我叫贾斯汀·斯蒂宾，一名肿瘤科教授。受聘于伦敦帝国理工大学。帝国理工大学有多所附属医院，我在哈默史密斯附属领导两个科研实验室，在查令十字医院接诊患者。
My name is Professor Justin Stebbing, I’m professor of cancer medicine and oncology at Imperial College London which encompasses a lot of hospitals such as Hammersmith where I have my two research laboratories, Charring Cross where I see NHS patients.
我们目前最想做的，我在尝试做到的，是把实验室研究与临床连接起来。
And what we are trying to do overall, what I’m trying to do is to link the research laboratory to the clinic, and the clinic to the research lab.
我希望由此能延长乳腺癌、肺癌、消化系统恶性肿瘤和黑色素瘤患者的生命，改善生活质量，以及提高治愈率。
And I’m trying to extend the quality and quantity of life and increase the cure rate in people with breast, lung, gastroenterological malignancies and melanoma.
我也参与新式免疫疗法的临床实验工作，在政府的第一个研究转化医学的国家级健康研究机构中担任肿瘤学教授，我还是全球最大癌症期刊之一《致癌基因》杂志的编辑。
And I specialize as well as in clinical trials of immunotherapy, the government’s first national institute of health research translational professor of oncology, I am editor of Oncogene, which is one of the world’s largest cancer journals.
并且我有一个非常出色的团队来协助我的工作。
And I have fabulous teams of people who help me make people better.
我工作的领域中，早前的研究一直是以小步前进的方式在进步。
In my career thus far, research has been made in small increment, little steps.
时至今日，研究的进步可谓都是大跳步的，而其中免疫疗法是进展最大的。
Now it’s made in giant leaps, and immunotherapy is by far in a way the largest leap I’ve ever seen.
它工作的原理并不是激发免疫系统，而是抑制免疫抑制系统。
It doesn’t work by stimulating immune system, it inhibits the inhibition of the immune system。
我认为，在接下来的20年中，我们可以通过免疫疗法、化疗与免疫疗法相结合，或者不同免疫疗法相结合的方式治疗病患。
I think in 20 years’ time, we will either be treating people with immunotherapy, chemotherapy and immunotherapy, or immunotherapy and immunotherapy.
我们现在认为，癌症是一个系统性的疾病，并且会影响到每一个人。
We are understanding that cancer is a systemic disease that affects everyone.
在上个世纪甚至更长的时间里，医生一直试图通过控制免疫系统来治疗癌症。
And really for the last century or even longer, physicians have been trying to harness the power of immune system to treat cancer.
1909 (1908)年，伊拉·伊里奇·梅契尼科夫因为癌症的免疫逃逸理论获得了诺贝尔生理学医学奖。
I mean in 1909 (1908) Ilya Ilyich Mechnikov won the Nobel Prize for immune escape theory of cancer.
我们都会患癌症，但一般情况下，免疫系统会清除癌症。
They said we all develop cancers but the immune system clears them.
我们已知接受器官移植的患者更易患癌，比如肾移植。
We know that in people after transplants such as a kidney transplant, they develop malignancies.
如果去除免疫抑制反应，恶性肿瘤就会好转，但对移植患者来说，此时移植的器官也会损伤。
And if you take away the immunosuppression, the malignancy goes away, so does the transplant.
我们还知道，在1983年，HIV的流行是从皮肤癌开始被发现的，这是另外一种在年轻人中发生的恶性肿瘤。
And we know in 1983, the HIV pandemic began with skin cancers, another tumours in young men.
现在我们的观点是，例如肺癌、血癌、头颈部恶性肿瘤、特定类型的结肠癌、特定类型的乳腺癌，非常多的癌症，以及更多新发现的癌症种类，比如黑色素瘤和肾肿瘤，常见的情况是，即使免疫疗法没有治愈肿瘤，肿瘤也会演变成慢性病，病人会继续带病生存很多年，因为免疫系统会好比每天做一次活检那样，持续监测肿瘤。
Now what we are saying is that diseases such as lung cancers, blood cancer, head and neck cancer, certain types of colon cancer, certain types of breast cancer, the list is long and getting longer. Melanoma and renal cancer, that these immunotherapies, are often that if they are not curing the condition, they are turning it into a long term disease that people can live with for years and years and years, because the immune system is performing a biopsy every second of the day on cancer.
因为免疫系统也是你自己的一部分。
It’s your own.
所谓的个性化的治疗，就是在恰当的时间，使用合适的药，治疗病人相应的肿瘤，揭开保护癌症细胞的保护壳，从而利用自身的免疫系统来战胜肿瘤。
When we talk about personalization of care, which is treating the right person at the right time, with the right drug, for the right tumour, using your own immune system to fight it by uncloaking the protective shield over cancer cells.
这是一个巨大的进步。
It’s a really dramatic improvement.
不仅在于这种治疗有效果、有效率，更在于毒性领域。
Not just in terms of the effectiveness, the efficacy, but also in terms of the toxicity.
所有药物都有副作用，但是相比较于能引起疲乏、脱发、或多重感染的传统化疗药物，这些药物的毒性要好的多。
Sure all drugs have side-effects, but the toxic profile of these drugs compared to traditional chemo-therapeutics which cause fatigue, hair loss, multiple sorts of infections, is so so much better.
现在，我们通常所做的，我通常所做的是，把肿瘤想象成伦敦的地铁系统去理解它。
At the current time, what we typically do, what I typically do is that I understand the person’s cancer as being like London underground tube system.
