演講MP3+雙語文稿:第一種能夠治愈癌癥的療法

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【演講人及介紹】Carl June

卡爾·瓊，抗擊癌癥的著名先驅(qū)

【演講主題】第一種能夠治愈癌癥的療法

【演講文稿-中英文】

Translated by Li Ying (Amelia) Hu Reviewedby Wanna Shi

00:12

So this is the first time I've told thisstory in public, the personal aspects of it. Yogi Berra was a world-famousbaseball player who said, "If you come to a fork in the road, takeit." Researchers had been, for more than a century, studying the immune systemas a way to fight cancer, and cancer vaccines have, unfortunately, beendisappointing. They've only worked in cancers caused by viruses, like cervicalcancer or liver cancer.

這是我第一次在公眾場合從個(gè)人層面來講這件事。約吉·貝拉（Yogi Berra）是一名世界著名的棒球運(yùn)動(dòng)員，他曾說：“當(dāng)你遇到時(shí)機(jī)，請把握住它吧。”一個(gè)多世紀(jì)以來，研究人員一直在研究用免疫系統(tǒng)來抗癌，但不幸的是，癌癥疫苗的開發(fā)一直不盡如人意。這些疫苗只對由病毒引起的癌癥起作用，如宮頸癌或肝癌，

00:45

So cancer researchers basically gave up onthe idea of using the immune system to fight cancer. And the immune system, inany case, did not evolve to fight cancer; it evolved to fight pathogensinvading from the outside. So its job is to kill bacteria and viruses. And thereason the immune system has trouble with most cancers is that it doesn'tinvade from the outside; it evolves from its own cells. And so either theimmune system does not recognize the cancer as a problem, or it attacks acancer and also our normal cells, leading to autoimmune diseases like colitisor multiple sclerosis.

所以癌癥研究人員基本上放棄了用免疫系統(tǒng)來抗癌的思路。無論如何，免疫系統(tǒng)都沒能進(jìn)化到足以抗癌的地步，只能對抗外來入侵的病原體。它的職責(zé)就是殺滅細(xì)菌和病毒。免疫系統(tǒng)之所以難以對抗大多數(shù)的癌癥，是因?yàn)橐鸢┌Y的并不是外來入侵的病原，而是人體自身細(xì)胞出現(xiàn)了癌變。所以免疫系統(tǒng)要么沒有識(shí)別癌癥，要么既攻擊癌細(xì)胞，又攻擊正常細(xì)胞，結(jié)果引發(fā)了自身免疫性疾病，如結(jié)腸炎或多發(fā)性硬化癥。

01:26

So how do you get around that? Our answerturned out to be synthetic immune systems that are designed to recognize andkill cancer cells. That's right -- I said a synthetic immune system. You dothat with genetic engineering and synthetic biology. We did it with thenaturally occurring parts of the immune system, called B cells and T cells.These were our building blocks. T cells have evolved to kill cells infectedwith viruses, and B cells are the cells that make antibodies that are secretedand then bind to kill bacteria. Well, what if you combined these two functionsin a way that was designed to repurpose them to fight cancer? We realized itwould be possible to insert the genes for antibodies from B cells into T cells.

那該怎么辦呢？我們的解決辦法是設(shè)計(jì)合成免疫系統(tǒng)，用它來識(shí)別并殺死癌細(xì)胞。對，我說的是合成免疫系統(tǒng)，可以通過基因工程和合成生物學(xué)來實(shí)現(xiàn)，使用免疫系統(tǒng)中自然產(chǎn)生的部分，即 B 細(xì)胞和 T 細(xì)胞。這些是構(gòu)建免疫系統(tǒng)的基本單位。T 細(xì)胞可以殺死染上病毒的細(xì)胞，而 B 細(xì)胞則可以分泌出抗體，通過與細(xì)菌相結(jié)合來消滅細(xì)菌。如果把這兩種功能結(jié)合起來，改變其功能用來抗癌，那會(huì)怎樣？我們發(fā)現(xiàn)，可以將 B 細(xì)胞的抗體基因注入 T 細(xì)胞。

