Many of us have lost family, friends or loved ones

癌症，

to this horrible disease.

這可怕的疾病，

I know there are some of you in the audience

讓許多人失去親友摯愛。

who are cancer survivors,

我知道在座的你們，

or who are fighting cancer at this moment.

有人是癌症的倖存者，

My heart goes out to you.

有人則正在對抗癌症，

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

我的心與你們同在。

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

癌症常讓人聯想到 悲傷、憤怒與恐懼。

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

讓我由癌症研究前線的角度 向各位報告一個好消息。

In fact, we lie at the intersection

我們在抗癌的戰爭中 正開始顯現出勝勢。

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

我們正處於數個研究的交叉點之中，

The first is cancer genomics.

也就是在癌症研究中 三項最令人興奮的發展。

The genome is a composition

首先是癌症基因組。

of all the genetic information encoded by DNA

基因組是

in an organism.

包含在生物 DNA 內，

In cancers, changes in the DNA called mutations

所有的基因訊息。

are what drive these cancers to go out of control.

癌細胞裡面的 DNA 變化稱作突變，

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

是造成癌細胞失控的主因。

that first mapped the mutations of cancers.

十年前我是約翰霍普金斯 醫學院的團隊之一。

We did this first for colorectal,

此團隊率先探測到癌細胞突變。

breast, pancreatic and brain cancers.

我們最開始是在直腸癌、

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

乳癌、胰腺癌和腦癌細胞中進行。

all over the world,

自此之後全球有 70 個國家，

working to understand the genetic basis of these diseases.

超過 90 個研究計畫，

Today, tens of thousands of cancers are understood

著手了解癌症的遺傳基礎。

down to exquisite molecular detail.

如今上萬種癌症

The second revolution is precision medicine,

能透過精微的分子細節加以了解。

also known as "personalized medicine."

第二項變革是精準醫療，

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

也稱「個人化醫療」。

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

相較於一藥治萬病的癌症治療方式，

based on their unique genetic profile.

現在有一種全新等級的藥物 能依照癌症的基因檔案，

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

以標靶方式進行治療。

called targeted therapies,

現在對這樣量身訂做的藥物 有一個專有名詞，

available to physicians even today

即「標靶治療」。

to be able to personalize their therapy for their patients,

這種藥讓當今的醫生

and many others are in development.

能為病人量身訂做適合的治療，

The third exciting revolution is immunotherapy,

還有許多藥物正在研發中。

and this is really exciting.

第三項的革新是免疫療法，

Scientists have been able to leverage the immune system

這著實振奮人心。

in the fight against cancer.

科學家能夠讓免疫系統發揮作用，

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

對抗癌症。

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

例如我們已找出 許多遏止癌細胞的方法，

to be able to fight cancer.

及能重啟免疫系統的新藥物，

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

以對抗癌症。

from the body,

此外現在也有方法能自人體

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

取出免疫細胞，

to fight cancer.

然後訓練它們，改變其基因結構後，

Almost sounds like science fiction, doesn't it?

再重新植入體內，以對抗癌症。

While I was a researcher at the National Cancer Institute,

聽起來很像科幻小說，對嗎？

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

當我還是美國 國立癌症研究所的研究員時，

and watched the development firsthand.

我有幸能與這個領域的先驅共事，

It's been pretty amazing.

第一手目睹發展過程，

Today, over 600 clinical trials are open,

感覺頗為神奇。

actively recruiting patients to explore all aspects in immunotherapy.

現在有六百多種臨床試驗，

While these three exciting revolutions are ongoing,

積極地公開招募病患 以探索免疫療法的各個方面。

unfortunately, this is only the beginning,

這三項振奮人心的革新 仍持續進行中，

and there are still many, many challenges.

不幸的是這僅是開端，

Let me illustrate with a patient.

眼前仍面臨重重挑戰。

Here is a patient with a skin cancer called melanoma.

讓我用病患照片做說明。

It's horrible; the cancer has gone everywhere.

這名病人罹患名為 「黑素瘤」的皮膚癌。

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

很可怕，癌細胞四處擴散。

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

但是科學家探測出癌細胞的突變，

And the result is almost miraculous.

並針對其中一種突變給予特殊治療。

Tumors almost seem to melt away.

結果幾乎可說是奇蹟。

Unfortunately, this is not the end of the story.

腫瘤幾乎消失不見。

A few months later, this picture is taken.

不幸的是，故事還沒結束。

The tumor has come back.

幾個月後又照了這張照片，

The question is: Why?

腫瘤又復發了。

The answer is tumor heterogeneity.

這不禁讓人思考為什麼 ？

Let me explain.

答案是「腫瘤異質性」。

Even a cancer as small as one centimeter in diameter

容我解釋。

harbors over a hundred million different cells.

就算癌細胞小到只有一公分的直徑，

While genetically similar,

也包含了上億種不同的細胞。

there are small differences in these different cancers

儘管有相似的基因，

that make them differently prone to different drugs.

不同的癌細胞有著微小的差異，

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

讓不同的藥適用不同癌細胞。

that kills almost all the cells,

所以就算有一種超級有效的藥，

there is a chance that there's a small population

幾乎能夠殺掉所有細胞，

that's resistant to the drug.

