Newsletter No. 435

6 No. 435, 4.4.2014 瞄準肺癌 Taking Aim at Lung Cancer 新任李樹芬醫學基金腫瘤學教授的莫樹錦教授，在3月 11日發表其就職演講，題目為「向肺癌宣戰」。 抗癌猶如打仗，可惜長久以來人類在肺癌戰場上一直節 節敗退。一切歸咎於1492年10月，哥倫布探險隊一位中 尉吸食了第一口煙。香煙在1902年開始大量生產，加上 廣告宣傳，吸煙蔚然成風。單在2011年，全球死於肺癌的 人數已高達一百萬。惟到近年，有賴分子標靶治療的發 展，我們才開始在這場慘烈的戰事中重奪陣地。有了新武 器之後，現在的問題是該如何打贏這場戰爭。不妨借鑑 古人的智慧，《孫子兵法》云：「知己知彼，百戰不殆。」 過去數十年，我們把肺癌籠統分為小細胞肺癌和非小細 胞肺癌，但這並非全部事實。現在我們能夠掌握個別癌 細胞的分子圖譜，藉此針對該腫瘤，有的放矢。 莫教授在演講中解釋分子標靶治療的機理，藉着了解個 別肺癌的分子圖譜，可以針對腫瘤對症下藥。最佳例子 是發現了上皮因子受體突變這個致癌因子，並研發出表 皮因子酪胺酸酶抑制劑，再加上對於組織和血液樣本的 高靈敏度和特異性分析，可用作有該類突變病人的第一 線標準治療手段。這在ELM4-ALK易位變異病患者身上 亦得到印證。有了特定的遺傳信息在手，莫教授就能進行 臨床試驗，測試專門針對突變的藥物，結果令人振奮。莫 教授盼望，憑着更精良的檢測，採用綜合療法策略，以及 對付抗藥性問題，能為帶有已知致癌因子的病患提供更 佳的治療。 孫子曰：「謀無術則成事難，術無謀則必敗。」毫無疑問， 現時投放於肺癌研究的資源已不少，可惜更多精力擺在 了滿足監管要求。在研究發現和治療策略方面，我們必 須擺脫「人有我有」及「人有我優」的競爭觀念，檢討臨 床試驗背後的理念，並重新審視監管指引，以令更多資 源能用於研發新療法，這樣才能在抗癌研究方面有長足 進步。 在這場與肺癌的抗戰中，醫生、病人、家人、倡導者、研究 人員、製藥企業和政府等均參與其中，必須同心協力發 展新的研究策略和治療。近年來，全球朝着這個目標的 合作愈來愈多，唯有如此，我們才能贏取最終勝利，令病 人得到更好的照顧。 Prof. Tony S.K. Mok, newly appointed Li Shu Fan Medical Foundation Professor of Clinical Oncology at The Chinese University of Hong Kong, delivered his inaugural lecture entitled ‘Declaration of War against Lung Cancer’ on 11 March. Fighting cancer is like fighting a war. Unfortunately we have been losing the battle against lung cancer for many years. It all started in October 1492 when tobacco was first smoked by a lieutenant on Columbus’s expedition. Its popularity was fanned by the manufacturing of cigarettes in 1902 and the promulgation of the corresponding advertisements. In 2011, global casualties from lung cancer amounted to one million. Only in recent years, with the development of molecular targeted therapy, have we begun to gain some ground in this tough fight. We are equipped with new weapons but the question now is how we can win the war. Ancient wisdom from Sun Tzu’s The Art of War provides guidance: ‘If you know the enemy and know yourself, you need not fear the result of a hundred battles.’ For many decades we have wrongly addressed lung cancer as single entity illness: small cell lung cancer or non- small cell lung cancer. But that is not the full picture. By understanding the molecular profile of each individual lung cancer, we are capable of targeting the tumor successfully. In the lecture, Professor Mok expounded the mechanism of molecular targeted therapy, which can be used to target the tumor by understanding the molecular profile of each individual lung cancer. The best example of this is the discovery of Epidermal Growth Factor Receptor (EGFR) mutation as a driver oncogene, and the establishment of EGFR Tyrosine Kinase Inhibitor (TKI). These discoveries, together with high sensitivity and specificity analysis of tissue and blood samples, could be used as the standard first line treatment for patients harbouring the mutation. The same concept is reconfirmed in patients with ELM4- ALK translocation mutation. With information of the specific genetic information, Professor Mok was able to conduct clinical trials with specific drug targeted for a mutation. The results have been encouraging. Professor Mok hopes to optimize treatment for patients with known driver oncogene by sophisticated detection, strategy on combination therapy and combating resistance. Sun Tzu also taught that: ‘Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.’ There is little doubt that a lot of resources are being put into lung cancer research but even more are put into meeting regulatory requirements. Our progress could be greatly enhanced by reducing ‘me too’ and ‘me better’ discoveries and strategies, reviewing the philosophy behind clinical trials as well as revisiting regulatory guidelines so that more resources could be used in the discovery of novel treatment. In this war against lung cancer, all parties with a stake in it including doctors, patients, families, advocates, researchers, pharmaceutical companies and governments must join hands and develop novel strategies in research and care delivery. In recent years, we have seen a lot more global collaboration towards this objective. Only with such an effort will we be able to take better care of our patients and come out as the victors. 左起：中大醫學院院長陳家亮教授、食物及衞生局局長高永文醫生、中大李樹芬醫學基金腫瘤學教授莫樹錦教授、李樹芬醫學基金 會主席李維達醫生，以及中大校長沈祖堯教授 From left: Prof. Francis Chan, Dean of Medicine, CUHK; Dr. Ko Wing-man, Secretary for Food and Health, HKSAR; Prof. Tony S.K. Mok, Li Shu Fan Medical Foundation Professor of Clinical Oncology, CUHK; Dr. Walton Li, chairman, Board of Governors, Li Shu Fan Medical Foundation; and Prof. Joseph J.Y. Sung, Vice-Chancellor, CUHK