Everybody in our society's life is touched by cancer -- if not personally, then through a loved one, a family member, colleague, friend. And once our lives are touched by cancer, we quickly learn that there are basically three weapons, or three tools, that are available to fight the disease: surgery, radiation and chemotherapy. And once we get involved in the therapeutic decisions, again either personally or with our loved ones and family members, we also very quickly learn the benefits, the trade-offs and the limitations of these tools.
在我的生活圈子中,每個人都有與癌症交手的機會 如果不是個人親身經驗 也會因為或是至愛或家庭成員, 同事或朋友而與癌症交鋒 一旦我們的生活被癌症入侵後 我們會很快瞭解 目前基本上只有 三個武器, 或者說三個工具, 可以 用來對抗癌症: 手術, 放射療法及化療 而且一旦我們捲入 治療的決策群時, 相同的, 不管是親身體驗 或因至愛或家庭成員 我們一樣會很快知道 選擇任何一種治療方法, 有何好處? 有何損失? 及其極限。.
I'm very thankful to Jay and to Mark and the TEDMED team for inviting me today to describe a fourth tool, a new tool, that we call Tumor Treating Fields. Tumor Treating Fields were invented by Dr. Yoram Palti, professor emeritus at the Technion in Israel. And they use low-intensity electric fields to fight cancer. To understand how Tumor Treating Fields work, we first need to understand what are electric fields.
我非常感謝杰和馬克 當然還有TEDMED團隊 能讓我今天在此 向大家介紹第四種治療癌症的工具--新工具 我們稱它為"腫瘤治療電能場"。 "腫瘤治療電能場" 是尤昂 帕提 博士所發明的 他是以色列理工學院的榮譽教授。 是利用低強度 的電場 來對抗癌症。 想要瞭解"腫瘤治療電場" 如何運作 我們必須要先瞭解 什麼是電場?
Let me first address a few popular misconceptions. First of all, electric fields are not an electric current that is coursing through the tissue. Electric fields are not ionizing radiation, like X-rays or proton beams, that bombard tissue to disrupt DNA. And electric fields are not magnetism. What electric fields are are a field of forces. And these forces act on, attract, bodies that have an electrical charge.
讓我在此先呈清 幾個大家普遍的誤解 首先,電場 不是電流 穿越病人組織。 電場 不是游離輻射 像X 光或質子光束 會摧毀轟炸病人的組織 來破壞其DNA。 電場 也非利用磁性來作用 什麼是電場呢?電場是 “帶電粒子”在空間中所建立的“場”。 是具有“作用力” 作用, 吸引, 使病人體內 產生電荷。
The best way to visualize an electric field is to think of gravity. Gravity is also a field of forces that act on masses. We can all picture astronauts in space. They float freely in three dimensions without any forces acting on them. But as that space shuttle returns to Earth, and as the astronauts enter the Earth's gravitational field, they begin to see the effects of gravity. They begin to be attracted towards Earth. And as they land, they're fully aligned in the gravitational field. We're, of course, all stuck in the Earth's gravitational field right now. That's why you're all in your chairs. And that's why we have to use our muscle energy to stand up, to walk around and to lift things.
最好的例子去想像電場是 把它看成重力(地球萬有引力) 重力也是相互作用的物理場 只是重力是有關於質量 我們可以想像在外太空中的太空人。 在三度空間中, 他們自由浮動 不須任何力量去推動他們。 但是當太空船 回航地球時 像太空人進入地球的引力場, 他們開始感受到重力的影響。 他們開始被吸引到地球。 當他們登陸地球, 他們就完全被地球引力場所控制。 當然我們現在都被困在地球的引力場內。 這就是為什麼你們會全坐在椅子上。 這就是為什麼我們必須使用肌肉的能量 才能站起來,走動 和舉起任何東西。
In cancer, cells rapidly divide and lead to uncontrolled tumor growth. We can think of a cell from an electrical perspective as if it's a mini space station. And in that space station we have the genetic material, the chromosomes, within a nucleus. And out in the cytoplasmic soup we have special proteins that are required for cell division that float freely in this soup in three dimensions. Importantly, those special proteins are among the most highly charged objects in our body. As cell division begins the nucleus disintegrates, the chromosomes line up in the middle of the cell and those special proteins undergo a three-dimensional sequence whereby they attach and they literally click into place end-on-end to form chains. These chains then progress and attach to the genetic material and pull the genetic material from one cell into two cells. And this is exactly how one cancer cell becomes two cancer cells, two cancer cells become four cancer cells, and we have ultimately uncontrolled tumor growth.