02:21

So how do you do that? Well, we used an HIVvirus as a Trojan horse to get past the T cells' immune system. The result is achimera, a fantastic fire-breathing creature from Greek mythology, with alion's head, a goat's body and a serpent's tail. So we decided that theparadoxical thing that we had created with our B-cell antibodies, our T cellscarrier and the HIV Trojan horse should be called "Chimeric AntigenReceptor T cells," or CAR T cells. The virus also inserts genetic informationto activate the T cells and program them into their killing mode.

那該怎么做呢？我們用一個(gè)艾滋病病毒（HIV）作為特洛伊木馬，避開 T 細(xì)胞的免疫系統(tǒng)，結(jié)果造出了個(gè)喀邁拉（嵌合體），那是古希臘故事中獅頭、羊身、蛇尾的吐火怪物。我們用 B 細(xì)胞的抗體、以 T 細(xì)胞為載體，以 HIV 為特洛伊木馬造出了一個(gè)自相矛盾的東西，我們決定把它叫做“嵌合抗原受體 T 細(xì)胞”或 CAR-T 細(xì)胞。該病毒還插入了基因信息，以激活 T 細(xì)胞，并將其編程，使其進(jìn)入殺滅模式。

03:05

So when CAR T cells are injected intosomebody with cancer, what happens when those CAR T cells see and bind to theirtumor target? They act like supercharged killer T cells on steroids. They startthis crash-defense buildup system in the body and literally divide and multiplyby the millions, where they then attack and kill the tumor. All of this meansthat CAR T cells are the first living drug in medicine. CAR T cells break themold. Unlike normal drugs that you take -- they do their job and getmetabolized, and then you have to take them again -- CAR T cells stay alive andon the job for years. We have had CAR T cells stay in the bodies of our cancerpatients now for more than eight years. And these designer cancer T cells, CART cells, have a calculated half-life of more than 17 years. So one infusion cando the job; they stay on patrol for the rest of your life.

我們將 CAR-T 細(xì)胞注入癌癥患者體內(nèi)，當(dāng)這些細(xì)胞看到并粘附于其腫瘤靶點(diǎn)，會(huì)發(fā)生什么？它們就像類固醇上強(qiáng)悍的 T 細(xì)胞殺手，開始在體內(nèi)建立防撞系統(tǒng)，分裂并繁殖出數(shù)百萬個(gè)細(xì)胞，然后攻擊并殺死腫瘤細(xì)胞。這些都意味著 CAR-T 細(xì)胞是醫(yī)學(xué)史上首款活體藥物。CAR-T 細(xì)胞擊破霉菌，它們不像患者服用的普通藥物——普通藥物在發(fā)揮藥效后會(huì)被代謝掉，然后患者得再服藥，而 CAR-T 細(xì)胞則可存活多年，且藥效很持久。我們的癌癥患者其體內(nèi)的 CAR-T 細(xì)胞至今已存活了 8 年多。這些定制的癌癥 T 細(xì)胞，即 CAR-T 細(xì)胞，其半衰期預(yù)計(jì)超過 17 年，所以輸一次藥液就可以守護(hù)病人的余生。

04:06

This is the beginning of a new paradigm inmedicine. Now, there was one major challenge to these T-cell infusions. Theonly source of T cells that will work in a patient are your own T cells, unlessyou happen to have an identical twin. So for most of us, we're out of luck. Sowhat we did was to make CAR T cells. We had to learn to grow the patient's ownT cells. And we developed a robust platform for this in the 1990s. Then in1997, we first tested CAR T cells in patients with advanced HIV-AIDS. And wefound that those CAR T cells survived in the patients for more than a decade.And it improved their immune system and decreased their viruses, but it didn'tcure them.

