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

譯者: Szu-Wen Kung 審譯者: Wilde Luo

Cancer.

癌症，

Many of us have lost family, friends or loved ones

這可怕的疾病，

to this horrible disease.

讓許多人失去親友摯愛。

I know there are some of you in the audience

我知道在座的你們，

who are cancer survivors,

有人是癌症的倖存者，

or who are fighting cancer at this moment.

有人則正在對抗癌症，

My heart goes out to you.

我的心與你們同在。

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

癌症常讓人聯想到 悲傷、憤怒與恐懼。

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

讓我由癌症研究前線的角度 向各位報告一個好消息。

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

我們在抗癌的戰爭中 正開始顯現出勝勢。

In fact, we lie at the intersection

我們正處於數個研究的交叉點之中，

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

也就是在癌症研究中 三項最令人興奮的發展。

The first is cancer genomics.

首先是癌症基因組。

The genome is a composition

基因組是

of all the genetic information encoded by DNA

包含在生物 DNA 內，

in an organism.

所有的基因訊息。

In cancers, changes in the DNA called mutations

癌細胞裡面的 DNA 變化稱作突變，

are what drive these cancers to go out of control.

是造成癌細胞失控的主因。

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

十年前我是約翰霍普金斯 醫學院的團隊之一。

that first mapped the mutations of cancers.

此團隊率先探測到癌細胞突變。

We did this first for colorectal,

我們最開始是在直腸癌、

breast, pancreatic and brain cancers.

乳癌、胰腺癌和腦癌細胞中進行。

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

自此之後全球有 70 個國家，

all over the world,

超過 90 個研究計畫，

working to understand the genetic basis of these diseases.

著手了解癌症的遺傳基礎。

Today, tens of thousands of cancers are understood

如今上萬種癌症

down to exquisite molecular detail.

能透過精微的分子細節加以了解。

The second revolution is precision medicine,

第二項變革是精準醫療，

also known as "personalized medicine."

也稱「個人化醫療」。

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

相較於一藥治萬病的癌症治療方式，

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

現在有一種全新等級的藥物 能依照癌症的基因檔案，

based on their unique genetic profile.

以標靶方式進行治療。

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

現在對這樣量身訂做的藥物 有一個專有名詞，

called targeted therapies,

即「標靶治療」。

available to physicians even today

這種藥讓當今的醫生

to be able to personalize their therapy for their patients,

能為病人量身訂做適合的治療，

and many others are in development.

還有許多藥物正在研發中。

The third exciting revolution is immunotherapy,

第三項的革新是免疫療法，

and this is really exciting.

這著實振奮人心。

Scientists have been able to leverage the immune system

科學家能夠讓免疫系統發揮作用，

in the fight against cancer.

對抗癌症。

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

例如我們已找出 許多遏止癌細胞的方法，

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

及能重啟免疫系統的新藥物，

to be able to fight cancer.

以對抗癌症。

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

此外現在也有方法能自人體

from the body,

取出免疫細胞，

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

然後訓練它們，改變其基因結構後，

再重新植入體內，以對抗癌症。

to fight cancer.

Almost sounds like science fiction, doesn't it?

聽起來很像科幻小說，對嗎？

While I was a researcher at the National Cancer Institute,

當我還是美國 國立癌症研究所的研究員時，

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

我有幸能與這個領域的先驅共事，

and watched the development firsthand.

第一手目睹發展過程，

It's been pretty amazing.

感覺頗為神奇。

Today, over 600 clinical trials are open,

現在有六百多種臨床試驗，

actively recruiting patients to explore all aspects in immunotherapy.

積極地公開招募病患 以探索免疫療法的各個方面。

While these three exciting revolutions are ongoing,

這三項振奮人心的革新 仍持續進行中，

unfortunately, this is only the beginning,

不幸的是這僅是開端，

and there are still many, many challenges.

眼前仍面臨重重挑戰。

Let me illustrate with a patient.

