這系列的第一集，我們講解了PD1/PDL1的運作原理。798Please respect copyright.ＰＥＮＡＮＡtP9nIjFkVt
Link: https://www.penana.com/article/471125798Please respect copyright.ＰＥＮＡＮＡNnxlu0Gnm5
798Please respect copyright.ＰＥＮＡＮＡKsTdGqdIA9
第二集我們講述CTLA4與T cell功用的關係。798Please respect copyright.ＰＥＮＡＮＡJR1lMgdvW8
Link:https://www.penana.com/article/472480798Please respect copyright.ＰＥＮＡＮＡLaFvrROGdA
798Please respect copyright.ＰＥＮＡＮＡbJiBdhDPa5
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。798Please respect copyright.ＰＥＮＡＮＡejj1dP5odD
https://www.penana.com/article/479229798Please respect copyright.ＰＥＮＡＮＡkUfj3Ak8yq
798Please respect copyright.ＰＥＮＡＮＡKT9iGajEO5
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。798Please respect copyright.ＰＥＮＡＮＡ710QnAUNuX
798Please respect copyright.ＰＥＮＡＮＡSNsLcqZWTr
798Please respect copyright.ＰＥＮＡＮＡ0dGtJHezFG
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。798Please respect copyright.ＰＥＮＡＮＡ05Jy2IOa05
798Please respect copyright.ＰＥＮＡＮＡknkCFZK26S
798Please respect copyright.ＰＥＮＡＮＡFBXuTQB593
798Please respect copyright.ＰＥＮＡＮＡ60mEzjYhrS
（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。798Please respect copyright.ＰＥＮＡＮＡGyGCeFCWz7
798Please respect copyright.ＰＥＮＡＮＡuFaEsDh1wf
798Please respect copyright.ＰＥＮＡＮＡ5bx9EpzctH
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。798Please respect copyright.ＰＥＮＡＮＡ7dqpQHHD9w
798Please respect copyright.ＰＥＮＡＮＡHyrMHTxl45
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)。798Please respect copyright.ＰＥＮＡＮＡEer6aPHk7c
798Please respect copyright.ＰＥＮＡＮＡxIpI2mZ9MD
798Please respect copyright.ＰＥＮＡＮＡpYSodkWa0D
(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。798Please respect copyright.ＰＥＮＡＮＡW5SxrIMYDN
798Please respect copyright.ＰＥＮＡＮＡWdDFuEynNR
798Please respect copyright.ＰＥＮＡＮＡMKNHZqYS9c
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，798Please respect copyright.ＰＥＮＡＮＡJpWMHADlBE
因此血液會有癌細胞的DNA。798Please respect copyright.ＰＥＮＡＮＡwdAhR2Cyq3
798Please respect copyright.ＰＥＮＡＮＡse4EW9qaWo
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。798Please respect copyright.ＰＥＮＡＮＡFzL19QL3kG
798Please respect copyright.ＰＥＮＡＮＡKrTGI5g2c3
在這裡，我們暫稱癌細胞在血液中的DNA為ctDNA，Circulating Tumor DNA。798Please respect copyright.ＰＥＮＡＮＡ4FK5L39qKa
798Please respect copyright.ＰＥＮＡＮＡPAon6zxofW
（圖4）圖中為利用阻擋PD1的抗體Pembrolizumab作治療的兩名病人結果。798Please respect copyright.ＰＥＮＡＮＡrZTHMrRVf2
798Please respect copyright.ＰＥＮＡＮＡdAcmJCWxl4
798Please respect copyright.ＰＥＮＡＮＡeWaV0kQrKc
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。798Please respect copyright.ＰＥＮＡＮＡj3DTh3dWG5
798Please respect copyright.ＰＥＮＡＮＡPxSw60Kens
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。798Please respect copyright.ＰＥＮＡＮＡEAvz4knWxj
798Please respect copyright.ＰＥＮＡＮＡdSjCxIQFYm
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。798Please respect copyright.ＰＥＮＡＮＡpxrJdOnKb6
798Please respect copyright.ＰＥＮＡＮＡlAllom0p5v
798Please respect copyright.ＰＥＮＡＮＡQJgVqb3OMx
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。798Please respect copyright.ＰＥＮＡＮＡmjvUktihvQ
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。798Please respect copyright.ＰＥＮＡＮＡWaD3zCFuHy
798Please respect copyright.ＰＥＮＡＮＡJqmDankmlu
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。798Please respect copyright.ＰＥＮＡＮＡXCo7J4yNm1
798Please respect copyright.ＰＥＮＡＮＡHI4piQhgrx
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。798Please respect copyright.ＰＥＮＡＮＡHOtYA3C62y
798Please respect copyright.ＰＥＮＡＮＡWHPUXafa1W
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。798Please respect copyright.ＰＥＮＡＮＡ1lY7vkbadx
798Please respect copyright.ＰＥＮＡＮＡvGjKvHWgWn
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/toc798Please respect copyright.ＰＥＮＡＮＡaD4PpHqALF
798Please respect copyright.ＰＥＮＡＮＡSpOIZ69bMk
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。798Please respect copyright.ＰＥＮＡＮＡJgumIqEuOM
798Please respect copyright.ＰＥＮＡＮＡYrlWDqPKOe
Link:798Please respect copyright.ＰＥＮＡＮＡmBfOgwIcSl
https://www.penana.com/user/27349/%E8%96%AF%E4%BB%94%E8%81%9E%E8%8C%B1%E8%8E%89/portfolio798Please respect copyright.ＰＥＮＡＮＡRhs5DQHLla
798Please respect copyright.ＰＥＮＡＮＡSJST1lBZVs
798Please respect copyright.ＰＥＮＡＮＡfKKppTZS2A
有興趣接收科學資訊的話，歡迎follow IG: potatopigtongue。798Please respect copyright.ＰＥＮＡＮＡ27Ui8mBRK8
798Please respect copyright.ＰＥＮＡＮＡbRwC5A5TvL
https://www.instagram.com/potatopigtongue/798Please respect copyright.ＰＥＮＡＮＡNxHacSbfYB
798Please respect copyright.ＰＥＮＡＮＡczQMddb4es
798Please respect copyright.ＰＥＮＡＮＡWLk3SVMWHr
Ref1:https://www.nature.com/articles/s43018-020-009798Please respect copyright.ＰＥＮＡＮＡ8lJmRJPrxI