這是醫(yī)學(xué)新模式的開始。但這種 T 細(xì)胞療法面臨著一個(gè)巨大的挑戰(zhàn)。能在患者體內(nèi)起作用的 T 細(xì)胞，其唯一來源是自體的 T 細(xì)胞，除非患者碰巧有個(gè)同卵雙胞胎。所以對于大多數(shù)人來說，我們都沒這么幸運(yùn)。所以為了創(chuàng)造 CAR-T 細(xì)胞，我們得學(xué)會(huì)培育患者自體的 T 細(xì)胞。20 世紀(jì) 90年代，我們開發(fā)了一個(gè)強(qiáng)大的平臺(tái)，1997 年，我們首次在晚期艾滋病患者身上測試了 CAR-T 細(xì)胞。我們發(fā)現(xiàn)，這些 CAR-T 細(xì)胞在病人體內(nèi)存活了十多年。它增強(qiáng)了患者的免疫系統(tǒng)，并減少了病毒，但它并沒能治愈患者。

04:55

So we went back to the laboratory, and overthe next decade made improvements to the CAR T cell design. And by 2010, webegan treating leukemia patients. And our team treated three patients withadvanced chronic lymphocytic leukemia in 2012. It's a form of incurableleukemia that afflicts approximately 20,000 adults every year in the UnitedStates. The first patient that we treated was a retired Marine sergeant and aprison corrections officer. He had only weeks to live and had, in fact, alreadypaid for his funeral. The cells were infused, and within days, he had highfevers. He developed multiple organ failures, was transferred to the ICU andwas comatose. We thought he would die, and, in fact, he was given last rites.But then, another fork in the road happened. So, around 28 days after the CAR Tcell infusion, he woke up, and the physicians finally examined him, and thecancer was gone. The big masses that had been there had melted. Bone marrowbiopsies found no evidence of leukemia, and that year, in our first threepatients we treated, two of three have had durable remissions now for eightyears, and one had a partial remission.

所以我們又回到實(shí)驗(yàn)室，在接下來的十年里，我們改進(jìn)了 CAR-T 細(xì)胞的設(shè)計(jì)。到了 2010 年，我們開始治療白血病患者。2012 年，我們的團(tuán)隊(duì)治療了三位晚期慢性 淋巴細(xì)胞白血病患者。這是一種無法治愈的白血病，在美國，每年折磨著約兩萬名成人。我們治療的第一位病人是位退役海軍中士、前獄警，他只有幾周可活了，實(shí)際上，他已經(jīng)為自己籌備好了葬禮。在給他注入了 CAR-T 細(xì)胞后，幾天內(nèi)，他發(fā)起了高燒，多個(gè)器官開始衰竭，被轉(zhuǎn)到重癥監(jiān)護(hù)室，他昏迷不醒。我們以為他要死了，他接受了臨終禱告。但后來出現(xiàn)了轉(zhuǎn)機(jī)，在注射了 CAR-T 細(xì)胞大約 28 天后，他醒了，醫(yī)生給他做了最終檢查，他的癌癥消失了，原來在那里的大腫塊已經(jīng)消腫了，骨髓活檢未發(fā)現(xiàn)白血病跡象。那一年，在我們首批治療的三位患者中，其中兩位的病情持續(xù)緩解，至今已八年了，一位病情得到了部分緩解。

06:13

The CAR T cells had attacked the leukemiain these patients and had dissolved between 2.9 and 7.7 pounds of tumor in eachpatient. Their bodies had become veritable bioreactors for these CAR T cells,producing millions and millions of CAR T cells in the bone marrow, blood andtumor masses. And we discovered that these CAR T cells can punch far abovetheir weight class, to use a boxing analogy. Just one CAR T cell can kill 1,000tumor cells. That's right -- it's a ratio of one to a thousand. The CAR T celland its daughter progeny cells can divide and divide and divide in the bodyuntil the last tumor cell is gone.

