x
這系列的第一集，我們講解了PD1/PDL1的運作原理。778Please respect copyright.ＰＥＮＡＮＡ5r0HQygFZR
Link: https://www.penana.com/article/471125778Please respect copyright.ＰＥＮＡＮＡEao7eKR6pF
778Please respect copyright.ＰＥＮＡＮＡ3TsRhQS9IX
第二集我們講述CTLA4與T cell功用的關係。778Please respect copyright.ＰＥＮＡＮＡeG6gLbZXyo
Link:https://www.penana.com/article/472480778Please respect copyright.ＰＥＮＡＮＡiQJnGPL71D
778Please respect copyright.ＰＥＮＡＮＡfj0PdImoIP
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。778Please respect copyright.ＰＥＮＡＮＡfcpc1t8GRh
https://www.penana.com/article/479229778Please respect copyright.ＰＥＮＡＮＡtX0bLTEqlv
778Please respect copyright.ＰＥＮＡＮＡ7uL0HgPcLr
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。778Please respect copyright.ＰＥＮＡＮＡc0LRPnvwwn
778Please respect copyright.ＰＥＮＡＮＡcWjFE6CHTN
778Please respect copyright.ＰＥＮＡＮＡbpwKkPNcoG
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。778Please respect copyright.ＰＥＮＡＮＡaggMehiuIQ
778Please respect copyright.ＰＥＮＡＮＡKd0Xcy5DgY
778Please respect copyright.ＰＥＮＡＮＡ2u8tMCrdol
778Please respect copyright.ＰＥＮＡＮＡVnFsS0MbDt
（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。778Please respect copyright.ＰＥＮＡＮＡo0Q1NCwjoJ
778Please respect copyright.ＰＥＮＡＮＡXYoV28B2as
778Please respect copyright.ＰＥＮＡＮＡZiLR6YXfQ3
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。778Please respect copyright.ＰＥＮＡＮＡbNG68deYpB
778Please respect copyright.ＰＥＮＡＮＡvuHkSGs1ga
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)。778Please respect copyright.ＰＥＮＡＮＡePqMB2yQN9
778Please respect copyright.ＰＥＮＡＮＡijdY4n7TOk
778Please respect copyright.ＰＥＮＡＮＡC6lPXBnLZf
(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。778Please respect copyright.ＰＥＮＡＮＡogrnQLVelw
778Please respect copyright.ＰＥＮＡＮＡJRplGJoZFF
778Please respect copyright.ＰＥＮＡＮＡVSk4fBXwO5
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，778Please respect copyright.ＰＥＮＡＮＡjqKWaTmnrw
因此血液會有癌細胞的DNA。778Please respect copyright.ＰＥＮＡＮＡ7epevp2RvA
778Please respect copyright.ＰＥＮＡＮＡ6QaEwAV8Bi
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。778Please respect copyright.ＰＥＮＡＮＡq4Orcz2jPr
778Please respect copyright.ＰＥＮＡＮＡzmf8JFAKMf
在這裡，我們暫稱癌細胞在血液中的DNA為ctDNA，Circulating Tumor DNA。778Please respect copyright.ＰＥＮＡＮＡ2B4cPYltV7
778Please respect copyright.ＰＥＮＡＮＡgfU8Qtp2xS
（圖4）圖中為利用阻擋PD1的抗體Pembrolizumab作治療的兩名病人結果。778Please respect copyright.ＰＥＮＡＮＡh5Mt6VDXrH
778Please respect copyright.ＰＥＮＡＮＡhXRTkuTs6F
778Please respect copyright.ＰＥＮＡＮＡBfdvcoovxK
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。778Please respect copyright.ＰＥＮＡＮＡ8cbqPDiWZE
778Please respect copyright.ＰＥＮＡＮＡA3nXE1ojR0
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。778Please respect copyright.ＰＥＮＡＮＡ68BoCkiAY8
778Please respect copyright.ＰＥＮＡＮＡ6mZQLWIv6x
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。778Please respect copyright.ＰＥＮＡＮＡahAKYKrQaT
778Please respect copyright.ＰＥＮＡＮＡvxzVHjgUeK
778Please respect copyright.ＰＥＮＡＮＡTBRrRyGuue
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。778Please respect copyright.ＰＥＮＡＮＡrNR59jLDeT
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。778Please respect copyright.ＰＥＮＡＮＡVj8Hg6A2Hp
778Please respect copyright.ＰＥＮＡＮＡ9QIkvgcME7
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。778Please respect copyright.ＰＥＮＡＮＡz2pYYf8JbM
778Please respect copyright.ＰＥＮＡＮＡQ5F6VbjgRx
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。778Please respect copyright.ＰＥＮＡＮＡqXbfTPjFyi
778Please respect copyright.ＰＥＮＡＮＡO5E32pwFoB
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。778Please respect copyright.ＰＥＮＡＮＡVJjo4mOLQO
778Please respect copyright.ＰＥＮＡＮＡ4ArCYxiMXI
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/toc778Please respect copyright.ＰＥＮＡＮＡ66Aq5wtNjM
778Please respect copyright.ＰＥＮＡＮＡfFEHAlxFGJ
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。778Please respect copyright.ＰＥＮＡＮＡ2i9JmK7Da8
778Please respect copyright.ＰＥＮＡＮＡJUKtiNZpFD
Link:778Please respect copyright.ＰＥＮＡＮＡlhcczFytnI
https://www.penana.com/user/27349/%E8%96%AF%E4%BB%94%E8%81%9E%E8%8C%B1%E8%8E%89/portfolio778Please respect copyright.ＰＥＮＡＮＡ1IYZWuRAin
778Please respect copyright.ＰＥＮＡＮＡgJEO8kHVlT
778Please respect copyright.ＰＥＮＡＮＡjEXIJKtEI1
有興趣接收科學資訊的話，歡迎follow IG: potatopigtongue。778Please respect copyright.ＰＥＮＡＮＡdpw8v1fkBt
778Please respect copyright.ＰＥＮＡＮＡDnGtMXLxPf
https://www.instagram.com/potatopigtongue/778Please respect copyright.ＰＥＮＡＮＡEBcjKuBhfV
778Please respect copyright.ＰＥＮＡＮＡilBgD4G4d3
778Please respect copyright.ＰＥＮＡＮＡIVBJQ9BLqZ
Ref1:https://www.nature.com/articles/s43018-020-009778Please respect copyright.ＰＥＮＡＮＡN5rwSRrU3c