卻仍可能有一小叢細胞，

This ultimately is the population

對這種藥物是有抵抗力的。

that comes back,

這類細胞到最後，

and takes over the patient.

終究還是會復發，

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

在病人身體蔓延。

Well, the key, then,

所以問題是，對於這樣的資訊 我們能做些甚麼？

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

關鍵在於

as soon as we can,

加緊腳步將上述的醫療進展 及早應用於癌症治療。

before these resistance clones emerge.

且愈快愈好，

The key to cancer and curing cancer is early detection.

免得這些抗藥細胞植株出現。

And we intuitively know this.

治療癌症的關鍵是及早發現。

Finding cancer early results in better outcomes,

我們其實也知道，

and the numbers show this as well.

及早發現癌症 會有較好的治療結果，

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

這也受到研究數據證實。

only 17 percent of the women survive at five years.

以卵巢癌來說 若到第四期才偵測到癌細胞，

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

能存活五年的婦女只有 17%。

over 92 percent of women will survive.

但是若能在第一期就偵測到癌症，

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

有超過 92% 的婦女能存活下來。

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

令人難過的是只有 15% 的婦女 能在第一期偵測到癌症，

We desperately need better detection mechanisms for cancers.

絕大多數約七成的婦女 是在第三、四期才知道罹癌。

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

我們急需更好的癌症偵測機制。

First is medical procedures,

目前最佳的癌症偵測方式有三種。

which is like colonoscopy for colon cancer.

第一是醫療行為，

Second is protein biomarkers, like PSA for prostate cancer.

像是以結腸鏡檢測結腸癌。

Or third, imaging techniques,

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 。

such as mammography for breast cancer.

第三是醫學影像技術，

Medical procedures are the gold standard;

如偵測乳癌的乳房造影檢查。

however, they are highly invasive

醫療行為是黃金準則，

and require a large infrastructure to implement.

不過具高侵入性，

Protein markers, while effective in some populations,

需要推行大型的醫療設備。

are not very specific in some circumstances,

蛋白質生物標記對某些族群有效，

resulting in high numbers of false positives,

在有些情況下效果並不理想，

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

誤判的比例很高，

Imaging methods, while useful in some populations,

往往白費力氣和工夫。

expose patients to harmful radiation.

造影檢查對某些族群有效，

In addition, it is not applicable to all patients.

讓病人暴露在有害的放射線下，

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

也不適合所有病人。

So what we need is a method that is noninvasive,

例如乳房造影檢查 對有緻密乳房的婦女有一定難度，

that is light in infrastructure,

所以我們需要一種 不具侵入性的方法、

that is highly specific,

不需用到大型醫療設備、

that also does not have false positives,

具高特異性、

does not use any radiation

不會有誤判、

and is applicable to large populations.

不會用到放射線，

Even more importantly,

而且能適用於廣大族群。

we need a method to be able to detect cancers

更重要的是，

before they're 100 million cells in size.

我們需要的是 能夠偵測到癌細胞的方法，

Does such a technology exist?

尤其是在癌細胞數目 達到上億之前發現。

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

這樣的技術存在嗎？

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

如果沒有，我就不會站在這裡演講。

Central to our technology is a simple blood test.

我很高興將我們 最新發展的技術與各位分享。

The blood circulatory system, while seemingly mundane,

此項技術的核心是簡易的血液檢驗。

is essential for you to survive,

血液循環系統看似沒甚麼，

providing oxygen and nutrients to your cells,

對人類的生存卻至關重要，

and removing waste and carbon dioxide.

能為人體細胞提供氧氣和養分，

Here's a key biological insight:

移除廢物和二氧化碳。

Cancer cells grow and die faster than normal cells,

從生物觀點來說的關鍵是：

and when they die,

癌細胞的生長和死亡速度 比正常細胞來得快，

DNA is shed into the blood system.

當癌細胞死亡時，

Since we know the signatures of these cancer cells

DNA 會進入血液循環系統。

from all the different cancer genome sequencing projects,

我們從所有不同癌症的 基因組定序計畫中，

we can look for those signals in the blood

知曉了各種癌細胞的基因特點，

to be able to detect these cancers early.

我們便可從血液中尋找罹癌訊號，

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

好能及早偵測到癌症。

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

與其等到癌細胞 增殖並造成明顯症狀，

or for them to be prominent enough

或癌細胞密集到足以顯影，

for you to be able to visualize on medical procedures,

或讓癌細胞生長到足以

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

透過醫療行為目測到，

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

我們能在癌細胞 還未成氣候時開始進行偵測，

So let me tell you how we do this.

尋找血液中微量的 DNA。

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

跟大家解釋這如何進行。

no radiation, no complicated equipment --

先從簡易的血液檢驗開始，

a simple blood test.

不需放射線和複雜的設備，

Then the blood is shipped to us,

就是簡單的血液檢驗。

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

然後血液取樣運送到本團隊，

While your body is mostly healthy cells,

我們從血液中取出 DNA。

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

此時人體的細胞大多是健康的，

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

因此取得的 DNA 多是來自健康細胞。

that comes from the cancer cells.