這種 CAR-T 細(xì)胞攻擊了這些患者的白血病細(xì)胞，并且使每位患者的腫瘤消減了 2.9-7.7 磅。他們的身體已經(jīng)成為這些 CAR-T 細(xì)胞名副其實(shí)的生物反應(yīng)器，在骨髓、血液和腫瘤組織中繁殖出數(shù)百萬個(gè) CAR-T 細(xì)胞。用拳擊來打個(gè)比方，我們發(fā)現(xiàn)，這些 CAR-T 細(xì)胞可以與遠(yuǎn)遠(yuǎn)超過他們重量等級(jí)的對手對打。一個(gè) CAR-T 細(xì)胞就能殺死 1000 個(gè)腫瘤細(xì)胞，沒錯(cuò)，這是一對一千的比率。CAR-T 細(xì)胞及其子代細(xì)胞可以在體內(nèi)不斷分裂，直到最后一個(gè)腫瘤細(xì)胞消失。

06:58

There's no precedent for this in cancermedicine. The first two patients who had full remission remain todayleukemia-free, and we think they are cured. These are people who had run out ofoptions, and by all traditional methods they had, they were like modern-dayLazarus cases. All I can say is: thank goodness for those forks in the road.

這在癌癥醫(yī)學(xué)史上前所未有。最先的兩位病人的病情完全好轉(zhuǎn)，至今一直沒再出現(xiàn)白血病細(xì)胞，我們相信，他們已經(jīng)痊愈了。他們用盡了所有的傳統(tǒng)方法，均告無效，他們一籌莫展，而現(xiàn)在他們就像是現(xiàn)代的拉撒路病例?！咀ⅲ悍褐羔t(yī)學(xué)上“起死回生”的現(xiàn)象】我只能說：謝天謝地，時(shí)來運(yùn)轉(zhuǎn)。

07:23

Our next step was to get permission totreat children with acute leukemia, the most common form of cancer in kids. Thefirst patient we enrolled on the trial was Emily Whitehead, and at that time,she was six years old. She had gone through a series of chemotherapy andradiation treatments over several years, and her leukemia had always come back.In fact, it had come back three times. When we first saw her, Emily was veryill. Her official diagnosis was advanced, incurable leukemia. Cancer hadinvaded her bone marrow, her liver, her spleen. And when we infused her withthe CAR T cells in the spring of April 2012, over the next few days, she didnot get better. She got worse, and in fact, much worse. As our prisoncorrections officer had in 2010, she, in 2012, was admitted to the ICU, andthis was the scariest fork in the whole road of this story.

我們的下一步是要得到批準(zhǔn)，治療兒童急性白血病，這是最常見的兒童腫瘤性疾病。我們收治第一位參加試驗(yàn)的病人是艾米莉 · 懷特黑德（Emily Whitehead），當(dāng)時(shí)，她年僅六歲。在過去幾年里，她接受了 一系列的化療和放療，但她的白血病總是復(fù)發(fā)。實(shí)際上，復(fù)發(fā)了三次。我們第一次看到艾米麗時(shí)，她病得很重。她的正式診斷是白血病晚期，沒得治了，癌癥細(xì)胞已侵入她的骨髓、肝臟和脾臟。我們在 2012 年 4 月春為她進(jìn)行了 CAR-T 細(xì)胞治療，在接下來的日子里，她的病情不見好轉(zhuǎn)，反而每況愈下，事實(shí)上，她的病情出現(xiàn)了惡化。就像 2010 年那位獄警所經(jīng)歷的那樣，2012 年，她進(jìn)了重癥監(jiān)護(hù)室，這是整個(gè)故事中最可怕的一個(gè)關(guān)口。

08:21

By day three, she was comatose and on lifesupport for kidney failure, lung failure and coma. Her fever was as high as 106degrees Fahrenheit for three days. And we didn't know what was causing thosefevers. We did all the standard blood tests for infections, and we could notfind an infectious cause for her fever. But we did find something very unusualin her blood that had never been seen before in medicine. She had elevatedlevels of a protein called interleukin-6, or IL-6, in her blood. It was, infact, more than a thousandfold above the normal levels. And here's where yetanother fork in the road came in.

