x
這系列的第一集，我們講解了PD1/PDL1的運作原理。745Please respect copyright.ＰＥＮＡＮＡeVRP2qThW4
Link: https://www.penana.com/article/471125745Please respect copyright.ＰＥＮＡＮＡzqosp0aRXx
745Please respect copyright.ＰＥＮＡＮＡAyPYm9Dfkr
第二集我們講述CTLA4與T cell功用的關係。745Please respect copyright.ＰＥＮＡＮＡfPWoUyskCq
Link:https://www.penana.com/article/472480745Please respect copyright.ＰＥＮＡＮＡTjGaM0XgFu
745Please respect copyright.ＰＥＮＡＮＡ6pnUmUbWMN
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。745Please respect copyright.ＰＥＮＡＮＡwzbnMP6XVF
https://www.penana.com/article/479229745Please respect copyright.ＰＥＮＡＮＡ9WttFP15Z0
745Please respect copyright.ＰＥＮＡＮＡsMvDP5JRkG
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。745Please respect copyright.ＰＥＮＡＮＡkYVusFKw8u
745Please respect copyright.ＰＥＮＡＮＡjQICV1YAoc
745Please respect copyright.ＰＥＮＡＮＡMI75DgFTA9
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。745Please respect copyright.ＰＥＮＡＮＡBEjbUuLS4I
745Please respect copyright.ＰＥＮＡＮＡ2fiZxqJQGZ
745Please respect copyright.ＰＥＮＡＮＡvgftHRZDIi
745Please respect copyright.ＰＥＮＡＮＡuvIvx30rji
（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。745Please respect copyright.ＰＥＮＡＮＡVXEIbaXWNv
745Please respect copyright.ＰＥＮＡＮＡCFFAb8HWyL
745Please respect copyright.ＰＥＮＡＮＡbvmAP4E10d
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。745Please respect copyright.ＰＥＮＡＮＡejfZSyyRx8
745Please respect copyright.ＰＥＮＡＮＡrsM2Z5ZKiw
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)。745Please respect copyright.ＰＥＮＡＮＡNfdetDymCX
745Please respect copyright.ＰＥＮＡＮＡjneE305DYr
745Please respect copyright.ＰＥＮＡＮＡ6yjltSeQzR
(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。745Please respect copyright.ＰＥＮＡＮＡUWItKYdyv9
745Please respect copyright.ＰＥＮＡＮＡ9yBBn2G7Tt
745Please respect copyright.ＰＥＮＡＮＡiCXhAsMJyT
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，745Please respect copyright.ＰＥＮＡＮＡyrMss8H0i9
因此血液會有癌細胞的DNA。745Please respect copyright.ＰＥＮＡＮＡIi8ONbTt49
745Please respect copyright.ＰＥＮＡＮＡ1DFTrjxFYI
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。745Please respect copyright.ＰＥＮＡＮＡYIt4L3xvus
745Please respect copyright.ＰＥＮＡＮＡMHPRbNNfef
在這裡，我們暫稱癌細胞在血液中的DNA為ctDNA，Circulating Tumor DNA。745Please respect copyright.ＰＥＮＡＮＡWIvleBCg3Q
745Please respect copyright.ＰＥＮＡＮＡly4j33LiTU
（圖4）圖中為利用阻擋PD1的抗體Pembrolizumab作治療的兩名病人結果。745Please respect copyright.ＰＥＮＡＮＡQ7emuEeyiI
745Please respect copyright.ＰＥＮＡＮＡ5PEk3z2mvA
745Please respect copyright.ＰＥＮＡＮＡMCkQWpAcvJ
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。745Please respect copyright.ＰＥＮＡＮＡMMy9bGM58Z
745Please respect copyright.ＰＥＮＡＮＡqE7kTD1IQV
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。745Please respect copyright.ＰＥＮＡＮＡQq5wswtVym
745Please respect copyright.ＰＥＮＡＮＡ3SzbrNf1cM
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。745Please respect copyright.ＰＥＮＡＮＡ28Hve0DVXI
745Please respect copyright.ＰＥＮＡＮＡIKClh5uD5g
745Please respect copyright.ＰＥＮＡＮＡjqABpWplDr
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。745Please respect copyright.ＰＥＮＡＮＡix1HtOUvjh
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。745Please respect copyright.ＰＥＮＡＮＡzITlIhQ7uX
745Please respect copyright.ＰＥＮＡＮＡTnrKKLSrSA
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。745Please respect copyright.ＰＥＮＡＮＡkfD7sb6CP0
745Please respect copyright.ＰＥＮＡＮＡ8laDIw1Il1
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。745Please respect copyright.ＰＥＮＡＮＡgYI6BbQjRW
745Please respect copyright.ＰＥＮＡＮＡgJEBip5gsP
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。745Please respect copyright.ＰＥＮＡＮＡFK4iAmtRbu
745Please respect copyright.ＰＥＮＡＮＡegZ0cps2pY
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/toc745Please respect copyright.ＰＥＮＡＮＡy8QiTqxGRh
745Please respect copyright.ＰＥＮＡＮＡPpKMIgDN8K
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。745Please respect copyright.ＰＥＮＡＮＡGgcqTaVLfe
745Please respect copyright.ＰＥＮＡＮＡaoumzyTAZ2
Link:745Please respect copyright.ＰＥＮＡＮＡiVp9gAO2yP
https://www.penana.com/user/27349/%E8%96%AF%E4%BB%94%E8%81%9E%E8%8C%B1%E8%8E%89/portfolio745Please respect copyright.ＰＥＮＡＮＡQT3LFjB0s7
745Please respect copyright.ＰＥＮＡＮＡQMuRVUOwkg
745Please respect copyright.ＰＥＮＡＮＡ4TvcD7eJQb
有興趣接收科學資訊的話，歡迎follow IG: potatopigtongue。745Please respect copyright.ＰＥＮＡＮＡuQHWFybODO
745Please respect copyright.ＰＥＮＡＮＡYdfD1S7X3u
https://www.instagram.com/potatopigtongue/745Please respect copyright.ＰＥＮＡＮＡdqjBT1c8J7
745Please respect copyright.ＰＥＮＡＮＡ2AMNVGXVKM
745Please respect copyright.ＰＥＮＡＮＡ6PD3Z15RMy
Ref1:https://www.nature.com/articles/s43018-020-009745Please respect copyright.ＰＥＮＡＮＡr1cV9j3oTL
