Bill Doyle: Treating cancer with electric fields

譯者: Inder Peng(彭) 審譯者: Sunny Kan Ngai Hang

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

在我的生活圈子中,每個人都有與癌症交手的機會

if not personally,

如果不是個人親身經驗

then through a loved one, a family member,

也會因為或是至愛或家庭成員,

colleague, friend.

同事或朋友而與癌症交鋒

And once our lives are touched by cancer,

一旦我們的生活被癌症入侵後

we quickly learn

我們會很快瞭解

that there are basically

目前基本上只有

three weapons, or three tools, that are available

三個武器, 或者說三個工具, 可以

to fight the disease:

用來對抗癌症:

surgery, radiation and chemotherapy.

手術, 放射療法及化療

And once we get involved

而且一旦我們捲入

in the therapeutic decisions,

治療的決策群時,

again either personally

相同的, 不管是親身體驗

or with our loved ones and family members,

或因至愛或家庭成員

we also very quickly learn

我們一樣會很快知道

the benefits, the trade-offs and the limitations

選擇任何一種治療方法, 有何好處? 有何損失?

of these tools.

及其極限。.

I'm very thankful to Jay and to Mark

我非常感謝杰和馬克

and the TEDMED team

當然還有TEDMED團隊

for inviting me today

能讓我今天在此

to describe a fourth tool, a new tool,

向大家介紹第四種治療癌症的工具--新工具

that we call Tumor Treating Fields.

我們稱它為"腫瘤治療電能場"。

Tumor Treating Fields

"腫瘤治療電能場"

were invented by Dr. Yoram Palti,

是尤昂 帕提 博士所發明的

professor emeritus at the Technion in Israel.

他是以色列理工學院的榮譽教授。

And they use low-intensity

是利用低強度

electric fields

的電場

to fight cancer.

來對抗癌症。

To understand how Tumor Treating Fields work,

想要瞭解"腫瘤治療電場" 如何運作

we first need to understand

我們必須要先瞭解

what are electric fields.

什麼是電場?

Let me first address

讓我在此先呈清

a few popular misconceptions.

幾個大家普遍的誤解

First of all, electric fields

首先,電場

are not an electric current

不是電流

that is coursing through the tissue.

穿越病人組織。

Electric fields

電場

are not ionizing radiation,

不是游離輻射

like X-rays or proton beams,

像X 光或質子光束

that bombard tissue

會摧毀轟炸病人的組織

to disrupt DNA.

來破壞其DNA。

And electric fields

電場

are not magnetism.

也非利用磁性來作用

What electric fields are

什麼是電場呢?電場是

are a field of forces.

“帶電粒子”在空間中所建立的“場”。

And these forces

是具有“作用力”

act on, attract, bodies

作用, 吸引, 使病人體內

that have an electrical charge.

產生電荷。

The best way to visualize an electric field

最好的例子去想像電場是

is to think of gravity.

把它看成重力(地球萬有引力)

Gravity is also a field of forces

重力也是相互作用的物理場

that act on masses.

只是重力是有關於質量

We can all picture astronauts in space.

我們可以想像在外太空中的太空人。

They float freely in three dimensions

在三度空間中, 他們自由浮動

without any forces acting on them.

不須任何力量去推動他們。

But as that space shuttle

但是當太空船

returns to Earth,

回航地球時

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

像太空人進入地球的引力場，

they begin to see the effects of gravity.

他們開始感受到重力的影響。

They begin to be attracted towards Earth.

他們開始被吸引到地球。

And as they land,

當他們登陸地球,

they're fully aligned in the gravitational field.

他們就完全被地球引力場所控制。

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

當然我們現在都被困在地球的引力場內。

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

這就是為什麼你們會全坐在椅子上。

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

這就是為什麼我們必須使用肌肉的能量

to stand up, to walk around

才能站起來，走動

and to lift things.

和舉起任何東西。

In cancer,

對癌症而言，

cells rapidly divide

細胞迅速分裂

and lead to uncontrolled tumor growth.

最後導致腫瘤生長快速失控。

We can think of a cell

讓我們想像一個細胞

from an electrical perspective

從電氣角度的眼光來看

as if it's a mini space station.