到了第三天，她出現(xiàn)了腎衰竭、肺衰竭，她昏迷不醒，得靠儀器來維持生命，她一連三天發(fā)高燒，高達(dá) 41 攝氏度，而我們卻不知道她發(fā)燒的原因。我們做了所有的標(biāo)準(zhǔn)血液檢查，排查感染，卻未發(fā)現(xiàn)引起發(fā)燒的感染病因。但我們的確在她的血液中發(fā)現(xiàn)了異常，這在醫(yī)學(xué)史上前所未見。她血液里一種叫白細(xì)胞介素-6（IL-6）的蛋白質(zhì)含量過高。事實(shí)上，比正常水平高出一千多倍，這又是一個(gè)關(guān)口。

09:08

By sheer coincidence, one of my daughtershas a form of pediatric arthritis. And as a result, I had been following as acancer doc, experimental therapies for arthritis for my daughter, in case shewould need them. And it so happened that just months before Emily was admittedto the hospital, a new therapy had been approved by the FDA to treat elevatedlevels of interleukin-6. And it was approved for the arthritis that my daughterhad. It's called tocilizumab. And, in fact, it had just been added to thepharmacy at Emily's hospital, for arthritis.

非常巧合的是，我有一個(gè)女兒得了小兒關(guān)節(jié)炎，因此，作為一名癌癥醫(yī)生，為了我的女兒，我一直在關(guān)注關(guān)節(jié)炎實(shí)驗(yàn)性療法，以備她會(huì)用到。就在艾米麗入院前幾個(gè)月，美國食品藥品監(jiān)督管理局（FDA）批準(zhǔn)了一種治療 白細(xì)胞介素-6含量過高的新療法。這種療法獲得批準(zhǔn)，用于治療 我女兒所得的這類關(guān)節(jié)炎，名為 IL-6 受體單克隆抗體注射劑（tocilizumab），該藥剛被添加到艾米麗所住醫(yī)院的藥房，用來治療關(guān)節(jié)炎。

09:47

So when we found Emily had these very highlevels of IL-6, I called her doctors in the ICU and said, "Why don't youtreat her with this arthritis drug?" They said I was a cowboy forsuggesting that. And since her fever and low blood pressure had not respondedto any other therapy, her doctor quickly asked permission to the institutionalreview board, her parents, and everybody, of course, said yes. And they triedit, and the results were nothing short of striking.

所以當(dāng)我們發(fā)現(xiàn)艾米麗的 IL-6 含量這么高，我打電話給她的重癥監(jiān)護(hù)室醫(yī)生，我說：“你不妨用這種關(guān)節(jié)炎藥給她治療一下吧？”他們說，我提這么個(gè)建議，簡直就是個(gè)莽夫。由于其他治療對她的高燒和低血壓都沒效，她的醫(yī)生很快向機(jī)構(gòu)審查委員會(huì)申請了許可，并征求了她父母的同意，自然，大家都同意了。于是他們嘗試了這種藥，結(jié)果療效非常驚人。

10:16

Within hours after treatment withtocilizumab, Emily began to improve very rapidly. Twenty-three days after hertreatment, she was declared cancer-free. And today, she's 12 years old andstill in remission.

接受 IL-6 受體單克隆抗體治療幾個(gè)小時(shí)后，艾米麗開始迅速好轉(zhuǎn)。治療 23 天后，她體內(nèi)已經(jīng)沒有癌細(xì)胞了。現(xiàn)在，她 12 歲了，仍然在康復(fù)中。

10:34

(Applause)

（掌聲）

10:44

So we now call this violent reaction of thehigh fevers and coma, following CAR T cells, cytokine release syndrome, or CRS.We've found that it occurs in nearly all patients who respond to the therapy.But it does not happen in those patients who fail to respond. So paradoxically,our patients now hope for these high fevers after therapy, which feels like"the worst flu in their life," when they get CAR T-cell therapies.They hope for this reaction because they know it's part of the twisting andturning path back to health. Unfortunately, not every patient recovers.Patients who do not get CRS are often those who are not cured. So there's astrong link now between CRS and the ability of the immune system to eradicateleukemia.