對癌症而言, 細胞迅速分裂 最後導致腫瘤生長快速失控。 讓我們想像一個細胞 從電氣角度的眼光來看 彷彿是一個小型的太空站。 在那個太空站中 有我們的遺傳物質,染色體, 存在一個細胞核內 外層的細胞質湯包中 有些特殊的蛋白質 是細胞分裂時所需要的 這些蛋白質在此湯中 向四面八方自由浮動 重要的是,這些特殊的蛋白質 是極易帶電荷的物質之一 在我們體內 當細胞開始分裂 細胞核解體, 在這細胞的正中間 染色體排起隊 這些特殊的蛋白質 進行三度空間排列 在那兒它們附上 然後文字上來說終端與終端點擊連結 形成許多鍊條。 這些鍊條 然後進化並連接上 遺傳物質上 然後拉扯著遺傳物質 最後從一個細胞分裂成兩個細胞。 這正是為什麼 一個癌症細胞會變成兩個癌細胞, 兩個癌細胞,成為四個癌細胞, 然後最終 腫瘤生長失控。
Tumor Treating Fields use externally placed transducers attached to a field generator to create an artificial electric field on that space station. And when that cellular space station is within the electric field, it acts on those highly charged proteins and aligns them. And it prevents them from forming those chains, those mitotic spindles, that are necessary to pull the genetic material into the daughter cells. What we see is that the cells will attempt to divide for several hours. And they will either enter into this so-called cellular suicide, programmed cell death, or they will form unhealthy daughter cells and enter into apoptosis once they have divided. And we can observe this.
"腫瘤治療電場" 使用體外傳感器 連接到電場發電機 創建一個人工電場 在那個"太空站"上。 所以當細胞"太空站" 籠罩在電場中, 就會活化這些極易帶電荷的蛋白質 控制它們 並阻止他們形成鏈條, 所謂的"有絲分裂紡錘體" 這是把遺傳物質拉進 兩個子細胞所須要的蛋白質。 這裡可看到的是,細胞會試圖分裂 歷經好幾個小時。 這些細胞不是將進入 所謂的細胞自殺狀態, 是細胞自殺的機制系統, 不然就形成不健康的子細胞 使細胞早衰進而死亡 這是如果他們有分裂成功的結果。 我們可以觀察到這一點。
What I'm going to show you next are two in vitro experiments. This is cultures, identical cultures, of cervical cancer cells. And we've stained these cultures with a green florescent dye so that we can look at these proteins that form these chains. The first clip shows a normal cell division without the Tumor Treating Fields. What we see are, first of all, a very active culture, a lot of divisions, and then very clear nuclei once the cells have separated. And we can see them dividing throughout. When we apply the fields -- again, in the identical time-scale to the identical culture -- you're going to see something different. The cells round up for division, but they're very static in that position. We'll see two cells in the upper part of the screen attempting to divide. The one within the circle manages. But see how much of the protein is still throughout the nucleus, even in the dividing cell. The one up there can't divide at all. And then this bubbling, this membrane bubbling, is the hallmark of apoptosis in this cell.
