DC细胞的抗原递呈原理见上图
五一假期本该是朋友圈po旅游照po美食照的季节，却被魏泽西事件刷了屏，百度及莆田系也再次被推上风口浪尖。 与此同时，癌症免疫治疗也带着负面形象进入很多人的视野。笔者出于两个目的写下本文：一是希望公众不要把癌症免疫治疗一棍子打死， 二是反思魏则西事件出现的原因。
首先简单介绍一下‘害死’魏则西的‘DC-CIK’免疫疗法。人体内几乎每天都会产生癌细胞，但为什么绝大多数人不会得癌症呢？这还要归功于人的免疫系统，尤其是可以杀死癌细胞的T细胞。但是T细胞本身并不具备识别癌细胞的本领，它只有在DC细胞的指引下才能行使功能。DC细胞发现癌细胞后会把癌细胞的重要特征‘告诉’T细胞，经过‘学习’后T细胞就可以准确攻击具有该特征的癌细胞。可见，DC细胞相当于战争中的侦察兵。而CIK细胞则为包括T细胞及NK细胞在内的一类免疫细胞。洛克菲勒大学的Ralph M. Steinman教授在被诊断出胰腺癌后一直通过分离自己血液中的DC细胞，经过体外扩增及激活后输回体内增加‘侦察兵’的数量进行治疗。该方法让原本只有三个月左右生存期的Steinman存活了近四年，他也因为DC细胞治疗的研究获得2011年诺贝尔医学奖。2010年第一款DC细胞治疗产品Provenge也经过FDA的批准并上市用于前列腺癌的治疗。由此可见，该治疗方法对于某些癌症并非完全无效的，更谈不上害死了魏则西。笔者甚至认为，排除莆田系、虚假宣传、武警二院等关键词后，魏则西接受的治疗方法是有一定科学依据的，因为他不幸罹患的滑膜肉瘤是不治之症，相信在此之前他已尝试了手术放化疗等常规疗法并到了山穷水尽的田地。
DC细胞治疗先驱Ralph M. Steinman
但又不得不指出DC细胞疗法只对<10%的病人是有效的。截至目前，FDA也只批准了DC细胞用于前列腺癌的治疗。那么魏则西是怎样感到自己被欺骗的呢？细胞免疫治疗不同于可批量生产的传统药物，长期以来对其药品属性还是医疗技术属性认定也不明晰，因此中国药监局与卫计委对其监管也是相互推诿。按照目前中国的规定，三甲医院或省及以上医院都可进行该治疗，但对该治疗的适用范围及使用程序却没有相关规定。宽松的监管政策及利益的驱使使该技术的使用在中国各个医院遍地开花，其宣传也与性病牛皮癣小广告出现在了同一根电线杆上。高昂的费用，难以保证的质量，夸大的宣传及对病情的绝望使魏则西深感他遇见了人性中最大的恶。
癌症免疫疗法本是一项很有前景的技术，它甚至是治愈某些癌症的最终答案。新一代免疫疗法如CAR-T疗法，PD/L-1抗体，CTLA-4抗体等开展的如火如荼。但与此同时，中国也急需相关政策的顶层设计，避免病人及家属受到欺骗的同时，也为免疫疗法发展创造一个更好的生存环境。
作者
王宝龙
简介
University College London 生化工程系博士
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