我們現(xiàn)在把這種在注入 CAR-T 細(xì)胞后出現(xiàn)高燒和昏迷的強(qiáng)列反應(yīng) 稱為細(xì)胞因子釋放綜合征（CRS）。我們發(fā)現(xiàn)，幾乎所有對該治療 有反應(yīng)的病人都出現(xiàn)了這種癥狀，但那些（對治療）沒有反應(yīng)的病人則沒有這些癥狀。所以這很矛盾，現(xiàn)在，我們的病人在接受 CAR-T 細(xì)胞治療時(shí)，都希望能發(fā)高燒，這種感覺就像是“得了有生以來最嚴(yán)重的流感”。他們希望有這種反應(yīng)，因?yàn)樗麄冎肋@是邁向恢復(fù)健康之路上 必經(jīng)的坎坷與曲折。不幸的是，并不是每位病人都能康復(fù)。沒有出現(xiàn) CRS 癥狀的病人通常無法治愈。所以 CRS 與免疫系統(tǒng)清除白血病細(xì)胞的能力緊密相關(guān)。

11:33

That's why last summer, when the FDAapproved CAR T cells for leukemia, they also co-approved the use of tocilizumabto block the IL-6 effects and the accompanying CRS in these patients. That wasa very unusual event in medical history. Emily's doctors have now completedfurther trials and reported that 27 out of 30 patients, the first 30 wetreated, or 90 percent, had a complete remission after CAR T cells, within amonth. A 90 percent complete remission rate in patients with advanced cancer isunheard of in more than 50 years of cancer research. In fact, companies oftendeclare success in a cancer trial if 15 percent of the patients had a completeresponse rate.

所以，去年夏天，F(xiàn)DA 在批準(zhǔn)用 CAR-T 細(xì)胞治療白血病時(shí)，還批準(zhǔn)了使用 IL-6 受體單克隆抗體注射劑來阻斷這些患者出現(xiàn)的 IL-6 影響和伴隨而來的 CRS 癥狀。這在醫(yī)學(xué)史上極不尋常。艾米麗的醫(yī)生們已經(jīng)完成了進(jìn)一步的試驗(yàn)，并在報(bào)告中指出，在首批治療的 30 位病人中，有 27 位，或者說 90% 的病人，在用 CAR-T 細(xì)胞治療后的一個(gè)月內(nèi)，病情得到了完全緩解。晚期癌癥患者病情完全緩解率達(dá) 90%，這在 50 多年的癌癥研究中聞所未聞。事實(shí)上，如果癌癥試驗(yàn)的結(jié)果有 15% 的患者獲得完全緩解，制藥公司一般就會(huì)宣布該癌癥試驗(yàn)成功。

12:28

A remarkable study appeared in the"New England Journal of Medicine" in 2013. An international study hassince confirmed those results. And that led to the approval by the FDA forpediatric and young adult leukemia in August of 2017.

2013 年，《新英格蘭醫(yī)學(xué)雜志》 發(fā)表了一項(xiàng)令人矚目的研究。此后，一項(xiàng)國際性研究 證實(shí)了這些研究結(jié)果。FDA 因而于 2017 年 8 月批準(zhǔn)了將該療法用于治療兒童和年輕人的白血病。

12:45

So as a first-ever approval of a cell andgene therapy, CAR T-cell therapy has also been tested now in adults withrefractory lymphoma. This disease afflicts about 20,000 a year in the UnitedStates. The results were equally impressive and have been durable to date. Andsix months ago, the FDA approved the therapy of this advanced lymphoma with CART cells. So now there are many labs and physicians and scientists around theworld who have tested CAR T cells across many different diseases, andunderstandably, we're all thrilled with the rapid pace of advancement. We're sograteful to see patients who were formerly terminal return to healthy lives, asEmily has. We're thrilled to see long remissions that may, in fact, be a cure.