接下去我要告訴你們的是 我們的兩個體外實驗。 這是培養皿 ,在一模一樣條件下, 培養子宮頸癌細胞。 我們將 讓它們帶有綠色螢光染料 這樣我們就可以看見這些蛋白質 形成鏈條, 第一個剪輯顯示 一個正常的細胞分裂 未受"腫瘤治療電場"影響。 首先,我們可看到 這個培養皿裡的 細胞分裂非常活躍, 當細胞分裂完成後 可看到很清楚的細胞核。 我們可以看到他們分裂的整個過程。 當我們應用"腫瘤治療電場" - 在相同長度的記錄時間內 來觀察生長條件相同的對照組 你們就會看到不同的結果。 這些細胞想要打起精神分裂成長, 但事實上他們卻在那裡沒有進展。 這是兩個細胞 在屏幕的上部 企圖分裂。 在圓圈內的那個。 但, 看!有多少的蛋白質 仍然貫穿圍繞細胞核, 甚至在細胞分裂時。 那個在上方位置的根本無法分裂 然後接著冒泡,細胞膜起泡, 就是一個標誌 是此細胞將凋亡的特徵。
Formation of healthy mitotic spindles is necessary for division in all cell types. We've applied Tumor Treating Fields to over 20 different cancers in the lab, and we see this effect in all of them. Now importantly, these Tumor Treating Fields have no effect on normal undividing cells.
健康的有絲分裂紡錘體的形成 是細胞分裂繁殖必要的 每一種細胞都是如此 我們已經應用"腫瘤治療電場" 在實驗室中, 應用於超過20種不同的癌症, 我們想確認它對各種不同癌症 的效果 重要的是,現在我們已確認 "腫瘤治療電場" 對正常未分裂的細胞 沒有干擾效果。
10 years ago, Dr. Palti founded a company called Novocure to develop his discovery into a practical therapy for patients. In that time, Novocure's developed two systems -- one system for cancers in the head and another system for cancers in the trunk of the body. The first cancer that we have focused on is the deadly brain cancer, GBM. GBM affects about 10,000 people in the U.S. each year. It's a death sentence. The expected five year survival is less than five percent. And the typical patient with optimal therapy survives just a little over a year, and only about seven months from the time that the cancer is first treated and then comes back and starts growing again.
10年前, 帕提博士創辦Novocure公司 以推展他的發現 使其能應用到病人的實際治療。 在那個時候,Novocure 開發兩個系統 - 一個系統是針對於頭部癌症 另一個系統是對身體軀幹內的癌症。 我們首先把重點放在GBM(多發性多形性膠質母細胞瘤) , 這是一種致命的腦癌。 在美國每年 約10,000人得到GBM。 對病人而言, 這是死亡宣判書。 預期可以有5年存活率的病人 低於百分之五。 而對大多數的GBM病人而言 即使使用最佳的治療方法 存活的時間只是略超過一年, 通常在第一次療程完成後 大約7個月後, 癌症會復發, 並開始再次增長。
Novocure conducted its first phase three randomized trial in patients with recurrent GBM. So these are patients who had received surgery, high dose radiation to the head and first-line chemotherapy, and that had failed and their tumors had grown back. We divided the patients into two groups. The first group received second-line chemotherapy, which is expected to double the life expectancy, versus no treatment at all. And then the second group received only Tumor Treating Field therapy. What we saw in that trial is that that the life expectancies of both groups -- so the chemotherapy treated group and the Tumor Treating Field group -- was the same. But importantly, the Tumor Treating Field group suffered none of the side effects typical of chemotherapy patients. They had no pain, suffered none of the infections. They had no nausea, diarrhea, constipation, fatigue that would be expected.
Novocure進行 其第一階段的三個隨機試驗 所有的病人全是GBM復發者。 這些患者 都曾接受手術治療, 接受頭部高劑量輻射的療程 和採取過第一線化療, 全失敗,他們的腫瘤全長回來。 我們把每次實驗的病人分兩組 第一組接受第二線化療, 估計可將比不給予治療時預期壽命 延長一倍的時間。 然後第二組 不給第二線化療藥物,只接受"腫瘤治療電場" 我們看到該試驗的結果是 這兩組病患的預期存活壽命 - 接受第二線化療藥物的化療組 和只接受"腫瘤治療電場"的這組病患 存活時間一樣 但重要的是, 只接受"腫瘤治療電場"的這組病患 無遭受任何 化療病人通常會有的副作用 他們沒有痛苦, 沒有遭受感染的高風險。 他們有沒有噁心,腹瀉, 便秘,疲勞 這些都是化療可能的副作用。
Based on this trial, in April of this year, the FDA approved Tumor Treating Fields for the treatment of patients with recurrent GBM. Importantly, it was the first time ever that the FDA included in their approval of an oncology treatment a quality of life claim.