彷彿是一個小型的太空站。

And in that space station

在那個太空站中

we have the genetic material, the chromosomes,

有我們的遺傳物質，染色體，

within a nucleus.

存在一個細胞核內

And out in the cytoplasmic soup

外層的細胞質湯包中

we have special proteins

有些特殊的蛋白質

that are required for cell division

是細胞分裂時所需要的

that float freely in this soup

這些蛋白質在此湯中

in three dimensions.

向四面八方自由浮動

Importantly, those special proteins

重要的是，這些特殊的蛋白質

are among the most highly charged objects

是極易帶電荷的物質之一

in our body.

在我們體內

As cell division begins

當細胞開始分裂

the nucleus disintegrates,

細胞核解體，

the chromosomes line up

在這細胞的正中間

in the middle of the cell

染色體排起隊

and those special proteins

這些特殊的蛋白質

undergo a three-dimensional sequence

進行三度空間排列

whereby they attach

在那兒它們附上

and they literally click into place end-on-end

然後文字上來說終端與終端點擊連結

to form chains.

形成許多鍊條。

These chains

這些鍊條

then progress and attach

然後進化並連接上

to the genetic material

遺傳物質上

and pull the genetic material

然後拉扯著遺傳物質

from one cell into two cells.

最後從一個細胞分裂成兩個細胞。

And this is exactly how

這正是為什麼

one cancer cell becomes two cancer cells,

一個癌症細胞會變成兩個癌細胞，

two cancer cells become four cancer cells,

兩個癌細胞,成為四個癌細胞，

and we have ultimately

然後最終

uncontrolled tumor growth.

腫瘤生長失控。

Tumor Treating Fields

"腫瘤治療電場"

use externally placed transducers

使用體外傳感器

attached to a field generator

連接到電場發電機

to create an artificial electric field

創建一個人工電場

on that space station.

在那個"太空站"上。

And when that cellular space station

所以當細胞"太空站"

is within the electric field,

籠罩在電場中，

it acts on those highly charged proteins

就會活化這些極易帶電荷的蛋白質

and aligns them.

控制它們

And it prevents them from forming those chains,

並阻止他們形成鏈條，

those mitotic spindles,

所謂的"有絲分裂紡錘體"

that are necessary to pull the genetic material

這是把遺傳物質拉進

into the daughter cells.

兩個子細胞所須要的蛋白質。

What we see is that the cells will attempt to divide

這裡可看到的是，細胞會試圖分裂

for several hours.

歷經好幾個小時。

And they will either enter into

這些細胞不是將進入

this so-called cellular suicide,

所謂的細胞自殺狀態，

programmed cell death,

是細胞自殺的機制系統，

or they will form unhealthy daughter cells

不然就形成不健康的子細胞

and enter into apoptosis

使細胞早衰進而死亡

once they have divided.

這是如果他們有分裂成功的結果。

And we can observe this.

我們可以觀察到這一點。

What I'm going to show you next

接下去我要告訴你們的是

are two in vitro experiments.

我們的兩個體外實驗。

This is cultures, identical cultures,

這是培養皿 ,在一模一樣條件下,

of cervical cancer cells.

培養子宮頸癌細胞。

And we've stained these cultures

我們將

with a green florescent dye

讓它們帶有綠色螢光染料

so that we can look at these proteins

這樣我們就可以看見這些蛋白質

that form these chains.

形成鏈條，

The first clip shows

第一個剪輯顯示

a normal cell division

一個正常的細胞分裂

without the Tumor Treating Fields.

未受"腫瘤治療電場"影響。

What we see

首先，我們可看到

are, first of all, a very active culture,

這個培養皿裡的

a lot of divisions,

細胞分裂非常活躍，

and then very clear nuclei

當細胞分裂完成後

once the cells have separated.

可看到很清楚的細胞核。

And we can see them dividing throughout.

我們可以看到他們分裂的整個過程。

When we apply the fields --

當我們應用"腫瘤治療電場" -

again, in the identical time-scale

在相同長度的記錄時間內

to the identical culture --

來觀察生長條件相同的對照組

you're going to see something different.

你們就會看到不同的結果。

The cells round up for division,

這些細胞想要打起精神分裂成長,

but they're very static in that position.

