupt DNA.

来扰乱DNA

And electric fields

第三，电场

are not magnetism.

也不是磁力

What electric fields are

电场

are a field of forces.

是一种力场

And these forces

这些力

act on, attract, bodies

能吸引和作用于

that have an electrical charge.

带电荷的物体

The best way to visualize an electric field

最直观的理解方法是

is to think of gravity.

类比重力

Gravity is also a field of forces

重力也是一种力场

that act on masses.

它作用于物质

We can all picture astronauts in space.

我们来想象一下太空中的宇航员

They float freely in three dimensions

他们不受重力影响

without any forces acting on them.

在三维空间里自由漂浮

But as that space shuttle

但是一旦航天飞机

returns to Earth,

回到地球

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

宇航员就进入地球的引力场

they begin to see the effects of gravity.

他们就开始受重力影响了

They begin to be attracted towards Earth.

受到地球的吸引力

And as they land,

着陆时

they're fully aligned in the gravitational field.

重力场则完全作用于他们

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

当然我们现在正困在地球的重力场里

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

所以各位才能坐在椅子上

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

所以我们不得不利用肌肉力量

to stand up, to walk around

才能站起来，走动

and to lift things.

和提起东西

In cancer,

恶性肿瘤里

cells rapidly divide

细胞能迅速分裂

and lead to uncontrolled tumor growth.

肿瘤的增大就一发不可收拾

We can think of a cell

从电学的角度

from an electrical perspective

我们可以把肿瘤想象成

as if it's a mini space station.

一个小型的空间站

And in that space station

在这个“空间站”里，

we have the genetic material, the chromosomes,

遗传物质染色体

within a nucleus.

位于细胞核内

And out in the cytoplasmic soup

细胞核外的细胞质中

we have special proteins

有细胞分裂过程中

that are required for cell division

需要的一种特殊蛋白质

that float freely in this soup

这些蛋白质在细胞质中

in three dimensions.

自由漂浮

Importantly, those special proteins

关键的是，这些特殊的蛋白质

are among the most highly charged objects

是人体中携带大量电荷的部分

in our body.

是人体中携带大量电荷的部分

As cell division begins

细胞分裂前期

the nucleus disintegrates,

细胞核分裂

the chromosomes line up

染色体排列在

in the middle of the cell

细胞中

and those special proteins

那些特殊蛋白质物质

undergo a three-dimensional sequence

经过三维排序

whereby they attach

从而能够

and they literally click into place end-on-end

端点相连

to form chains.

形成链条

These chains

这些链条

then progress and attach

就会进一步连上

to the genetic material

遗传物质

and pull the genetic material

然后将这些遗传物质

from one cell into two cells.

从一个细胞拉进两个细胞里

And this is exactly how

这就是一个癌细胞分裂生两个的过程

one cancer cell becomes two cancer cells,

这就是一个癌细胞分裂生两个的过程

two cancer cells become four cancer cells,

两个癌细胞再变成四个

and we have ultimately

最后变成

uncontrolled tumor growth.

无限增长的肿瘤

Tumor Treating Fields

肿瘤处理电场

use externally placed transducers

利用配有一个电场生成器的外置传感器

attached to a field generator

利用配有一个电场生成器的外置传感器

to create an artificial electric field

来人工制造电场

on that space station.

作用于那个“空间站”

And when that cellular space station

当那个细胞“空间站”

is within the electric field,

位于电场内时

it acts on those highly charged proteins

电场就能作用于那些高电荷的物质

and aligns them.

将其排序

And it prevents them from forming those chains,

进而阻碍其形成链条

those mitotic spindles,

那些有丝分裂纺锤体

that are necessary to pull the genetic material

纺锤体是把遗传物质拖放到

into the daughter cells.

子细胞的必要条件

What we see is that the cells will attempt to divide

我们就能看到细胞尝试数小时

for several hours.

进行分裂

And they will either enter into

最后它们要么进入

this so-called cellular suicide,

所谓的细胞自杀

programmed cell death,

一种程序化的细胞死亡

or they will form unhealthy daughter cells

或者最后形成非正常的子细胞

and enter into apoptosis

一旦分裂后

once they have divided.