根據這項試驗, 在今年4月, 美國食品衛生局(FDA)批准"腫瘤治療電場" 可被使用在 再復發型的GBM病患 重要的是,這是有史以來第一次 FDA批准加註 這種的腫瘤治療方法 提升了病人的生活品質。
So I'm going to show you now one of the patients from this trial. Robert Dill-Bundi is a famous Swiss cycling champion. He won the gold medal in Moscow in the 4,000 meter pursuit. And five years ago, Robert was diagnosed with GBM. He received the standard treatments. He received surgery. He received high dose radiation to the head. And he received first-line chemotherapy. A year after this treatment -- in fact, this is his baseline MRI. You can see that the black regions in the upper right quadrant are the areas where he had surgery. And a year after that treatment, his tumor grew back with a vengeance. That cloudy white mass that you see is the recurrence of the tumor.
我現在要告訴你們 一個我們臨床試驗 病人的故事 羅伯特·迪爾,邦地 一個著名的瑞士自行車賽冠軍。 曾在莫斯科 4000米的競賽贏得金牌 五年前, 羅伯特被確診得GBM。 他接收標準療法。 接受了手術。 他接受了頭部高劑量輻射的治療。 他也接收第一線化療。 接受治療後的一年 - 這是他的基礎核磁共振I。 可以看到這黑色區域 在右上角四分之一區 在那地方,他做了手術。 然而,治療後的一年, 他的腫瘤瘋狂生長回來。 你所看到那大塊多雲的白色區 就是復發的腫瘤。
At this point, he was told by his doctors that he had about 3 months to live. He entered our trial. And here we can see him getting the therapy. First of all, these electrodes are noninvasive. They're attached to the skin in the area of the tumor. Here you can see that a technician is placing them on there much like bandages. The patients learn to do this themselves And then the patients can undergo all the activities of their daily life. There's none of the tiredness. There's none of what is called the "chemo head." There's no sensation. It doesn't interfere with computers or electrical equipment. And the therapy is delivered continuously at home, without having to go into the hospital either periodically or continually.
在這種形狀下,他的醫生告訴他 他的壽命大概只有3個月左右。 他加入了我們的臨床實驗 這就是他所得到的治療。 首先,這些電極並無侵入性。 它們附著在皮膚上 在腫瘤領域裡。 從這裡你可見到 技術員把電極放置在那裡,很像繃帶。 病人很快就學習自己來 然後病人 可以進行他們日常生活的所有活動。 不再容易疲勞。 沒有什麼所謂的“化療頭。” 不再有強烈的反應。 它不會受電腦 或電器設備干擾。 病人可不間斷治療 即使是在家中 並無需定期 或不斷進入醫院。
These are Robert's MRIs, again, under only TTField treatment. This is a therapy that takes time to work. It's a medical device; it works when it's on. But what we can see is, by month six, the tumor has responded and it's begun to melt away. It's still there. By month 12, we could argue whether there's a little bit of material around the edges, but it's essentially completely gone. It's now five years since Robert's diagnosis, and he's alive, but importantly, he's healthy and he's at work. I'm going to let him, in this very short clip, describe his impressions of the therapy in his own words.
這些羅伯特的核磁共振圖, 只有用"腫瘤治療電場"來治療 這是個需要長時間的治療。 這是一個醫療儀器; 當開關被打開時就開始工作 6月後,我們可以看到的是, 腫瘤有所反應 它開始變小。 但它仍然存在。 接受治療的12個月後, 我們可以爭論是否在這裡, 仍有一點的癌組織殘留在周圍的邊緣, 但它基本上是完全消失了。 現在,五年了 從羅伯特被診斷出算起, 他還活著, 而且重要的是,他很健康 他也繼續工作。 我打算讓他在這簡短的記錄片中 親口描述他自己 對這種療法的感想
(Video) Robert Dill-Bundi: My quality of life, I rate what I have today a bit different than what most people would assume. I am the happiest, the happiest person in the world. And every single morning I appreciate life. Every night I fall asleep very well, and I am, I repeat, the happiest man in the world, and I'm thankful I am alive.