但事實上他們卻在那裡沒有進展。

We'll see two cells

這是兩個細胞

in the upper part of the screen

在屏幕的上部

attempting to divide.

企圖分裂。

The one within the circle manages.

在圓圈內的那個。

But see how much of the protein

但, 看!有多少的蛋白質

is still throughout the nucleus,

仍然貫穿圍繞細胞核，

even in the dividing cell.

甚至在細胞分裂時。

The one up there can't divide at all.

那個在上方位置的根本無法分裂

And then this bubbling, this membrane bubbling,

然後接著冒泡，細胞膜起泡，

is the hallmark

就是一個標誌

of apoptosis in this cell.

是此細胞將凋亡的特徵。

Formation of healthy mitotic spindles

健康的有絲分裂紡錘體的形成

is necessary for division

是細胞分裂繁殖必要的

in all cell types.

每一種細胞都是如此

We've applied Tumor Treating Fields

我們已經應用"腫瘤治療電場"

to over 20 different cancers in the lab,

在實驗室中, 應用於超過20種不同的癌症，

and we see this effect

我們想確認它對各種不同癌症

in all of them.

的效果

Now importantly,

重要的是，現在我們已確認

these Tumor Treating Fields have no effect

"腫瘤治療電場" 對正常未分裂的細胞

on normal undividing cells.

沒有干擾效果。

10 years ago,

10年前，

Dr. Palti founded a company called Novocure

帕提博士創辦Novocure公司

to develop his discovery

以推展他的發現

into a practical therapy for patients.

使其能應用到病人的實際治療。

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

在那個時候，Novocure 開發兩個系統 -

one system for cancers in the head

一個系統是針對於頭部癌症

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

另一個系統是對身體軀幹內的癌症。

The first cancer that we have focused on

我們首先把重點放在GBM(多發性多形性膠質母細胞瘤) ，

is the deadly brain cancer, GBM.

這是一種致命的腦癌。

GBM affects about 10,000 people

在美國每年

in the U.S. each year.

約10,000人得到GBM。

It's a death sentence.

對病人而言, 這是死亡宣判書。

The expected five year survival

預期可以有5年存活率的病人

is less than five percent.

低於百分之五。

And the typical patient

而對大多數的GBM病人而言

with optimal therapy

即使使用最佳的治療方法

survives just a little over a year,

存活的時間只是略超過一年，

and only about seven months

通常在第一次療程完成後

from the time that the cancer is first treated

大約7個月後，

and then comes back and starts growing again.

癌症會復發, 並開始再次增長。

Novocure conducted

Novocure進行

its first phase three randomized trial

其第一階段的三個隨機試驗

in patients with recurrent GBM.

所有的病人全是GBM復發者。

So these are patients

這些患者

who had received surgery,

都曾接受手術治療，

high dose radiation to the head

接受頭部高劑量輻射的療程

and first-line chemotherapy,

和採取過第一線化療，

and that had failed and their tumors had grown back.

全失敗，他們的腫瘤全長回來。

We divided the patients into two groups.

我們把每次實驗的病人分兩組

The first group received second-line chemotherapy,

第一組接受第二線化療，

which is expected to double the life expectancy,

估計可將比不給予治療時預期壽命

versus no treatment at all.

延長一倍的時間。

And then the second group

然後第二組

received only Tumor Treating Field therapy.

不給第二線化療藥物,只接受"腫瘤治療電場"

What we saw in that trial

我們看到該試驗的結果是

is that that the life expectancies of both groups --

這兩組病患的預期存活壽命 -

so the chemotherapy treated group

接受第二線化療藥物的化療組

and the Tumor Treating Field group --

和只接受"腫瘤治療電場"的這組病患

was the same.

存活時間一樣

But importantly,

但重要的是，

the Tumor Treating Field group

只接受"腫瘤治療電場"的這組病患

suffered none of the side effects

無遭受任何

typical of chemotherapy patients.

化療病人通常會有的副作用

They had no pain,

他們沒有痛苦，

suffered none of the infections.

沒有遭受感染的高風險。

They had no nausea, diarrhea,

他們有沒有噁心，腹瀉，

constipation, fatigue

便秘，疲勞

that would be expected.

