x
這系列的第一集，我們講解了PD1/PDL1的運作原理。596Please respect copyright.ＰＥＮＡＮＡ6m78BE5RKy
Link: https://www.penana.com/article/471125596Please respect copyright.ＰＥＮＡＮＡTb3UtFIcOL
596Please respect copyright.ＰＥＮＡＮＡJZn1MovGMY
第二集我們講述CTLA4與T cell功用的關係。596Please respect copyright.ＰＥＮＡＮＡi2zYSGLHSJ
Link:https://www.penana.com/article/472480596Please respect copyright.ＰＥＮＡＮＡqhbwYNnQAt
596Please respect copyright.ＰＥＮＡＮＡDj3QrX8ZHF
第三集我們講述增加T cell順利到達癌細胞位置的其中一種手段。596Please respect copyright.ＰＥＮＡＮＡDXUI4vzhGG
https://www.penana.com/article/479229596Please respect copyright.ＰＥＮＡＮＡJOPMckvxjP
596Please respect copyright.ＰＥＮＡＮＡbX9SryXkJk
而這一集我們將講解一道關於檢測阻擋PD1的抗體Pembrolizumab成效的研究。596Please respect copyright.ＰＥＮＡＮＡLFNWz75gnk
596Please respect copyright.ＰＥＮＡＮＡuVUsywKjb2
596Please respect copyright.ＰＥＮＡＮＡTSTSENrGnM
關於阻檔PD1的原理及初心，可參閱第一集，其後可直接跳過第二第三集來到第四集本集。596Please respect copyright.ＰＥＮＡＮＡEGlMOrkNxG
596Please respect copyright.ＰＥＮＡＮＡK1RPd2m4vW
596Please respect copyright.ＰＥＮＡＮＡp8LoxTjNDh
596Please respect copyright.ＰＥＮＡＮＡoPxeTGlfIc
（圖2）現今約只有20%的病人能夠從免疫治療中獲取長遠且持續的正面效果。596Please respect copyright.ＰＥＮＡＮＡM0m6FA8kYx
596Please respect copyright.ＰＥＮＡＮＡFlWtb6MHcW
596Please respect copyright.ＰＥＮＡＮＡirjvLUAUyE
其有效的程度實屬可圈可點，如果有方法能夠盡快得知免疫治療沒有預期成效的話，那就可以即時轉用其他治療手段，把握時候嘗試用第二種方法入手打擊癌症。596Please respect copyright.ＰＥＮＡＮＡXvNTj4tz4F
596Please respect copyright.ＰＥＮＡＮＡQ2aoQFeC03
對此，有科學家嘗試量度血液中癌細胞的DNA含量，觀察能否藉此方法預判免疫治療的效果（Ref1)。596Please respect copyright.ＰＥＮＡＮＡmllbZ7EouR
596Please respect copyright.ＰＥＮＡＮＡkz0E9VY5xu
596Please respect copyright.ＰＥＮＡＮＡj9KEU1qb3n
(圖3）癌細胞DNA之所以會出現在血液中，主要由兩大途徑所成。596Please respect copyright.ＰＥＮＡＮＡ0zWNlZEneG
596Please respect copyright.ＰＥＮＡＮＡDfYceyjzjO
596Please respect copyright.ＰＥＮＡＮＡxH8SVzxSFB
1.癌細胞會利用血液循環系統或者淋巴系統轉移到第二個位置，596Please respect copyright.ＰＥＮＡＮＡB1IC6Uks8C
因此血液會有癌細胞的DNA。596Please respect copyright.ＰＥＮＡＮＡZVobGXQHGs
596Please respect copyright.ＰＥＮＡＮＡyiZXiWXPEP
2.癌細胞亦會往外釋出名Exosome的物質，裡頭亦含有癌細胞的DNA。596Please respect copyright.ＰＥＮＡＮＡkiFZuULjq1
596Please respect copyright.ＰＥＮＡＮＡv8JOde9z5V
在這裡，我們暫稱癌細胞在血液中的DNA為ctDNA，Circulating Tumor DNA。596Please respect copyright.ＰＥＮＡＮＡPwwmW8yA0m
596Please respect copyright.ＰＥＮＡＮＡnzn9JYCYyl
（圖4）圖中為利用阻擋PD1的抗體Pembrolizumab作治療的兩名病人結果。596Please respect copyright.ＰＥＮＡＮＡlQTpn0TVRG
596Please respect copyright.ＰＥＮＡＮＡ1PcXagKbgk
