醫療新突破癌症不再是不治之症

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全世界規模最大的癌症中心——德州休士頓的 MD 安德森癌症中心——

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The largest cancer center in the world, MD Anderson in Houston, Texas,

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宣布了一項計畫，可大幅減少癌症死亡人數。

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has announced a plan to radically reduce deaths from cancer.

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有個主要目標就是黑色素瘤，

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One big target is melanoma.

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這是一種惡性皮膚癌。

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That's a malignant skin cancer.

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雖然尋找新藥物的前景可期，

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The search for new medications is promising,

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但同時也非常昂貴。

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but at the same time it's also very expensive.

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首席醫學特派員桑杰．古普塔帶來以下報導。

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Chief medical correspondent Sanjay Gupta has our report.

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三十二歲的布萊恩．羅斯原本正在追求一個夢想。

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At 32 years old, Brian Rose was chasing a dream.

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身為威奇塔溫納茨棒球隊的教練，他努力朝著大聯盟前進。

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Baseball coach for the Wichita Wingnuts, he was working his way up toward the big leagues.

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不過，在二○一○年四月，他卻在鏡子裡看見了一個令人擔憂的斑點。

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But in April 2010, he saw a troubling spot in the mirror.

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他覺得很好，並不認為自己需要接受檢查，

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He felt fine, and he didn't think he needed to get checked out,

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但他的女友露佩卻堅持。

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but his girlfriend, Lupe, insisted.

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結果露佩是對的。

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And she was right.

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那是皮膚癌，黑色素瘤。

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It was skin cancer, melanoma.

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他們把腫瘤切除，但六個月之後，

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They cut it out, but six months later,

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布萊恩的醫生卻跟他說癌細胞已經擴散到了肺部。

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Brian's doctor told him it had spread to his lungs.

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黑色素瘤一旦擴散幾乎鐵定致命，

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Once it spreads, melanoma is almost always deadly,

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不過，現在擊敗病魔的機會已比過去大得多。

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but the odds are better than they used to be.

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一個原因是布萊恩服用的一種藥物——澤波拉夫。

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One reason is a drug that Brian received -- Zelboraf.

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仔細聽布萊恩對這種藥物的描述。

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Listen closely to the way Brian describes that medication.

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我服用澤波拉夫的時候看過這些東西冒出來，

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I have seen these things pop up while taking Zelboraf,

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接著又看它們消失不見，

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and then you see them go away,

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然後又再次冒了出來，接著又消失。

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and then they kind of come back up, and then they go away.

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澤波拉夫對若干類型的黑色素瘤有效，這些黑色素瘤都帶有一種特有的基因稱為 BRAF。

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Zelboraf works on certain types of melanoma that carry a particular gene called BRAF.

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我們可以把 BRAF 想像成這種藥物的標靶。

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Think of BRAF like a target for the medicine.

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美國食品藥物管理署核准了澤波拉夫，就在幾個月前他們剛核准了另一種新藥物伊匹單抗。

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The FDA made Zelboraf available just months after it approved another new medication, Yervoy.

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這種藥物不保證有效，

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It doesn't always work,

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但大約有百分之十的機會可以看到腫瘤縮小百分之五十以上，

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but about 10 percent of the time, the tumor shrinks by more than 50 percent,

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有時候甚至會完全消失。

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sometimes it goes away entirely.

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這些新一代的藥物已經翻轉了不少癌症的情勢。

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This new generation of drugs is turning the tide against a variety of cancers.

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這一切確實都非常令人振奮，

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Now, all that's very exciting,

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但問題是許多突破通常附帶巨額高價。

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but the problem is that many of these breakthroughs often come with a significant sticker shock.

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舉例而言，癌思停這種藥物使用一年的花費是八萬八千美元。

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For example, Avastin, $88,000 a year for this medication.

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澤波拉夫是一個月一萬美元，

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Zelboraf, this is $10,000 a month.

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而且可能得隨著病患服用多久，就持續多久。

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And that can continue indefinitely as long as the patient's taking it.

