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這系列的第一集，我們講解了PD1/PDL1的運作原理。739Please respect copyright.ＰＥＮＡＮＡeHderMGViL
Link: https://www.penana.com/article/471125739Please respect copyright.ＰＥＮＡＮＡtwaI9XfdfC
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第二集我們講述CTLA4與T cell功用的關係。739Please respect copyright.ＰＥＮＡＮＡhLgc0opdt8
Link:https://www.penana.com/article/472480739Please respect copyright.ＰＥＮＡＮＡss1qKDLqMG
739Please respect copyright.ＰＥＮＡＮＡt5HIu0DEuy
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。739Please respect copyright.ＰＥＮＡＮＡp0avunyGKf
https://www.penana.com/article/479229739Please respect copyright.ＰＥＮＡＮＡCY34xrRebe
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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。739Please respect copyright.ＰＥＮＡＮＡiIGan1lHYv
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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。739Please respect copyright.ＰＥＮＡＮＡF10pQyPzJs
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（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。739Please respect copyright.ＰＥＮＡＮＡhXDd2ssrvn
739Please respect copyright.ＰＥＮＡＮＡxwId1BbJ9I
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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。739Please respect copyright.ＰＥＮＡＮＡgW3iFuiOpu
739Please respect copyright.ＰＥＮＡＮＡEUux1gOcQI
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)。739Please respect copyright.ＰＥＮＡＮＡUwFaYPvBjJ
739Please respect copyright.ＰＥＮＡＮＡRaQgCHRVWv
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(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。739Please respect copyright.ＰＥＮＡＮＡpspqfNMpgn
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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，739Please respect copyright.ＰＥＮＡＮＡS9MvR0ulef
因此血液會有癌細胞的DNA。739Please respect copyright.ＰＥＮＡＮＡID34OinR5e
739Please respect copyright.ＰＥＮＡＮＡCvGp88FnQc
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。739Please respect copyright.ＰＥＮＡＮＡiE0gttfFpz
739Please respect copyright.ＰＥＮＡＮＡOx2MJsL2oi
在這裡，我們暫稱癌細胞在血液中的DNA為ctDNA，Circulating Tumor DNA。739Please respect copyright.ＰＥＮＡＮＡYfKLRcRmnt
739Please respect copyright.ＰＥＮＡＮＡFaFp78ID2w
（圖4）圖中為利用阻擋PD1的抗體Pembrolizumab作治療的兩名病人結果。739Please respect copyright.ＰＥＮＡＮＡDLaX4FEAgC
739Please respect copyright.ＰＥＮＡＮＡYQEXA9W1rz
739Please respect copyright.ＰＥＮＡＮＡ3LpiJ3gcCK
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。739Please respect copyright.ＰＥＮＡＮＡl5cAx23zRr
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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。739Please respect copyright.ＰＥＮＡＮＡQ8dBsGsPEt
739Please respect copyright.ＰＥＮＡＮＡlNCmmFTphM
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。739Please respect copyright.ＰＥＮＡＮＡ2lRqP037vJ
739Please respect copyright.ＰＥＮＡＮＡliIVEMuDy4
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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。739Please respect copyright.ＰＥＮＡＮＡtNXVjfWbCf
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。739Please respect copyright.ＰＥＮＡＮＡG2Hf5qC2Zc
739Please respect copyright.ＰＥＮＡＮＡXY7mZmYOyu
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。739Please respect copyright.ＰＥＮＡＮＡBTTZjLXQtl
739Please respect copyright.ＰＥＮＡＮＡ6tGVIJR0Rf
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。739Please respect copyright.ＰＥＮＡＮＡwwogaIvyZR
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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。739Please respect copyright.ＰＥＮＡＮＡkUw6iAxbTi
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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/toc739Please respect copyright.ＰＥＮＡＮＡyAYNJcAywx
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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。739Please respect copyright.ＰＥＮＡＮＡ5pgYvQ3bUL
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Link:739Please respect copyright.ＰＥＮＡＮＡP8xahJMlAF
https://www.penana.com/user/27349/%E8%96%AF%E4%BB%94%E8%81%9E%E8%8C%B1%E8%8E%89/portfolio739Please respect copyright.ＰＥＮＡＮＡ32fbblgzWI
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有興趣接收科學資訊的話，歡迎follow IG: potatopigtongue。739Please respect copyright.ＰＥＮＡＮＡ1Lfzr8khmR
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https://www.instagram.com/potatopigtongue/739Please respect copyright.ＰＥＮＡＮＡs0FEyZKUG9
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Ref1:https://www.nature.com/articles/s43018-020-009739Please respect copyright.ＰＥＮＡＮＡGZlFG7thaa
