Cancer. Many of us have lost family, friends or loved ones to this horrible disease. I know there are some of you in the audience who are cancer survivors, or who are fighting cancer at this moment. My heart goes out to you. While this word often conjures up emotions of sadness and anger and fear, I bring you good news from the front lines of cancer research. The fact is, we are starting to win the war on cancer. In fact, we lie at the intersection of the three of the most exciting developments within cancer research.
Saratani. Wengi wetu tumepoteza ndugu wa familia marafiki au wapendwa wetu kwa ugonjwa huu mbaya sana. Nafahamu kuna baadhi yenu katika hadhira hii ni manusura wa saratani, au ambao wanapambana na saratani kwa sasa. Moyo wangu unaguswa nanyi. Wakati neno hili linaleta hisia za huzuni na hasira na hofu, Ninakuletea habari njema kutoka kwenye utafiti wa saratani Ukweli ni kwamba tunaanza kushinda vita ya saratani. Kiukweli, tupo katikati kwenye mambo matatu endelevu ndani utafiti wa Saratani wa kusisimua
The first is cancer genomics. The genome is a composition of all the genetic information encoded by DNA in an organism. In cancers, changes in the DNA called mutations are what drive these cancers to go out of control. Around 10 years ago, I was part of the team at Johns Hopkins that first mapped the mutations of cancers. We did this first for colorectal, breast, pancreatic and brain cancers. And since then, there have been over 90 projects in 70 countries all over the world, working to understand the genetic basis of these diseases. Today, tens of thousands of cancers are understood down to exquisite molecular detail.
Ya kwanza ni genome ya Saratani Genome ni uundwaji wa taarifa za kijenetikia zilizosimbwa na DNA ndani ya kiumbehai Kwenye saratani, mabadiliko ya DNA yaitwayo ubadilikaji seli ni kile kinachosukuma saratani hizi kushindwa kudhibitiwa Karibia miaka 10 iliyopita nilikuwa sehemu ya timu ya John Hopkins watu wa kwanza kuunda ramani ya mabadiliko ya saratani Tulifanya kwanza kwa ya utumbo, matiti, kongosho na saratani ya ubongo Na kuanzia hapo,, kumekuwa na zaidi ya miradi 90 kwenye nchi 70 duniani kote inayofanyia kazi kuelewa msingi wa jenetikia ya magonjwa haya. Leo hii, maelfu ya magonjwa ya saratani yanaeleweka hadi kipengele bora cha mwanzo cha molekyuli
The second revolution is precision medicine, also known as "personalized medicine." Instead of one-size-fits-all methods to be able to treat cancers, there is a whole new class of drugs that are able to target cancers based on their unique genetic profile. Today, there are a host of these tailor-made drugs, called targeted therapies, available to physicians even today to be able to personalize their therapy for their patients, and many others are in development.
Mapinduzi ya pili ni tiba mahsusi, yajulikanayo pia kama "tiba kulingana na ugonjwa". badala ya njia ya tiba aina moja kutumika kutibu saratani zote, kuna madaraja mapya ya dawa ambazo yanaweza kulenga saratani kulingana na wasifu wake wa kipekee kijenetikia Leo kuna makazi ya hizi dawa zilizotengenezwa ziitwazo tiba za kulenga, zinazopatikana kwa kila daktari hata leo kuweza kupanga tiba mahsusi kwa wagonjwa wao, na nyingine nyingi zinaendelezwa.
The third exciting revolution is immunotherapy, and this is really exciting. Scientists have been able to leverage the immune system in the fight against cancer. For example, there have been ways where we find the off switches of cancer, and new drugs have been able to turn the immune system back on, to be able to fight cancer. In addition, there are ways where you can take away immune cells from the body, train them, engineer them and put them back into the body to fight cancer. Almost sounds like science fiction, doesn't it?
mapinduzi ya tatu ya kusisimua ni tiba ya kingamaradhi na hii inasisimua kweli. Wanasanyansi wameweza kutumia vizuri mfumo wa kinga kupambana dhidi ya saratani. Kwa mfano, kumekuwa na njia ambazo tunakuta huzima saratani, na dawa mpya zimeweza kugeuza mfumo wa kinga tena, kuweza kupambana na saratani. Kwa kuongezea, kuna njia ambazo unaweza kuondoa seli za kinga kutoka mwilini, kuzifunza, kuziunda na kuzirudisha tena mwilini kupambana na saratani. Inaonekana kama hadithi ya sayansi ya kutunga si ndio?
