被诊断患有肺癌六周后,凯里(Kellie Carey)的医生终于不再回避有关她还能活多久的问题。凯里回忆起当时的情景。2010年5月一个阳光明媚的早晨,这位医生在他的办公室告诉她,也许三个月。
Kellie Carey's doctor finally stopped dodging questions about how long she had to live six weeks after he diagnosed her lung cancer.
然而她现在依然活着。这也证明长期以来科学界抗击肺癌的努力在这10年里取得了长足的进步。
'Maybe three months,' he told her in his office one sunny May morning in 2010, she recalls.
检查发现,凯里的肺癌属于一种罕见类型,研究人员在三年前刚刚通过破解基因编码的方式发现这种癌症的存在。这位45岁的女商人在2010年开始接受辉瑞制药有限公司(Pfizer Inc., 简称:辉瑞公司)一个针对这种肺癌的药物临床试验。她的医生们说,这个药专门针对她的癌症,与进行化疗相比,服用这个药可能会使她的生命延长更多年。
此事意义重大,因为数十年来旨在找到能使肺癌患者寿命平均延长区区数周的药物的努力都无一成功。
Yet she is still alive, a
testament to the most
extraordinarydecade of progress ever in the long
scientific struggle against lung cancer.
但是在有关导致形成肿瘤的基因突变的知识出现爆炸式增长后,如今首次有望研制出可以控制这种最常见也最致命的癌症的药物。
凯里患的是至少15个肺癌变种中的一种,10年前这些变种对科学家来说几乎都闻所未闻。研究人员通过破译肿瘤DNA编码已经识别出这些肺癌变种,其中大多数是在四年前刚刚被发现的,这种识别方法类似于罪证实验室通过分析DNA来从基因方面锁定嫌犯的做法。
Tests found Ms. Carey's lung
cancer to be of a rare type that researchers had found just three years earlier by deciphering its genetic code. The 45-year-old businesswoman in 2010 went on a drug Pfizer Inc. was testing for that type. By pinpointing her cancer, the drug probably helped give her years more to live than chemotherapy would have, her doctors say.
这些肺癌变种被发现后,主要癌症中心纷纷修改其治疗癌症的方法,制药公司则争先恐后的研制针对每一种肺癌变种的药物。
这些药物不能治愈癌症,并且面临一着些重大阻碍。但医生们现在开始谈论一种"精准施药"疗法,在这种疗法中,这些有针对性的药物对肿瘤的疗效远远好于以一治百的化疗。
That is
remarkable because lung
cancer for decades defied efforts to find drugs that could extend an average patient's life by even a few weeks.
美国食品和药物管理局 (Food and Drug Administration, 简称FDA)的药品评估与研究中心主管伍德科克(Janet Woodcock)说,我们看到的是一场癌症疗法革命的开始,我们只能希望,这场革命能够让我们达到控制或者治愈癌症的水平。
在显示这场革命的确已经开始的迹象中,2013年6月份研究发现,如果使用有针对性(即针对他们患上的已通过基因识别出的肺癌变种)的药物,肺癌患者的寿命比那些接受化疗的肺癌患者(他们患的肺癌未经过基因识别)长1.4年。
But an
explosion in knowledge about the genetic mutations that cause tumors is just now
offering the first real promise of drugs that can control what is the most-common and most-deadly cancer.
实际上,所谓肺癌已不再是少数几种常见的诊断疾病,而是一个在不断扩大的罕见癌症列表,每种肺癌都需要专门针对它的药物疗法。
休斯敦安德森癌症中心(MD Anderson Cancer Center)的肺癌专家海马赫(John V. Heymach)说,可能有超过半数的肿瘤都有一些变种可以让我们有针对性地使用药物,它们可能不会都获得成功,但我们知道在许多情况下,使用有针对性的药剂能取得非常好的疗效。
Ms. Carey has one of at least 15 lung-cancer variations, almost all of which scientists didn't know existed 10 years ago. Researchers have identified those variations, most of them in just the past four years, by decoding DNA in tumors--akin to how crime labs analyze DNA to genetically fingerprint suspects.