596Please respect copyright.ＰＥＮＡＮＡ3eIo4ssgXu
紅線為電腦斷層掃描觀察癌細胞大小的影像，而黑線為量度癌細胞在血液(ctDNA)的含量，可見黑線(量度ctDNA的含量)能夠更快預判免疫治療結果成效。596Please respect copyright.ＰＥＮＡＮＡTslow42gBe
596Please respect copyright.ＰＥＮＡＮＡiqlbqsRR8H
而且，有另外10名接受免疫治療的病人在初期(服用藥物後6-7星期)錄得ctDNA完全下降，亦同樣能夠比電腦斷層掃描觀察更早一步預判成效。596Please respect copyright.ＰＥＮＡＮＡbYtEflTaoJ
596Please respect copyright.ＰＥＮＡＮＡMXFzOUdrwD
而研究中有45名免疫治療的病人在初期沒有錄得任何的ctDNA跌幅，癌細胞的體積在其後亦沒有明顯縮細。596Please respect copyright.ＰＥＮＡＮＡdYy3xmnwJp
596Please respect copyright.ＰＥＮＡＮＡpyooRwm4m9
596Please respect copyright.ＰＥＮＡＮＡg7rFq9pBK2
對比含放射性的電腦斷層掃描，量度血液的ctDNA只需抽取病人的血液便可，明顯簡單且快捷。596Please respect copyright.ＰＥＮＡＮＡcjZlrcvy84
只不過每名病人的ctDNA排組均不一樣，先前需要拿取部份癌細胞組織，才能夠有效設計檢測ctDNA的方針。596Please respect copyright.ＰＥＮＡＮＡtywTYUZIuU
596Please respect copyright.ＰＥＮＡＮＡRDO0veN9O4
無論如何，若然日後能有研究進一步確立此方法的成效及可信性，定必大可增加對抗癌症的效益。596Please respect copyright.ＰＥＮＡＮＡKP600gERQ2
596Please respect copyright.ＰＥＮＡＮＡHNy96LUFPJ
另一方面，透過檢測血液的DNA來預先得知癌細胞的存在，亦是日後檢驗及預防癌症的主流大方向。596Please respect copyright.ＰＥＮＡＮＡbb9mB0NesS
596Please respect copyright.ＰＥＮＡＮＡX8Xxr4HhVP
如果想我快啲出文的話，請入去Penana網站科普專欄–薯不揀單俾一個like以及Bookmark，這對我非常之重要。596Please respect copyright.ＰＥＮＡＮＡEvnZNGRCrJ
596Please respect copyright.ＰＥＮＡＮＡ0pdt9UX8fq
Link: https://www.penana.com/story/66244/%E7%A7%91%E6%99%AE%E5%B0%88%E6%AC%84-%E8%96%AF%E4%B8%8D%E6%8F%80%E5%96%AE/toc596Please respect copyright.ＰＥＮＡＮＡHDcpGFOCxy
596Please respect copyright.ＰＥＮＡＮＡ0sW6UFNZcA
同時亦可以在Penana網站裡按「買一嚿/半嚿薯仔」，以課金的方式推動我繼續搜羅資料寫文，多謝。596Please respect copyright.ＰＥＮＡＮＡ8u45ikYxzE
596Please respect copyright.ＰＥＮＡＮＡXf1gPGMzxQ
Link:596Please respect copyright.ＰＥＮＡＮＡES4boNVtCP
https://www.penana.com/user/27349/%E8%96%AF%E4%BB%94%E8%81%9E%E8%8C%B1%E8%8E%89/portfolio596Please respect copyright.ＰＥＮＡＮＡ6V40lAuEV9
596Please respect copyright.ＰＥＮＡＮＡEQHSXSdgel
596Please respect copyright.ＰＥＮＡＮＡ0wmn2A0Ayu
有興趣接收科學資訊的話，歡迎follow IG: potatopigtongue。596Please respect copyright.ＰＥＮＡＮＡJmECDuDHlD
596Please respect copyright.ＰＥＮＡＮＡzWq3gYnviL
https://www.instagram.com/potatopigtongue/596Please respect copyright.ＰＥＮＡＮＡrIP3UdNqh2
596Please respect copyright.ＰＥＮＡＮＡP3V0mKu3HX
596Please respect copyright.ＰＥＮＡＮＡkXMyEarlAw
Ref1:https://www.nature.com/articles/s43018-020-009596Please respect copyright.ＰＥＮＡＮＡd8EmyLAIg3