作為首個(gè)獲得批準(zhǔn)的細(xì)胞與基因療法，CAR-T 細(xì)胞療法現(xiàn)在也已用于試驗(yàn)性 治療患有難治性淋巴瘤的成年人。這種疾病每年折磨著 近 2 萬名美國患者，治療結(jié)果也同樣令人矚目，且效果持久至今。六個(gè)月前，F(xiàn)DA 批準(zhǔn)了用 CAR-T 細(xì)胞治療晚期淋巴瘤?，F(xiàn)在世界上有很多實(shí)驗(yàn)室、醫(yī)生和科學(xué)家都在試用 CAR-T 細(xì)胞治療許多不同的疾病，毫無疑問，我們大家都為迅猛的進(jìn)展感到振奮。我們很高興看到，那些以前得了絕癥的病人，像艾米麗一樣康復(fù)，健康地生活。我們很興奮地看到，病情長期得到緩解，實(shí)際上可能是治愈了。

13:34

At the same time, we're also concernedabout the financial cost. It can cost up to 150,000 dollars to make the CAR Tcells for each patient. And when you add in the cost of treating CRS and othercomplications, the cost can reach one million dollars per patient. We mustremember that the cost of failure, though, is even worse. The currentnoncurative therapies for cancer are also expensive and, in addition, thepatient dies. So, of course, we'd like to see research done now to make thismore efficient and increase affordability to all patients. Fortunately, this isa new and evolving field, and as with many other new therapies and services,prices will come down as industry learns to do things more efficiently.

同時(shí)，我們也在關(guān)注著醫(yī)療費(fèi)。為一位病人合成 CAR-T 細(xì)胞的費(fèi)用高達(dá) 15 萬美元，加上治療 CRS 和其他并發(fā)癥的費(fèi)用，每個(gè)病人的治療費(fèi)高達(dá)一百萬美元。但是，我們還要記住，如果治療失敗，費(fèi)用會(huì)更高。目前，對癌癥無療效的治療費(fèi)用也十分高昂，而且病人依然會(huì)面臨死亡。我們當(dāng)然希望看到我們現(xiàn)在所做的研究能更有效，并讓所有病人都能付得起治療費(fèi)。所幸，這是個(gè)新領(lǐng)域，仍在不斷地發(fā)展，隨著許多其他新療法和服務(wù)的出現(xiàn)，行業(yè)效率會(huì)提高，治療價(jià)格會(huì)下降。

14:21

When I think about all the forks in theroad that have led to CAR T-cell therapy, there is one thing that strikes me asvery important. We're reminded that discoveries of this magnitude don't happenovernight. CAR T-cell therapies came to us after a 30-year journey, along aroad full of setbacks and surprises. In all this world of instant gratificationand 24/7, on-demand results, scientists require persistence, vision andpatience to rise above all that. They can see that the fork in the road is notalways a dilemma or a detour; sometimes, even though we may not know it at thetime, the fork is the way home.

我想著這一路走來，在研制 CAR-T 細(xì)胞治療中所遇到的各種重大關(guān)頭，有一件事我覺得非常重要。我們意識(shí)到，這些重大發(fā)現(xiàn)并非一蹴而就。我們花了 30 年，CAR-T 細(xì)胞療法才得以問世，這一路走來，雖道路曲折，但不乏驚喜。當(dāng)今世界，人們追求即時(shí)滿足，全天候按需出結(jié)果，在這樣的世界里，科學(xué)家需要堅(jiān)持不懈、有遠(yuǎn)見、有耐心，才能戰(zhàn)勝這一切，才能看清，岔道口并不總是進(jìn)退兩難的困境，或者要繞道而行；有時(shí)，在當(dāng)時(shí)可能還不知道，這個(gè)路口就是通往成功之路。

15:03

Thank you very much.

感謝大家。

15:04

(Applause)

（掌聲）