其他恶性肿瘤也是如此,近几年科学家们已经破译了乳腺癌、结肠癌、肾癌和皮肤癌等癌症的肿瘤DNA,发现了许多他们此前并不知道的癌症变种。
安德森癌症中心、范德堡大学(Vanderbilt University)和麻省综合医院(Massachusetts General Hospital)等越来越多的研究医院将破译肿瘤DNA列为大多数晚期癌症患者的常规检查项目。
The newfound variants have led major
cancer centers to revamp their approach to treating
cancer and have spurred a rush among drug companies to find medicines that
narrowly target each one.
新发现的癌症变种名单激励了制药行业。辉瑞公司、罗氏公司(Roche Holding Ag)和默克公司(Merck & Co. Inc.)争相研发针对每一种癌症变种的药物。
美国药物研究和生产商协会(Pharmaceutical Research and Manufacturers of America)说,去年,近1,000种癌症药物进入临床研发阶段,数量较2006年增长了52%。该组织的科学和监管事务负责人金(Bill Chin)说,大多数增幅来自于针对癌症变种的药物。
The drugs don't cure
cancer and face
significant hurdles. But doctors now talk of a 'precision medicine' approach in which those pinpoint drugs can treat tumors far more
effectively than catchall chemotherapy.
有三种针对新发现的肺癌变种的药品已上市销售。还有许多药品在临床试验阶段。一些被批准用于其它癌症的药品似乎对一些肺癌变种也有疗效。制药公司还在研制针对所有癌症变种的药品。
诺华制药公司(Novartis AG)正在临床研发阶段的27种肿瘤治疗药中至少有一半是针对癌症变种的。该公司旗下Novartis Oncology的总裁奥普诺(Herve Hoppenot)说,精准施药从根本上改变了我们考虑癌症药物研发的方式。
'What we're
seeing is the
beginning of a revolution in therapeutics,' says Janet Woodcock,
director of the Food and Drug Administration's Center for Drug Evaluation and Research. 'We can only hope that this gets us to where
cancer is managed or curable.'
去年6月份,FDA建立了一个"突破性疗法认定"资格,以加快审批那些在实验初期表现出显著疗效的实验药物,这其中就包括那些针对癌症变种的药品。
Ron Winslow
Among signs that revolution really is afoot: A June 2013 study found that lung-cancer patients who were treated with drugs targeted at their genetically identified varieties lived 1.4 years longer than patients on chemotherapy whose cancers weren't genetically identified.
In effect, lung
cancer is no longer a few common diagnoses. Instead, it is a growing list of rare cancers, each a target for its own drug regimen.
'It's likely that more than half of tumors have some
alteration we can target with a drug,' says John V. Heymach, a lung-cancer
specialist at MD Anderson Cancer Center, Houston. 'They may not all have the same success, but we know that in many cases, a targeted agent will work very well.'
The same goes for other malignancies: Scientists have decoded tumor DNA from breast, colon, kidney, skin and other cancers in recent years to discover scores of variations they didn't know existed before.
Research hospitals like MD Anderson, Vanderbilt University and Massachusetts General Hospital are among a growing number of
cancer practices that routinely decode the tumor DNA of most patients with
advanced cancer.
The lists of newfound variations have invigorated the drug industry, with companies like Pfizer, Roche Holding AG and Merck & Co. racing to develop drugs that target each one.
Last year, nearly 1,000
cancer drugs were in clinical development, up 52% from 2006, says the Pharmaceutical Research and Manufacturers of America, a trade group. The 'vast majority' of that growth is from drugs targeted at genetic mutations, says Bill Chin, the group's head of science and regulatory affairs.
Three drugs are on the market for newly discovered lung-cancer mutations. Dozens more are in clinical trials. Some approved for other cancers appear
effective for
specific lung cancers. And drug companies are targeting other mutations of all
cancer types.
At least half the 27 medicines on Novartis AG's current list of oncology drugs in clinical development target
cancer mutations. Precision medicine is 'fundamentally changing the way we think about
cancer drug development,' says Hervé Hoppenot, president of the company's Novartis Oncology unit.
Just last year, the FDA established a 'breakthrough therapy designation' to
hastenapproval of
experimental drugs that show
striking benefits in early trials, including those targeted at
cancer mutations.
Ron Winslow