這些都是化療可能的副作用。

Based on this trial,

根據這項試驗，

in April of this year,

在今年4月，

the FDA approved Tumor Treating Fields

美國食品衛生局(FDA)批准"腫瘤治療電場"

for the treatment of patients

可被使用在

with recurrent GBM.

再復發型的GBM病患

Importantly, it was the first time ever

重要的是，這是有史以來第一次

that the FDA included

FDA批准加註

in their approval of an oncology treatment

這種的腫瘤治療方法

a quality of life claim.

提升了病人的生活品質。

So I'm going to show you now

我現在要告訴你們

one of the patients

一個我們臨床試驗

from this trial.

病人的故事

Robert Dill-Bundi

羅伯特·迪爾，邦地

is a famous Swiss cycling champion.

一個著名的瑞士自行車賽冠軍。

He won the gold medal in Moscow

曾在莫斯科

in the 4,000 meter pursuit.

4000米的競賽贏得金牌

And five years ago,

五年前，

Robert was diagnosed with GBM.

羅伯特被確診得GBM。

He received the standard treatments.

他接收標準療法。

He received surgery.

接受了手術。

He received high dose radiation to the head.

他接受了頭部高劑量輻射的治療。

And he received first-line chemotherapy.

他也接收第一線化療。

A year after this treatment --

接受治療後的一年 -

in fact, this is his baseline MRI.

這是他的基礎核磁共振I。

You can see that the black regions

可以看到這黑色區域

in the upper right quadrant

在右上角四分之一區

are the areas where he had surgery.

在那地方,他做了手術。

And a year after that treatment,

然而,治療後的一年，

his tumor grew back with a vengeance.

他的腫瘤瘋狂生長回來。

That cloudy white mass that you see

你所看到那大塊多雲的白色區

is the recurrence of the tumor.

就是復發的腫瘤。

At this point, he was told by his doctors

在這種形狀下，他的醫生告訴他

that he had about 3 months to live.

他的壽命大概只有3個月左右。

He entered our trial.

他加入了我們的臨床實驗

And here we can see him getting the therapy.

這就是他所得到的治療。

First of all, these electrodes are noninvasive.

首先，這些電極並無侵入性。

They're attached to the skin

它們附著在皮膚上

in the area of the tumor.

在腫瘤領域裡。

Here you can see

從這裡你可見到

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

技術員把電極放置在那裡，很像繃帶。

The patients learn to do this themselves

病人很快就學習自己來

And then the patients

然後病人

can undergo all the activities of their daily life.

可以進行他們日常生活的所有活動。

There's none of the tiredness.

不再容易疲勞。

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

沒有什麼所謂的“化療頭。”

There's no sensation.

不再有強烈的反應。

It doesn't interfere

它不會受電腦

with computers or electrical equipment.

或電器設備干擾。

And the therapy is delivered continuously

病人可不間斷治療

at home,

即使是在家中

without having to go into the hospital

並無需定期

either periodically or continually.

或不斷進入醫院。

These are Robert's MRIs,

這些羅伯特的核磁共振圖，

again, under only TTField treatment.

只有用"腫瘤治療電場"來治療

This is a therapy that takes time to work.

這是個需要長時間的治療。

It's a medical device;

這是一個醫療儀器;

it works when it's on.

當開關被打開時就開始工作

But what we can see is, by month six,

6月後,我們可以看到的是，

the tumor has responded

腫瘤有所反應

and it's begun to melt away.

它開始變小。

It's still there.

但它仍然存在。

By month 12,

接受治療的12個月後，

we could argue whether

我們可以爭論是否在這裡,

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

仍有一點的癌組織殘留在周圍的邊緣，

but it's essentially completely gone.

但它基本上是完全消失了。

It's now five years

現在，五年了

since Robert's diagnosis,

從羅伯特被診斷出算起，

and he's alive,

他還活著，

but importantly, he's healthy

而且重要的是，他很健康

and he's at work.

他也繼續工作。

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

我打算讓他在這簡短的記錄片中

describe his impressions of the therapy

親口描述他自己

in his own words.

對這種療法的感想

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

羅伯特·迪爾.邦地:我的生活品質，

I rate what I have today

現在我給的評分是

a bit different than what most people would assume.