但有不到 1% 的微量 DNA，

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

是來自癌細胞。

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

我們接著運用分子生物法，

based on the information from the cancer genomics projects.

根據從癌症基因組計劃獲得的信息，

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

富集此與癌細胞有關的 DNA。

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

我們將採得的 DNA 置入 DNA 定序儀器，

and have this final readout.

儀器將 DNA 數位化成 A、C、T 和 G 四種鹼基 ，

Ultimately, we have information of billions of letters

並進行資料分析。

that output from this run.

我們最後從儀器分析結果，

We then apply statistical and computational methods

得出數十億 DNA 符號的資訊。

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

研究團隊接著用 統計數據和電腦判讀，

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

藉以找出資料中，

So does this actually work in patients?

顯示血液中微量 DNA 癌細胞的微小訊息。

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

這技術對病患真的有用嗎？

which patients will get cancer,

由於目前還無法真正預測

we use the next best population:

哪個病人會罹癌，

cancers in remission;

適於此研究的最好族群是：

specifically, lung cancer.

癌症緩解期的病患，

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

更明確來說：肺癌。

most lung cancers come back.

令人難過的是就算使用最好的藥物，

The key, then, is to see

絕大多數的肺癌仍會復發。

whether we're able to detect these recurrences of cancers

接下來的關鍵是，

earlier than with standard methods.

我們是否能比一般方法

We just finished a major trial

更早偵測到癌細胞的復發。

with Professor Charles Swanton at University College London,

我們的團隊與倫敦學院大學

examining this.

查爾斯·史汪頓教授 剛完成一項主要試驗，

Let me walk you through an example of one patient.

檢驗這項技術。

Here's an example of one patient who undergoes surgery

讓我用一名病患來舉例說明。

at time point zero,

這名病患在研究的時間起始點，

and then undergoes chemotherapy.

接受手術，

Then the patient is under remission.

然後接受化療，

He is monitored using clinical exams and imaging methods.

接著病人進入癌症緩解期。

Around day 450, unfortunately, the cancer comes back.

團隊用臨床檢查和造影技術監測。

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

癌細胞不幸在第 450 天復發。

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

問題來了：我們能夠及早知道嗎？

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

在這段期間我們定期抽血，

So at the initial time point, as expected,

以測量血液循環腫瘤 DNA。

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

剛開始時不出所料，

However, this goes away to zero in subsequent time points

血液中有大量的癌細胞 DNA。

and remains negligible after subsequent points.

但是接下來癌細胞 DNA 消失 ，

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

又過一段時間後 僅剩微乎其微的癌細胞。

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

但是血液中癌細胞 DNA 的量 到第 340 天開始增加，

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

它在第 400 到 450 天數量更多了。

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

這裡就是關鍵，如果你沒有了解到。

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

在第 340 天我們看到 血液中癌細胞 DNA 的增加，

than traditional methods.

這代表我們比傳統方式 早了一百多天，

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

偵測到癌細胞。

a hundred days earlier where we can do surgical interventions,

也就是我們能提早 100 多天治療病人。

or even a hundred days less for the cancer to grow

能提早 100 多天進行手術，

or a hundred days less for resistance to occur.

讓癌症少 100 多天的時間生長，

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

讓癌細胞少 100 多天的時間復發。

We're really excited about this information.

對有些病人而言這 100 天 乃是生死交關的關鍵。

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

這消息令人振奮。

in other cancers,

也因此我們目前對其他癌症，

including breast cancer, lung cancer

進行更多的研究，

and ovarian cancer,

包括乳癌、肺癌，

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

和卵巢癌。

Ultimately, I have a dream,

我迫不及待想知道 我們能多早發現這些癌症。

a dream of two vials of blood,

我有個終極夢想。

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

兩小瓶的血液取樣，

we'll have two vials of blood drawn.

在未來將成為 健康檢查程序的一部分，

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

採取兩小瓶血液取樣。

the DNA from all known signatures of cancer,

從這兩瓶取樣我們可以比較

and hopefully then detect cancers months to even years earlier.

來自所有具癌症跡象的 DNA，

Even with the therapies we have currently,

希望能早幾個月 甚至幾年偵測到癌症。

this could mean that millions of lives could be saved.

就算以我們現有的治療方式，

And if you add on to that recent advancements in immunotherapy

提早發現癌症代表 能拯救上百萬的生命。

and targeted therapies,

若加上近期的免疫療法的進步，

the end of cancer is in sight.

以及標靶式治療的進步，

The next time you hear the word "cancer,"

終結癌症就近在咫尺。

I want you to add to the emotions: hope.

下次當你聽到「癌症」一詞，

Hold on.

我期許各位也能想到「希望」，

Cancer researchers all around the world are working feverishly

永不放棄。

to beat this disease,

全球的癌症研究人員正積極努力，

and tremendous progress is being made.

期能戰勝癌症，

This is the beginning of the end.

也已有重大的進展。

We will win the war on cancer.

這是癌症之終結的開端，