细胞就死亡

And we can observe this.

我们可以观察到这些

What I'm going to show you next

下面我将展示一下

are two in vitro experiments.

两个体外试验

This is cultures, identical cultures,

这是两个完全一样的培养基

of cervical cancer cells.

培养的子宫癌细胞

And we've stained these cultures

我们用绿色萤光染料将

with a green florescent dye

培养基染色

so that we can look at these proteins

这样我们就能看到这些蛋白质

that form these chains.

是如何形成链条的

The first clip shows

第一条短片

a normal cell division

是一个正常的细胞分裂

without the Tumor Treating Fields.

没有治疗电场的干涉

What we see

我们能看到

are, first of all, a very active culture,

首先是一个非常活跃的培养基

a lot of divisions,

大量的分裂

and then very clear nuclei

一旦细胞分裂开来

once the cells have separated.

就有非常清晰的细胞核

And we can see them dividing throughout.

我们从从头至尾看到分裂过程

When we apply the fields --

然后我们使用了电场－

again, in the identical time-scale

同样的时间尺度

to the identical culture --

同样的培养基

you're going to see something different.

你会看到不一样的东西

The cells round up for division,

细胞开始分裂

but they're very static in that position.

但是都静止在原来的位置上

We'll see two cells

我们看到

in the upper part of the screen

屏幕上方的两个细胞

attempting to divide.

尝试分裂

The one within the circle manages.

圆圈内的这个分裂了

But see how much of the protein

但是看看有多少蛋白质

is still throughout the nucleus,

仍然贯穿细胞核

even in the dividing cell.

甚至是在细胞分裂时

The one up there can't divide at all.

上面的那个根本无法分裂

And then this bubbling, this membrane bubbling,

然后细胞膜就起泡

is the hallmark

这是细胞死亡的

of apoptosis in this cell.

一个标志特征

Formation of healthy mitotic spindles

有丝分裂纺锤体的正常形成

is necessary for division

对每一种细胞的分裂繁殖

in all cell types.

是一个必要的条件

We've applied Tumor Treating Fields

我们已经把肿瘤治疗电场

to over 20 different cancers in the lab,

在实验室中对20种不同的癌细胞进行了试验

and we see this effect

实验结果表明

in all of them.

全部有效果

Now importantly,

重要的是

these Tumor Treating Fields have no effect

肿瘤治疗电场对于

on normal undividing cells.

正常不分裂的细胞没有影响

10 years ago,

十年前

Dr. Palti founded a company called Novocure

帕尔提医生创立一个公司叫Novocure

to develop his discovery

致力于把这个发现

into a practical therapy for patients.

变成临床实用的疗法

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

那时Novocure开发了两个系统

one system for cancers in the head

一个针对头部的肿瘤

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

另一个是针对躯干上的肿瘤

The first cancer that we have focused on

我们针对的第一个癌症

is the deadly brain cancer, GBM.

是致命的脑癌GBM（多形性胶质母细胞瘤）

GBM affects about 10,000 people

在美国每年有将近一万人

in the U.S. each year.

受此病折磨

It's a death sentence.

患上脑癌如同被判死刑

The expected five year survival

不足百分之五的患者

is less than five percent.

能够存活到五年

And the typical patient

大多数病人

with optimal therapy

接受了最好的治疗后

survives just a little over a year,

也只能撑过一年多一点

and only about seven months

首次接受治疗后

from the time that the cancer is first treated

仅仅约是七个月

and then comes back and starts growing again.

癌症就会复发继续扩大

Novocure conducted

Novocure进行了

its first phase three randomized trial

第一阶段的三个随即试验

in patients with recurrent GBM.

病人都是GBM复发

So these are patients

他们都曾

who had received surgery,

接受过手术

high dose radiation to the head

高强度的头部放疗

and first-line chemotherapy,

和一线化疗

and that had failed and their tumors had grown back.

然而这些都失败了，肿瘤复发

We divided the patients into two groups.

我们把病人分成两组

The first group received second-line chemotherapy,

第一组接受二线化疗

which is expected to double the life expectancy,

对比完全不接受治疗的病人

versus no treatment at all.

预期能够延长一倍存活寿命

And then the second group

第二组

received only Tumor Treating Field therapy.