跟大部份的人認為的有些不同

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

我是最幸福的，在世界上最幸福的人。

And every single morning I appreciate life.

每一個早晨，我讚美感謝生命。

Every night I fall asleep very well,

每天晚上我都睡著很好，

and I am, I repeat,

而我，我再說一遍，

the happiest man in the world,

是在世界上最幸福的人，

and I'm thankful I am alive.

我很慶幸我還活著。

BD: Novocure's also working on lung cancer

BD:Novocure也用"腫瘤治療電場"來治療肺癌

as the second target.

治療肺癌, 是公司的第二目標

We've run a phase two trial

我們已經在瑞士進行了

in Switzerland

第二期臨床試驗

on, again, recurrent patients --

也是針對復發的患者 -

patients who have received standard therapy

就是那些已接受過標準療法的病人

and whose cancer has come back.

而癌症又復發的病人。

I'm going to show you another clip

下一個記錄片我將向您們介紹

of a woman named Lydia.

這個女子,麗迪亞

Lydia's a 66 year-old farmer

麗迪亞是一個66 歲的農夫

in Switzerland.

她住在瑞士

She was diagnosed with lung cancer

她被診斷出患有肺癌

five years ago.

已有5 年。

She underwent four different regimes of chemotherapy

她曾接受了四個不同的化療

over two years,

這些療程長達超過兩年

none of which had an effect.

沒有一個療程成功

Her cancer continued to grow.

她的惡性腫瘤一直擴大

Three years ago,

三年前,

she entered the Novocure lung cancer trial.

她加入了我們(Novocure) 的肺癌臨床試驗

You can see, in her case,

現在 在您眼前的她

she's wearing her transducer arrays,

她帶著她專屬的傳感器系統

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

第一組的一個放置在胸前另一個置於背後，

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

然後第二組是並列護蓋在肚子肝臟的位置上

You can see the Tumor Treating Field field generator,

在此您們可見到"腫瘤治療電場"的發電機

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

但更重要的是您見證到她生活的品質

She is managing her farm.

她可以管理自己的農場

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

她與她的子孫們互動良好。

And when we talked to her,

當有機會跟她詳談時

she said that when she was undergoing chemotherapy,

她告訴我們:當她以前接受化療時,

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

為了點滴輸液, 她不得不每月去醫院。

Her whole family suffered

她的整個家庭承受許多煎熬

as her side effect profile came and went.

尤其是療程的副作用起起落落時

Now she can run

現在她可以自主管理

all of the activities of her farm.

所有農場的事務活動。

It's only the beginning.

雖然"腫瘤治療電場" 只是才剛啟步

(Applause)

掌聲

In the lab, we've observed tremendous synergies

在實驗室中, 我們也發現許多的協同效應

between chemotherapy and Tumor Treating Fields.

如果把化療和"腫瘤治療電場" 一同使用

There's research underway now at Harvard Medical School

現在哈佛大學正在進行這項研究

to pick the optimum pairs

來找出最佳組合

to maximize that benefit.

為病人創造最大的利益。

We also believe that Tumor Treating Fields will work with radiation

我們也相信"腫瘤治療電場"也可配合放射線療法

and interrupt the self-repair mechanisms that we have.

強化其阻止癌症細胞修復機轉的能力

There's now a new research project underway

現在一個新的研究計劃會

at the Karolinska in Sweden

在瑞典卡羅林斯卡醫學院進行

to prove that hypothesis.

來証明這個理論

We have more trials planned

我們有更多臨床試驗計劃

for lung cancer,

來針對肺癌,

pancreatic cancer, ovarian cancer

胰臟癌,卵巢癌

and breast cancer.

乳癌的治療。

And I firmly believe

我深切的相信

that in the next 10 years

在未來的幾十年

Tumor Treating Fields

"腫瘤治療電場"

will be a weapon available to doctors and patients

會成為醫生跟病患的武器

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

用來治療所有以往治療上極度困難的固體腫瘤。

I'm also very hopeful

我也非常希望

that in the next decades,

在未來歲月裡

we will make big strides

我們將向前大邁進

on reducing that death rate

努力減低癌症致死率

that has been so challenging in this disease.

這一直以來是治療癌症最大的挑戰。

Thank you.

謝謝!

(Applause)

鼓掌