While I was a researcher at the National Cancer Institute, I had the privilege of working with some of the pioneers of this field and watched the development firsthand. It's been pretty amazing. Today, over 600 clinical trials are open, actively recruiting patients to explore all aspects in immunotherapy.
Wakati nilipokuwa mtafiti kwenye Chuo cha Taifa cha Saratani, Nilibahatika kufanyakazi na baadhi ya waanzilishi wa idara hii na kuangalia maendeleo ya awali. imekuwa ya kustaajabisha sana. Leo, kuna zaidi ya majaribio 600 ya kikliniki, yakuwafunza wagonjwa kuangalia vipengele vyote vya tiba ya kingamaradhi
While these three exciting revolutions are ongoing, unfortunately, this is only the beginning, and there are still many, many challenges. Let me illustrate with a patient. Here is a patient with a skin cancer called melanoma. It's horrible; the cancer has gone everywhere. However, scientists were able to map the mutations of this cancer and give a specific treatment that targets one of the mutations. And the result is almost miraculous. Tumors almost seem to melt away. Unfortunately, this is not the end of the story. A few months later, this picture is taken. The tumor has come back. The question is: Why? The answer is tumor heterogeneity. Let me explain.
Wakati mapinduzi haya matatu ya kusisimua yanaendelea, bahati mbaya huu ni mwanzo tu, na bado kuna changamoto nyingi. Ngoja nitolee mfano kwa mgonjwa Hapa ni mgonjwa mwenye saratani ya ngozi iitwayo melanoma. ni mbaya sana; saratani imeenea kila mahali. Ingawa wanasayansi waliweza kuunda ramani ya mabadiliko ya saratani hii na kutoa tiba mahsusi kwa kulenga mabadiliko Na matokeo ni karibia muujiza. Uvimbe ulionekana kuyeyuka kabisa. Bahati mbaya huu sio mwisho wa hadithi. Miezi michache baadae, hii picha ilipigwa. Uvimbe umerudi tena. Swali ni: Kwanini? Jibu ni uvimbe mbalimbali Ngoja nifafanue zaidi.
Even a cancer as small as one centimeter in diameter harbors over a hundred million different cells. While genetically similar, there are small differences in these different cancers that make them differently prone to different drugs. So even if you have a drug that's highly effective, that kills almost all the cells, there is a chance that there's a small population that's resistant to the drug. This ultimately is the population that comes back, and takes over the patient.
Hata saratani ndogo kiasi cha sentimita moja katika mduara huhifadhi seli zaidi ya milioni mia moja tofauti. Pamoja na kufanana kijenetikia, kuna tofauti ndogo katika saratani hizi tofauti inazozifanya zigeuke tofauti kwa dawa tofauti. Hivyo hata kama una dawa yenye kufanya kazi vizuri, ambayo huua karibia seli zote, kunauwezekano kwamba kuna idadi ndogo ya seli ambayo ni sugu kwa dawa. Hii hatimaye ni idadi ya seli ambazo hurudi, na kumchukua tena mgonjwa.
So then the question is: What do we do with this information? Well, the key, then, is to apply all these exciting advancements in cancer therapy earlier, as soon as we can, before these resistance clones emerge. The key to cancer and curing cancer is early detection. And we intuitively know this. Finding cancer early results in better outcomes, and the numbers show this as well. For example, in ovarian cancer, if you detect cancer in stage four, only 17 percent of the women survive at five years. However, if you are able to detect this cancer as early as stage one, over 92 percent of women will survive. But the sad fact is, only 15 percent of women are detected at stage one, whereas the vast majority, 70 percent, are detected in stages three and four.
Sasa basi swali ni: Tunafanyia nini taarifa hii? Chamsingi basi, Ni kutumia maboresho yote haya ya kusisimua kwa tiba ya saratani mapema, mapema tunavyoweza, kabla ya seli sugu zinazojinakili kuibuka Kitu muhimu kwa saratani na kuitibu ni kuigundua mapema na wote tunaelewa haraka hili. Kugundua saratani mapema hupelekea matokeo mazuri, na takwimu zinaonyesha hili pia. Mfano, katika saratani ya ovari, ukiigundua ikiwa hatua ya nne, ni asilimia 17 pekee ya wanawake husalia kwa miaka mitano Ingawa, ikiwa utaweza kugundua saratani hii mapema ikiwa hatua ya kwanza, zaidi ya asilimia 92 watasalia. Kinachohuzuni sha ni, asilimia 15 tu ya wanawake hugundua ikiwa hatua ya kwanza, ambapo wengi wao, asilimia 70 hugunduka katia hatua ya tatu au ya nne.