讓我用病患照片做說明。

Here is a patient with a skin cancer called melanoma.

這名病人罹患名為 「黑素瘤」的皮膚癌。

It's horrible; the cancer has gone everywhere.

很可怕，癌細胞四處擴散。

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

但是科學家探測出癌細胞的突變，

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

並針對其中一種突變給予特殊治療。

And the result is almost miraculous.

結果幾乎可說是奇蹟。

Tumors almost seem to melt away.

腫瘤幾乎消失不見。

Unfortunately, this is not the end of the story.

不幸的是，故事還沒結束。

A few months later, this picture is taken.

幾個月後又照了這張照片，

The tumor has come back.

腫瘤又復發了。

The question is: Why?

這不禁讓人思考為什麼 ？

The answer is tumor heterogeneity.

答案是「腫瘤異質性」。

Let me explain.

容我解釋。

Even a cancer as small as one centimeter in diameter

就算癌細胞小到只有一公分的直徑，

harbors over a hundred million different cells.

也包含了上億種不同的細胞。

While genetically similar,

儘管有相似的基因，

there are small differences in these different cancers

不同的癌細胞有著微小的差異，

that make them differently prone to different drugs.

讓不同的藥適用不同癌細胞。

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

所以就算有一種超級有效的藥，

that kills almost all the cells,

幾乎能夠殺掉所有細胞，

there is a chance that there's a small population

卻仍可能有一小叢細胞，

that's resistant to the drug.

對這種藥物是有抵抗力的。

This ultimately is the population

這類細胞到最後，

that comes back,

終究還是會復發，

and takes over the patient.

在病人身體蔓延。

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

所以問題是，對於這樣的資訊 我們能做些甚麼？

Well, the key, then,

關鍵在於

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

加緊腳步將上述的醫療進展 及早應用於癌症治療。

as soon as we can,

且愈快愈好，

before these resistance clones emerge.

免得這些抗藥細胞植株出現。

The key to cancer and curing cancer is early detection.

治療癌症的關鍵是及早發現。

And we intuitively know this.

我們其實也知道，

Finding cancer early results in better outcomes,

及早發現癌症 會有較好的治療結果，

and the numbers show this as well.

這也受到研究數據證實。

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

以卵巢癌來說 若到第四期才偵測到癌細胞，

only 17 percent of the women survive at five years.

能存活五年的婦女只有 17%。

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

但是若能在第一期就偵測到癌症，

over 92 percent of women will survive.

有超過 92% 的婦女能存活下來。

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

令人難過的是只有 15% 的婦女 能在第一期偵測到癌症，

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

絕大多數約七成的婦女 是在第三、四期才知道罹癌。

We desperately need better detection mechanisms for cancers.

我們急需更好的癌症偵測機制。

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

目前最佳的癌症偵測方式有三種。

First is medical procedures,

第一是醫療行為，

which is like colonoscopy for colon cancer.

像是以結腸鏡檢測結腸癌。

Second is protein biomarkers, like PSA for prostate cancer.

第二是蛋白質生物標記， 像檢測前列腺癌的前列腺特異抗原 。

Or third, imaging techniques,

第三是醫學影像技術，

such as mammography for breast cancer.

如偵測乳癌的乳房造影檢查。

Medical procedures are the gold standard;

醫療行為是黃金準則，

however, they are highly invasive

不過具高侵入性，

and require a large infrastructure to implement.

需要推行大型的醫療設備。

Protein markers, while effective in some populations,

蛋白質生物標記對某些族群有效，

are not very specific in some circumstances,

在有些情況下效果並不理想，

resulting in high numbers of false positives,

誤判的比例很高，

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

往往白費力氣和工夫。

Imaging methods, while useful in some populations,

造影檢查對某些族群有效，

expose patients to harmful radiation.

讓病人暴露在有害的放射線下，

In addition, it is not applicable to all patients.