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至於伊匹單抗，這種藥則是四劑十二萬美元，這是標準的療程。

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And Yervoy, this medication is $120,000 for four doses, which makes up standard therapy.

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這可是令人咋舌的高價，

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Big sticker shock,

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而且還不包含數十萬美元的醫院費用與醫生收費。

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and that doesn't even take into account the hundreds of thousands of dollars in hospital's fees and physician's charges,

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這一切都是治療癌症病患的花費。

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all that goes into taking care of a patient with cancer.

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布萊恩參與了一項臨床試驗，因此得以免費取得澤波拉夫。

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As part of a clinical trial, Brian got Zelboraf free.

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在食品藥物管理署核准了這種藥物之後，他還能夠繼續服用，

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Once it was approved by the FDA, he was only able to continue

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只因為製造這種藥物的公司同意繼續提供。

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because the company that makes the drug agreed to keep providing it.

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在某些人身上，澤波拉夫能夠帶來奇蹟似的效果。

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In some people, Zelboraf works miracles.

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問題是，這樣的效果並不持久。

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The problem is, they don't last.

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我有些原本只能臥病在床的病患，

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I've had patients that have been bedridden

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竟然能夠起床並且帶他們的孩子到迪士尼樂園去玩，

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and that have been able to get up and take their kids to Disney World.

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所以這種藥物確實有些驚人的效果。

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So it's had some dramatic responses.

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問題是，效果只能持續短短幾個月。

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The issue is, they only last a few months.

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接著，腫瘤就又再次出現。

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Then the tumor comes back.

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今年夏天，胡醫師向布萊恩表示，該是嘗試其他療法的時候了。

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And this summer, Dr. Hwu told Brian it's time to try something else.

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布萊恩是世界上最早獲得這種療法的病患之一。

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Brian is one of the first people in the world to receive this.

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這種療法稱為 TIL「帶有樹突細胞的腫瘤浸潤淋巴細胞」（註）。

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It's called TIL with dendritic cells.

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胡醫師從布萊恩的腫瘤中取出稱為「T細胞」的免疫細胞。

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Dr. Hwu takes immune cells called T-cells from Brian's tumor.

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T 細胞能夠攻擊癌症。

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T-cells can attack cancer.

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胡醫師培育這些細胞，

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Dr. Hwu nurtures those cells,

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與生長因子混合，

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mixing them with the growth factor,

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接著再培育其他免疫細胞，即「樹突細胞」，

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then grows other immune cells, dendritic cells,

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這種細胞的效果相當於疫苗，

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which acts as a vaccine.

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能夠協助 T 細胞在布萊恩的體內繁殖。

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It helps T-cells multiply in Brian's body.

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他將把 T 細胞與樹突細胞的混合劑注入布萊恩體內。

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He'll infuse the mixture of T-cells and dendritic cells into Brian.

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實際上，這就是一顆抗癌的智慧導彈。

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In effect, it's an anti-cancer smart bomb.

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你也有其他罹患晚期黑色素瘤的病患接受過這種治療。

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You've had other patients who've had advanced melanoma, who've gone through this therapy.

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現在病患人數不多，這是全新的療法。

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There aren't many patients right now. It's brand-new.

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其中一些病患的狀況怎麼樣？

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How have some of those patients done?

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我們的反應比例介於百分之四十到五十之間，

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Well, our response rate is between 40 to 50 percent,

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對於轉移性的晚期黑色素瘤而言算是非常高。

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which is very high for metastatic advanced melanoma.

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其中有些病患的狀況非常好，

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And some of those patients have done very well,

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至今已有二至三年沒有任何病徵。

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over two and three years now without any sign of disease.

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再強調一次，別忘了，若沒有接受這樣的治療，這些病患大多數都不免在八個月內死亡。

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Again, remember, most of these patients would otherwise die in eight months.

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如果情況發展順利，胡醫師希望能夠讓這種療法更普及。

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If it keeps going well, Dr. Hwu hopes to make this much more available.

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他並指出，整個癌症領域正處於轉捩點。

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And he says the cancer field as a whole, is at a turning point.