We desperately need better detection mechanisms for cancers. The current best ways to screen cancer fall into one of three categories. First is medical procedures, which is like colonoscopy for colon cancer. Second is protein biomarkers, like PSA for prostate cancer. Or third, imaging techniques, such as mammography for breast cancer. Medical procedures are the gold standard; however, they are highly invasive and require a large infrastructure to implement. Protein markers, while effective in some populations, are not very specific in some circumstances, resulting in high numbers of false positives, which then results in unnecessary work-ups and unnecessary procedures. Imaging methods, while useful in some populations, expose patients to harmful radiation. In addition, it is not applicable to all patients. For example, mammography has problems in women with dense breasts.
Tunahitaji bila kukata tamaa njia bora za kugundua saratani. Njia bora za sasa za kupima saratani ziko kwenye moja ya vipengele vitatu, Kwanza ni vipimo vya kitabibu, kama vile kolonoskopi kiangaza utumbo kwa saratani ya utumbo. Pili ni vipimo vya protini, kama PSA kwa saratani ya tezi dume. Au tatu vipimo vya picha, kama mamografi kwa saratani ya matiti. Vipimo vya kitatibu ni viwango bora; ingawa, hutumia vifaa vyenye ncha na huhitaji miundombinu itumiayo eneo kubwa kwa upimaji. Vipimo ya Protini, vikiwa na matokeo mazuri kwa baadhi ya majaribio, havitoi majibu kamili kwa hali nyingine za majaribio ambayo hupelekea matokeo ya kiwango kisicho sahihi, ambayo pia hupelekea utafiti zaidi usio na lazima au upasuaji utafiti kwa njia ya picha waweza kuwa na manufaa kwa baadhi huweka wagonjwa kwenye mionzi hatarishi. kwa kuongezea, haitumiki kwa wagonjwa wote. Mfano, kipimo cha mamografia kina matatizo kwa wanawake wenye matiti yaliyojaa
So what we need is a method that is noninvasive, that is light in infrastructure, that is highly specific, that also does not have false positives, does not use any radiation and is applicable to large populations. Even more importantly, we need a method to be able to detect cancers before they're 100 million cells in size. Does such a technology exist? Well, I wouldn't be up here giving a talk if it didn't.
Hivyo tunachohitaji ni njia ambazo hazihitaji upasuaji huo ni mwanga kwa miundombinu, na ni bayana kikamillifu ambayo pia haina majibu yasiyo sahihi haitumii mionzi yoyote na inatumika kwa idadi kubwa na cha muhimu zaidi tunahitaji njia itakayoweza kugundua saratani kabla kufikia ukubwa wa seli milioni 100 Teknolojia ya aina hiyo ipo? Nisingkuwepo hapa kufanya mjadala kama isingekuwepo.
I'm excited to tell you about this latest technology we've developed. Central to our technology is a simple blood test. The blood circulatory system, while seemingly mundane, is essential for you to survive, providing oxygen and nutrients to your cells, and removing waste and carbon dioxide. Here's a key biological insight: Cancer cells grow and die faster than normal cells, and when they die, DNA is shed into the blood system. Since we know the signatures of these cancer cells from all the different cancer genome sequencing projects, we can look for those signals in the blood to be able to detect these cancers early. So instead of waiting for cancers to be large enough to cause symptoms, or for them to be dense enough to show up on imaging, or for them to be prominent enough for you to be able to visualize on medical procedures, we can start looking for cancers while they are relatively pretty small, by looking for these small amounts of DNA in the blood.
Nina shauku ya kuwaambia kuhusu teknolojia mpya tuliyoendeleza Kiini cha teknolojia yetu ni kipimo rahisi cha damu Mfumo wa mzunguko wa damu, wakati unaonekana ni wa kawaida ni muhimu sana kwa wewe kuishi kutoa hewa ya oksijeni na virutubisho kwa seli zako, na kuondoa taka na kaboni daioksidi Haya ni melezo ya msingi kibaolojia: Seli za saratani hukua na kufa haraka kuliko seli za kawaida, na zinapokufa, DNA hunyambuka kwenye mfumo wa damu, Kwakuwa tunajua alama ya seli hizi za saratani kwenye saratani tofauti za kazi za mfuatano wa genome tunaweza kuona hivyo viashiria kwenye damu kuweza kugundua saratani hizi mapema. Hivyo badala ya kusubiri kwa saratani kuwa kubwa kiasi cha kuonyesha dalili, au kwa zenyewe kujaa kiasi cha kuonekana kwa vipimo vya picha au kwa zenyewe kujitokeza vyakutosha kwa wewe kuweza kuziona kwenye mchakato wa kitabibu tunaweza kuanza kutafuta saratani zingali bado ndogo sana, kwa kuangalia hiki kiasi kidogo cha DNA kwenye damu.