也不適合所有病人。

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

例如乳房造影檢查 對有緻密乳房的婦女有一定難度，

So what we need is a method that is noninvasive,

所以我們需要一種 不具侵入性的方法、

that is light in infrastructure,

不需用到大型醫療設備、

that is highly specific,

具高特異性、

that also does not have false positives,

不會有誤判、

does not use any radiation

不會用到放射線，

and is applicable to large populations.

而且能適用於廣大族群。

Even more importantly,

更重要的是，

we need a method to be able to detect cancers

我們需要的是 能夠偵測到癌細胞的方法，

before they're 100 million cells in size.

尤其是在癌細胞數目 達到上億之前發現。

Does such a technology exist?

這樣的技術存在嗎？

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

如果沒有，我就不會站在這裡演講。

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

我很高興將我們 最新發展的技術與各位分享。

Central to our technology is a simple blood test.

此項技術的核心是簡易的血液檢驗。

The blood circulatory system, while seemingly mundane,

血液循環系統看似沒甚麼，

is essential for you to survive,

對人類的生存卻至關重要，

providing oxygen and nutrients to your cells,

能為人體細胞提供氧氣和養分，

and removing waste and carbon dioxide.

移除廢物和二氧化碳。

Here's a key biological insight:

從生物觀點來說的關鍵是：

Cancer cells grow and die faster than normal cells,

癌細胞的生長和死亡速度 比正常細胞來得快，

and when they die,

當癌細胞死亡時，

DNA is shed into the blood system.

DNA 會進入血液循環系統。

Since we know the signatures of these cancer cells

我們從所有不同癌症的 基因組定序計畫中，

from all the different cancer genome sequencing projects,

知曉了各種癌細胞的基因特點，

we can look for those signals in the blood

我們便可從血液中尋找罹癌訊號，

to be able to detect these cancers early.

好能及早偵測到癌症。

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

與其等到癌細胞 增殖並造成明顯症狀，

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

或癌細胞密集到足以顯影，

or for them to be prominent enough

或讓癌細胞生長到足以

for you to be able to visualize on medical procedures,

透過醫療行為目測到，

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

我們能在癌細胞 還未成氣候時開始進行偵測，

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

尋找血液中微量的 DNA。

So let me tell you how we do this.

跟大家解釋這如何進行。

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

先從簡易的血液檢驗開始，

no radiation, no complicated equipment --

不需放射線和複雜的設備，

a simple blood test.

就是簡單的血液檢驗。

Then the blood is shipped to us,

然後血液取樣運送到本團隊，

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

我們從血液中取出 DNA。

While your body is mostly healthy cells,

此時人體的細胞大多是健康的，

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

因此取得的 DNA 多是來自健康細胞。

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

但有不到 1% 的微量 DNA，

that comes from the cancer cells.

是來自癌細胞。

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

我們接著運用分子生物法，

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

根據從癌症基因組計劃獲得的信息，

富集此與癌細胞有關的 DNA。

based on the information from the cancer genomics projects.

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

我們將採得的 DNA 置入 DNA 定序儀器，

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

儀器將 DNA 數位化成 A、C、T 和 G 四種鹼基 ，

and have this final readout.

並進行資料分析。

Ultimately, we have information of billions of letters

我們最後從儀器分析結果，

that output from this run.

得出數十億 DNA 符號的資訊。

We then apply statistical and computational methods

研究團隊接著用 統計數據和電腦判讀，

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

藉以找出資料中，

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

顯示血液中微量 DNA 癌細胞的微小訊息。

So does this actually work in patients?

這技術對病患真的有用嗎？

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

由於目前還無法真正預測

which patients will get cancer,

哪個病人會罹癌，

we use the next best population:

適於此研究的最好族群是：

cancers in remission;

癌症緩解期的病患，

specifically, lung cancer.

更明確來說：肺癌。

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

令人難過的是就算使用最好的藥物，

most lung cancers come back.