我利用活检技术取用一些细胞，如今我们甚至可以抽血做实时的液体活检。
So I take some cells out to me with a biopsy, we can even do a liquid biopsy from the blood to do it in real time.
并且，我们对它进行基因测序。
And we sequence it.
我们解码了这些肿瘤细胞内含的基因，共三百万个字母组成的密码，然后试图从中找出到底是国王十字地铁站、尤斯顿地铁站，还是滑铁卢地铁站出了问题，或者异常可能来自维多利亚站，堤岸站，东阿克顿站和哈默史密斯站。用这样的方法，我们围绕这些异常，制定一个个性的治疗方案。
We unravel all three billion letters that it’s made of and we try and work out if King’s Cross Euston and Waterloo aren’t working, or it’s Victoria, Embankment, East Acton and Hammersmith, and by doing that, we aim to tailor make an individual’s treatment around it.
但问题是，有时候我们发现，所有的地铁站都有问题，所以你需要进行地毯式的维护；或者有时候你发现尤斯顿站运转异常，却没有治疗尤斯顿的药；或者有时尤斯顿站不运行了，我们也有适合的药，但是光治疗它没用，因为尤斯顿站并不能控制整个地铁线网，尤斯顿站只控制北方线和维多利亚线。如果疾病想从卡姆登站经过尤斯顿站到维多利亚站，即使尤斯顿被药物隔开不能下车了，没关系，疾病还是可以到达维多利亚站。因为你可以换线绕过尤斯顿，经过国王十字车站倒车过去，甚至可以改乘公交和出租车。
But the problem is, sometimes we find that all the tube stations aren’t working properly, so you need a carpet booming approach, or you find that Euston isn’t working but we don’t have a drug for Euston, or that Euston isn’t working and we have a drug for it but Euston isn’t controlling the whole tube network, it’s only controlling the Northern and the Victorian lines, and if you think you are trying to get from Camden town to Victoria via Euston, even if Euston isn’t there, you can go around it, go via King’s Cross, or get a bus or a taxi.
癌症细胞就是这样。
So cancer cells are like that.
他们会找到其他的通路。
They find other ways.
通过在基因组水平的研究，我们能找到哪个地铁站是目标。通过去除癌症细胞的PdL1保护屏障，我们可以用免疫疗法，指引自己的身体去对抗癌症。通过这样，我们实际上在有效性与毒性两方面，正在彻底改善癌症患者的生命。但是如果说免疫疗法之路有一英里长，我们不过刚走了10到20码。
So by understanding it more on a genomic level, we can understand which tube stations to target, but if you direct your body to fight it with immunotherapy, by uncloaking the PdL1 protective shield that exists on cancer cells, we are actually changing the lives of people with cancer, on the both the effectiveness side and the toxicity side but if the immunotherapy road is a mile long, we are only about ten to twenty yards into it.
我们还有很多需要学习的地方。
So we have so much more to learn.
我们一直学习去分析的，不仅是人类的基因组，我们也在研究这些基因的行为，并试图把基因型与表型联系起来，探究基因怎样控制在我们身上发生的一切。
So what we are learning to analyse is, as well as people’s genomes, we are analysing their behaviour and linking genotype to phenotype, the way our genes control what happens to us.
癌症一直是一个和年龄相关的疾病。
Cancer is still a disease of age.
今天，每两个人中，就有一个可能发生癌症，而过去是每三人中有一个，这其实是因为我们的寿命更长了。
And now one in two of us, not one in three of us are going to develop cancer, because we are living longer.
我们实际正在理清什么时候该治疗，如何治疗，以及什么时候不治疗。
And we are actually understanding when to treat, how to treat, but also when not to treat.
我们利用大数据分析，这不仅是关于医学，细胞学，分子生物学和药学，我们利用云端，最新的生物信息学，统计分析软件，和最新的技术来整合全部的细胞生物信息，这就是大数据。
And we are using big data analysis where it’s not just about medicine, cell biology, molecular biology, and the drugs, we are using the cloud, the latest bioinformatics, and statistical analysis software, and the latest in technical expertise to integrate with all of the cell biology information, we call that big data.
让我们回到地铁站的类比，我们已经明确了一些新的地铁站，这些地铁站我们以前并不知道他们在癌症中的重要性。
Just go back to the tube station analogy, we’ve identified some new tube stations that weren’t known about before as being important in cancer.
我们试图制造一些智能炸弹，然后丢到这些地铁站，而不损害其它的地铁站。
And we are trying to make smart bombs, just to drop on those tube stations, leaving all the others clear.
这样做来，同样地，我们并不是用一种“一刀切”的治疗策略。
So by doing so. Once agin, we are not using a one size fits all approach.
我们是在订制治疗，给每一个病人做到个性化的治疗，以同时增加生命质量和生命长度。这是我们努力的方向。因为质量或长度，单独的存在都没有什么用。
We are tailor-making it to the individual treatment, to the individual patient, to extend both quality and quantity of life, which is what you are trying to do, because one without the other isn’t very useful.
行医25年，从牛津大学，到美国东海岸，再回到伦敦，我们这个学科，以前进展缓慢，现在发展迅猛。如今是做肿瘤科医生最令人振奋的时代。
I’ve been a doctor for 25 years.I studied in Oxford, I then went to America for many years on the East coast and then came back here and all those has been going on, the developments have been in little steps, now it’s in large increments.So it’s a very exciting time to be looking after people with cancer as well.
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