So let me tell you how we do this. First, like I said, we start off with a simple blood test -- no radiation, no complicated equipment -- a simple blood test. Then the blood is shipped to us, and what we do is extract the DNA out of it. While your body is mostly healthy cells, most of the DNA that's detected will be from healthy cells. However, there will be a small amount, less than one percent, that comes from the cancer cells. Then we use molecular biology methods to be able to enrich this DNA for areas of the genome which are known to be associated with cancer, based on the information from the cancer genomics projects. We're able to then put this DNA into DNA-sequencing machines and are able to digitize the DNA into A's, C's, T's and G's and have this final readout. Ultimately, we have information of billions of letters that output from this run. We then apply statistical and computational methods to be able to find the small signal that's present, indicative of the small amount of cancer DNA in the blood.
Hivyo ngoja niwaambie tunavyofanya Kwanza kama nilivyosema, tunaanza na kipimo rahisi cha damu-- bila mionzi, bila vifaa vya kutatanisha-- kipimo rahisi cha damu. Kisha damu huletwa kwetu, na tunachofanya tunatoa DNA kutoka kwenye damu Wwakati mwili wako una seli zenye afya DNA nyingi zinazogundulika zinakuwa kutoka kwenye seli zenye afya. Ingawa kunaweza kuwa na kiasi kidogo, pungufu ya asilimia moja, zinazotoka kwenye seli za saratani Kisha hutumia njia za molekyuli kibaolojia kurutubisha hii DNA kwa maeneo ya genome ambayo hufahamika kuhusishwa na saratani. kutokana na taarifa kutoka kwenye kazi za genome za saratani Tunaweza kuweka hii DNA kwenye mashine za mfuatano wa DNA na zinaweza kuweka DNA kidigitali kuwa A,C,T na G na kufikia tamati kuzisoma Hatimaye , tuna taarifa ya mabilioni ya herufi matokeo hayo kwa majaribio haya, Tunayatumia njia za kitakwimu na za ukokotoaji kuweza kupata viashiria vidogo vilivyopo vinavyoonyesha kiasi kidogo cha DNA za saratani kwenye damu.
So does this actually work in patients? Well, because there's no way of really predicting right now which patients will get cancer, we use the next best population: cancers in remission; specifically, lung cancer. The sad fact is, even with the best drugs that we have today, most lung cancers come back. The key, then, is to see whether we're able to detect these recurrences of cancers earlier than with standard methods.
Kwahiyo hii inafanya kazi kwa wagonjwa? Hivyo, kwakuwa hakuna njia ya kutegemea kutabiri sasa hivi wagonjwa wapi watapata saratani tunatumia idadi bora inayofuata: saratani zilizotulia: hususan, saratani ya mapafu kinachosikitisha, pamoja na dawa bora tulizonazo hivi leo, saratani nyingi za mapafu hurudi. kitu muhimu basi ni kuona ikiwa tunaweza kugundua kujirudia huku kwa saratani mapema zaidi ya kutumia njia za kawaida
We just finished a major trial with Professor Charles Swanton at University College London, examining this. Let me walk you through an example of one patient. Here's an example of one patient who undergoes surgery at time point zero, and then undergoes chemotherapy. Then the patient is under remission. He is monitored using clinical exams and imaging methods. Around day 450, unfortunately, the cancer comes back. The question is: Are we able to catch this earlier? During this whole time, we've been collecting blood serially to be able to measure the amount of ctDNA in the blood. So at the initial time point, as expected, there's a high level of cancer DNA in the blood. However, this goes away to zero in subsequent time points and remains negligible after subsequent points. However, around day 340, we see the rise of cancer DNA in the blood, and eventually, it goes up higher for days 400 and 450.