絕大多數的肺癌仍會復發。

The key, then, is to see

接下來的關鍵是，

whether we're able to detect these recurrences of cancers

我們是否能比一般方法

earlier than with standard methods.

更早偵測到癌細胞的復發。

We just finished a major trial

我們的團隊與倫敦學院大學

with Professor Charles Swanton at University College London,

查爾斯·史汪頓教授 剛完成一項主要試驗，

examining this.

檢驗這項技術。

Let me walk you through an example of one patient.

讓我用一名病患來舉例說明。

Here's an example of one patient who undergoes surgery

這名病患在研究的時間起始點，

at time point zero,

接受手術，

and then undergoes chemotherapy.

然後接受化療，

Then the patient is under remission.

接著病人進入癌症緩解期。

He is monitored using clinical exams and imaging methods.

團隊用臨床檢查和造影技術監測。

Around day 450, unfortunately, the cancer comes back.

癌細胞不幸在第 450 天復發。

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

問題來了：我們能夠及早知道嗎？

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

在這段期間我們定期抽血，

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

以測量血液循環腫瘤 DNA。

So at the initial time point, as expected,

剛開始時不出所料，

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

血液中有大量的癌細胞 DNA。

However, this goes away to zero in subsequent time points

但是接下來癌細胞 DNA 消失 ，

and remains negligible after subsequent points.

又過一段時間後 僅剩微乎其微的癌細胞。

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

但是血液中癌細胞 DNA 的量 到第 340 天開始增加，

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

它在第 400 到 450 天數量更多了。

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

這裡就是關鍵，如果你沒有了解到。

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

在第 340 天我們看到 血液中癌細胞 DNA 的增加，

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

這代表我們比傳統方式 早了一百多天，

than traditional methods.

偵測到癌細胞。

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

也就是我們能提早 100 多天治療病人。

a hundred days earlier where we can do surgical interventions,

能提早 100 多天進行手術，

or even a hundred days less for the cancer to grow

讓癌症少 100 多天的時間生長，

or a hundred days less for resistance to occur.

讓癌細胞少 100 多天的時間復發。

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

對有些病人而言這 100 天 乃是生死交關的關鍵。

We're really excited about this information.

這消息令人振奮。

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

也因此我們目前對其他癌症，

in other cancers,

進行更多的研究，

including breast cancer, lung cancer

包括乳癌、肺癌，

and ovarian cancer,

和卵巢癌。

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

我迫不及待想知道 我們能多早發現這些癌症。

Ultimately, I have a dream,

我有個終極夢想。

a dream of two vials of blood,

兩小瓶的血液取樣，

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

在未來將成為 健康檢查程序的一部分，

we'll have two vials of blood drawn.

採取兩小瓶血液取樣。

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

從這兩瓶取樣我們可以比較

the DNA from all known signatures of cancer,

來自所有具癌症跡象的 DNA，

and hopefully then detect cancers months to even years earlier.

希望能早幾個月 甚至幾年偵測到癌症。

Even with the therapies we have currently,

就算以我們現有的治療方式，

this could mean that millions of lives could be saved.

提早發現癌症代表 能拯救上百萬的生命。

And if you add on to that recent advancements in immunotherapy

若加上近期的免疫療法的進步，

and targeted therapies,

以及標靶式治療的進步，

the end of cancer is in sight.

終結癌症就近在咫尺。

The next time you hear the word "cancer,"

下次當你聽到「癌症」一詞，

I want you to add to the emotions: hope.

我期許各位也能想到「希望」，

Hold on.

永不放棄。

Cancer researchers all around the world are working feverishly

全球的癌症研究人員正積極努力，

to beat this disease,

期能戰勝癌症，

and tremendous progress is being made.

也已有重大的進展。

This is the beginning of the end.

這是癌症之終結的開端，

We will win the war on cancer.

我們終會打贏對抗癌症的戰爭。

And to me, this is amazing news.

對我來說，這是很棒的好消息。

Thank you.

謝謝各位。

(Applause)

（掌聲）