羅伯特·迪爾.邦地:我的生活品質, 現在我給的評分是 跟大部份的人認為的有些不同 我是最幸福的,在世界上最幸福的人。 每一個早晨,我讚美感謝生命。 每天晚上我都睡著很好, 而我,我再說一遍, 是在世界上最幸福的人, 我很慶幸我還活著。
BD: Novocure's also working on lung cancer as the second target. We've run a phase two trial in Switzerland on, again, recurrent patients -- patients who have received standard therapy and whose cancer has come back. I'm going to show you another clip of a woman named Lydia. Lydia's a 66 year-old farmer in Switzerland. She was diagnosed with lung cancer five years ago. She underwent four different regimes of chemotherapy over two years, none of which had an effect. Her cancer continued to grow. Three years ago, she entered the Novocure lung cancer trial.
BD:Novocure也用"腫瘤治療電場"來治療肺癌 治療肺癌, 是公司的第二目標 我們已經在瑞士進行了 第二期臨床試驗 也是針對復發的患者 - 就是那些已接受過標準療法的病人 而癌症又復發的病人。 下一個記錄片我將向您們介紹 這個女子,麗迪亞 麗迪亞是一個66 歲的農夫 她住在瑞士 她被診斷出患有肺癌 已有5 年。 她曾接受了四個不同的化療 這些療程長達超過兩年 沒有一個療程成功 她的惡性腫瘤一直擴大 三年前, 她加入了我們(Novocure) 的肺癌臨床試驗
You can see, in her case, she's wearing her transducer arrays, one of the front of her chest, one on the back, and then the second pair side-to-side over the liver. You can see the Tumor Treating Field field generator, but importantly you can also see that she is living her life. She is managing her farm. She's interacting with her kids and her grand kids. And when we talked to her, she said that when she was undergoing chemotherapy, she had to go to the hospital every month for her infusions. Her whole family suffered as her side effect profile came and went. Now she can run all of the activities of her farm. It's only the beginning.
現在 在您眼前的她 她帶著她專屬的傳感器系統 第一組的一個放置在胸前另一個置於背後, 然後第二組是並列護蓋在肚子肝臟的位置上 在此您們可見到"腫瘤治療電場"的發電機 但更重要的是您見證到她生活的品質 她可以管理自己的農場 她與她的子孫們互動良好。 當有機會跟她詳談時 她告訴我們:當她以前接受化療時, 為了點滴輸液, 她不得不每月去醫院。 她的整個家庭承受許多煎熬 尤其是療程的副作用起起落落時 現在她可以自主管理 所有農場的事務活動。 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 between chemotherapy and Tumor Treating Fields. There's research underway now at Harvard Medical School to pick the optimum pairs to maximize that benefit. We also believe that Tumor Treating Fields will work with radiation and interrupt the self-repair mechanisms that we have. There's now a new research project underway at the Karolinska in Sweden to prove that hypothesis.
在實驗室中, 我們也發現許多的協同效應 如果把化療和"腫瘤治療電場" 一同使用 現在哈佛大學正在進行這項研究 來找出最佳組合 為病人創造最大的利益。 我們也相信"腫瘤治療電場"也可配合放射線療法 強化其阻止癌症細胞修復機轉的能力 現在一個新的研究計劃會 在瑞典卡羅林斯卡醫學院進行 來証明這個理論
We have more trials planned for lung cancer, pancreatic cancer, ovarian cancer and breast cancer. And I firmly believe that in the next 10 years Tumor Treating Fields will be a weapon available to doctors and patients for all of these most-difficult-to-treat solid tumors. I'm also very hopeful that in the next decades, we will make big strides on reducing that death rate that has been so challenging in this disease.
我們有更多臨床試驗計劃 來針對肺癌, 胰臟癌,卵巢癌 乳癌的治療。 我深切的相信 在未來的幾十年 "腫瘤治療電場" 會成為醫生跟病患的武器 用來治療所有以往治療上極度困難的固體腫瘤。 我也非常希望 在未來歲月裡 我們將向前大邁進 努力減低癌症致死率 這一直以來是治療癌症最大的挑戰。
Thank you.
謝謝!
(Applause)
鼓掌