Hivi karibuni tumemaliza jaribio kubwa pamoja na Profesa Charles Swaton kwenye Chuo kikuu London, kuchunguza hili. Ngoja niwaelekeze kupitia mfano wa mgonjwa mmoja. Hapa ni mfano wa mgonjwa mmoja anayefanyiwa upasuaji kwa wakati nukta sifuri, na kisha anapitia tibakemo inayotumia kemikali Kisha mgonjwa huingia kipindi cha ugonjwa kutulia Hufuatiliwa kwa kutumia njia za uchunguzi na picha ikifika siku ya 450, bahati mbaya saratani inarudi. Swali ni: tunaweza kuigundua mapema? Kwa kipindi chote hiki tumekuwa tukikusanya damu kwa mfululizo kuweza kupima kiasi cha ctDNA kwenye damu. Kwa muda cha awali , kama ilivyotegemewa kuna kiwango kikubwa cha DNA ya saratani kwenye damu. Ingawa hii huenda kuwa sifuri katika pointi za muda unaofuata na kubakia isiyo na umuhimu baada ya pointi zinazofuata Ingawa, karibia siku ya 340, tunaona ongezeko la DNA kwenye damu, na hatimaye inaongezeka kwa siku ya 400 na 450,
Here's the key, if you've missed it: At day 340, we see the rise in the cancer DNA in the blood. That means we are catching this cancer over a hundred days earlier than traditional methods. This is a hundred days earlier where we can give therapies, a hundred days earlier where we can do surgical interventions, or even a hundred days less for the cancer to grow or a hundred days less for resistance to occur. For some patients, this hundred days means the matter of life and death. We're really excited about this information.
Hiki ni muhimu, kama ilikupita: kwenye siku ya 340 tunaona ongezeko la DNA ya saratani kwenye damu. Hii inamaanisha tunaikamata hii saratani zaidi ya siku mia moja mapema kuliko njia zilizo zoeleka. Hii ni siku mia moja mapema ambapo tunaweza kutoa tiba, siku mia moja mapema tunaweza kuzuia kwa kufanya upasuaji au hata pungufu ya siku mia moja kwa saratani kukua au pungufu ya siku mia moja kwa usugu wa ugonjwa. kutokea Kwa baadhi ya wagonjwa siku hizi mia moja ni suala la kufa au kupona Tuna shauku kubwa kuhusu taarifa hii.
Because of this assignment, we've done additional studies now in other cancers, including breast cancer, lung cancer and ovarian cancer, and I can't wait to see how much earlier we can find these cancers.
Kwa sababu ya kazi hii tumefanya utafiti wa ziada sasa katika saratani nyingine ikijumuisha saratani ya matiti, mapafu na saratani ya ovari, nina hamu kubwa kuona ni mapema kiasi gani tutagundua saratani hizi.
Ultimately, I have a dream, a dream of two vials of blood, and that, in the future, as part of all of our standard physical exams, we'll have two vials of blood drawn. And from these two vials of blood we will be able to compare the DNA from all known signatures of cancer, and hopefully then detect cancers months to even years earlier. Even with the therapies we have currently, this could mean that millions of lives could be saved. And if you add on to that recent advancements in immunotherapy and targeted therapies, the end of cancer is in sight.
Hatimaye, nina ndoto, ndoto ya vichupa viwili vya damu, na hiyo, mbeleni, kama sehemu ya uchunguzi wetu wa kawaida wa mwili, tutakuwa na vichupa 2 vilivyotolewa damu na kwenye vichupa hivi vya damu tutaweza kulinganisha DNA kutoka kwenye alama zote za saratani kwa matumaini ya kugundua saratani miezi au hata miaka mapema Hata pamoja na tiba tulizonazo sasa, hii inamaanisha mamilioni ya maisha yanaweza kuokolewa. na ukiongezea maendeleo hivi karibuni ya tiba ya kingamaradhi na tiba za kulenga mwisho wa saratani unaonekana.
The next time you hear the word "cancer," I want you to add to the emotions: hope. Hold on. Cancer researchers all around the world are working feverishly to beat this disease, and tremendous progress is being made.
Utakapo sikia tena neno "saratani" Nataka uongeze kwenye hisia: matumaini. Subiri kwanza. Watafiti wa saratani duniani wanafanya kazi kwa msisimko mkubwa kuushinda ugonjwa huu na maendeleo makubwa yanafanywa.
This is the beginning of the end. We will win the war on cancer. And to me, this is amazing news.
Huu ni mwanzo wa mwisho wake. Tutashinda vita dhidi ya saratani. Na kwangu, hizi ni habari za kustaajabu
Thank you.
Ahsanteni.
(Applause)
(Makofi)