只接受肿瘤治疗电场的治疗

What we saw in that trial

在这个实验中

is that that the life expectancies of both groups --

我们看到两组－

so the chemotherapy treated group

放疗组

and the Tumor Treating Field group --

和肿瘤治疗电场治疗组

was the same.

预期寿命是一样的

But importantly,

但重要的是

the Tumor Treating Field group

接受肿瘤治疗电场的对照组

suffered none of the side effects

没有遭受任何化疗的

typical of chemotherapy patients.

副作用

They had no pain,

没有疼痛

suffered none of the infections.

没有感染

They had no nausea, diarrhea,

没有恶心或腹泻

constipation, fatigue

便秘或疲劳

that would be expected.

这些可能的症状

Based on this trial,

基于今年4月的试验

in April of this year,

基于今年4月的试验

the FDA approved Tumor Treating Fields

FDA批准了肿瘤治疗电场法

for the treatment of patients

用于GBM复发病人的

with recurrent GBM.

治疗

Importantly, it was the first time ever

这是FDA首次

that the FDA included

把生命质量的要求

in their approval of an oncology treatment

放入对肿瘤治疗的

a quality of life claim.

批准条款

So I'm going to show you now

所以我将

one of the patients

展示一位

from this trial.

来自此试验的病人

Robert Dill-Bundi

罗伯特･狄尔邦迪

is a famous Swiss cycling champion.

是著名瑞士自行车赛冠军

He won the gold medal in Moscow

他曾在莫斯科

in the 4,000 meter pursuit.

四千米竞赛中获得金牌

And five years ago,

五年前

Robert was diagnosed with GBM.

罗伯特被诊断为GBM

He received the standard treatments.

他接受了标准疗法

He received surgery.

实施了手术

He received high dose radiation to the head.

接受了高强度的放疗

And he received first-line chemotherapy.

也接受了一线化疗

A year after this treatment --

治疗后一年－

in fact, this is his baseline MRI.

这是他的脑部核磁共振成像的基线

You can see that the black regions

右上角的

in the upper right quadrant

黑色区域

are the areas where he had surgery.

就是手术的部位

And a year after that treatment,

治疗一年后

his tumor grew back with a vengeance.

肿瘤复发

That cloudy white mass that you see

图上大块的白色云状物

is the recurrence of the tumor.

就是复发的肿瘤

At this point, he was told by his doctors

当时医生告诉他

that he had about 3 months to live.

只有三个多月的寿命了

He entered our trial.

他加入了我们的试验

And here we can see him getting the therapy.

这里我们可以看到他在接受治疗

First of all, these electrodes are noninvasive.

首先这些电极是体外的

They're attached to the skin

它们附着在肿瘤的对应范围内的皮肤上

in the area of the tumor.

它们附着在肿瘤的对应范围内的皮肤上

Here you can see

这儿你可以看到

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

一位技术人员正把绷带模样的东西放上去

The patients learn to do this themselves

病人会自己学习操作

And then the patients

这样一来

can undergo all the activities of their daily life.

病人就可以正常进行日程活动

There's none of the tiredness.

没有疲乏症状

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

没有chemo head症状（记忆力减退，思维能力下降等）

There's no sensation.

感觉不到装置

It doesn't interfere

不需要电脑或电子设备

with computers or electrical equipment.

不需要电脑或电子设备

And the therapy is delivered continuously

治疗可以在家中

at home,

持续进行

without having to go into the hospital

不必不停或者时不时地

either periodically or continually.

往医院跑

These are Robert's MRIs,

这些是罗伯特仅接受了肿瘤治疗电场法之后

again, under only TTField treatment.

的核磁共振成像图

This is a therapy that takes time to work.

这个治疗得花上不少时间才能起效

It's a medical device;

这是个医疗设备

it works when it's on.

打开时才工作

But what we can see is, by month six,

但是我们看到，第六个月

the tumor has responded

肿瘤就有了变化

and it's begun to melt away.

开始缩小

It's still there.

不过还在那儿

By month 12,

12月的时候

we could argue whether

可以说

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

只有周边还有一些残余

but it's essentially completely gone.

