利用人體自身免疫機制來消除腫瘤細胞，並不是現在才有的想法。早在1881年，美國紐約癌症醫院（史隆凱特靈癌症中心的前身）的外科醫師柯里（William B. Coley）就觀察到，癌症病患在嚴重感染後，腫瘤竟然意外消失，因此推論患者對抗感染的免疫反應，也能夠對抗腫瘤。往後幾十年間，癌症免疫監控（immune surveillance）的概念逐漸成形，科學家認為，人體的免疫系統能夠持續辨識突變的細胞或腫瘤細胞，並把它們清除。可是，一旦腫瘤細胞的偽裝伎倆奏效，逃過免疫監控的腫瘤便逐漸壯大，因此若能重新振奮人體的免疫作用機制，應該可以有效對抗腫瘤。
唐獎生技醫藥獎頒給了免疫學家艾利森指出，人體免疫系統具有三項其他癌症療法沒有的特徵，是其在抗癌應用上相當大的優勢。
May 03, 2016
Of the 32 patients included, 37.5% experienced some decrease in tumor burden from baseline. Twenty-seven of the patients met protocol-specified inclusion criteria for the efficacy analysis, and in those patients the overall response rate was 18.5%. One patient (3.7%) had a complete response, four had a partial response (14.8%), seven had stable disease (25.9%), and 13 patients had progressive disease (48.1%). The overall disease control rate (complete or partial response or stable disease for at least 24 weeks) was 25.9%.
Here are some of the things I've learned over the past two years.
CTLA-4 pathway blocks the immune system from starting an immune response against cancer. How tumor employ this mechanism to block anti tumor response is still not completely known. What the scientists do know is when the dendritic cells present tumor antigens to an naive T-cell (a T cell which never been activated), it fails to activate the T-cell.
Mutational landscape determines sensitivity to PD-1 blockade in non–small cell lung cancer
anti PD1和anti CTLA4藥物要有效的前提是病人已經對癌症已有免疫反應
所謂已有免疫反應是指病人已經有抗癌症的 毒殺型T細胞
我之前讀到的報告 anti pd1治療大腸癌反應率在20%左右
剛好基因修復缺陷病人發生率為15% 至20%左右