但是大部分是消失了

It's now five years

现在是罗伯特被确诊为GBM后的

since Robert's diagnosis,

第五年

and he's alive,

他仍然活着

but importantly, he's healthy

更重要的是，他很健康

and he's at work.

还在工作

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

让他来在这个短片里

describe his impressions of the therapy

亲自介绍一下

in his own words.

他对治疗的感受

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

（视频）罗伯特･狄尔邦迪：我现在的

I rate what I have today

生命质量

a bit different than what most people would assume.

我觉得 人们可能意想不到

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

我是这世上最最开心的人

And every single morning I appreciate life.

每个早晨我都感谢生命

Every night I fall asleep very well,

每个晚上我都沉沉熟睡

and I am, I repeat,

我的确是

the happiest man in the world,

世界上最开心的人

and I'm thankful I am alive.

我很感激我还活着

BD: Novocure's also working on lung cancer

BD：Novocure对肺癌也有效

as the second target.

这是第二目标

We've run a phase two trial

我们在瑞士进行了

in Switzerland

第二期临床试验

on, again, recurrent patients --

也是针对复发患者

patients who have received standard therapy

病人都曾接受过标准治疗

and whose cancer has come back.

而癌症又复发了

I'm going to show you another clip

我将展示一个视频

of a woman named Lydia.

来自一位叫莉迪雅的女士

Lydia's a 66 year-old farmer

莉迪雅是名66岁的农妇

in Switzerland.

住在瑞士

She was diagnosed with lung cancer

五年前

five years ago.

她被诊断为肺癌

She underwent four different regimes of chemotherapy

她在两年内接受了四种不同的化疗

over two years,

她在两年内接受了四种不同的化疗

none of which had an effect.

没有一个有效果

Her cancer continued to grow.

她的肿瘤持续增大

Three years ago,

三年前

she entered the Novocure lung cancer trial.

她参加了Novocure的肺癌临床试验

You can see, in her case,

可以看到

she's wearing her transducer arrays,

她携带着她的传感器设备

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

一个在胸前一个在背后

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

另一副并排放在肝部上方

You can see the Tumor Treating Field field generator,

你能看到肿瘤治疗电场的生发器

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

但更重要的可以看到她仍然照常生活

She is managing her farm.

经营她的农场

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

她和儿女还有孙子孙女们一起玩乐

And when we talked to her,

我们和她聊天的时候

she said that when she was undergoing chemotherapy,

她说当她接受化疗时

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

每个月她得去医院接受输液

Her whole family suffered

她的整个家庭因为

as her side effect profile came and went.

她的治疗副作用而遭罪

Now she can run

现在她能自己

all of the activities of her farm.

从事农场的所有活计

It's only the beginning.

这只是开始

(Applause)

（掌声）

In the lab, we've observed tremendous synergies

在实验室里，我们观察到了很多

between chemotherapy and Tumor Treating Fields.

化疗和肿瘤处理场的协同增进效果

There's research underway now at Harvard Medical School

这些试验正在哈佛医学院进行

to pick the optimum pairs

来挑选出最优组合

to maximize that benefit.

最大化效果

We also believe that Tumor Treating Fields will work with radiation

我们也相信肿瘤治疗电场能和放疗协调工作

and interrupt the self-repair mechanisms that we have.

从而阻断肿瘤的自我修复机制

There's now a new research project underway

这是一项在瑞典的Karolinska

at the Karolinska in Sweden

进行的新研究项目

to prove that hypothesis.

来证实我们的假设

We have more trials planned

我们还有更多的临床实验

for lung cancer,

针对肺癌的

pancreatic cancer, ovarian cancer

胰腺癌，卵巢癌

and breast cancer.

还有乳腺癌

And I firmly believe

我坚信

that in the next 10 years

未来十年里

Tumor Treating Fields

肿瘤治疗电场

will be a weapon available to doctors and patients

将成为医生和患者的武器

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

来对付所有顽固的实质固态肿瘤

I'm also very hopeful

我也希望

that in the next decades,

在未来十年

we will make big strides

我们能在

on reducing that death rate

减少以上疾病的死亡率上

that has been so challenging in this disease.

有更大的进步

Thank you.

谢谢

(Applause)

（掌声）