TEDMED 2018
Carl June: A "living drug" that could change the way we treat cancer
Carl June: "Obat hidup" yang mengubah cara pengobatan kanker
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Carl June adalah pelopor di balik terapi sel T CAR: pengobatan kanker inovatif yang meningkatkan sistem imun pasien untuk menyerang dan membunuh tumor. Mengangkat tema inovasi, dia bercerita bagaimana riset selama tiga puluh tahun menghasilkan terapi yang membasmi leukemia yang dulunya dianggap tak dapat disembuhkan, serta menjelaskan bagaimana terapi ini juga dapat digunakan untuk memerangi kanker jenis lain.
Carl June - Oncologist, researcher, professor
Carl June is a renowned pioneer in the fight against cancer. Full bio
Carl June is a renowned pioneer in the fight against cancer. Full bio
Double-click the English transcript below to play the video.
00:12
So this is the first time
I've told this story in public,
I've told this story in public,
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Ini pertama kalinya saya
menceritakan ini di depan umum,
menceritakan ini di depan umum,
00:15
the personal aspects of it.
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aspek personalnya.
00:19
Yogi Berra was a world-famous
baseball player who said,
baseball player who said,
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Yogi Berra adalah pemain bisbol
terkenal yang berkata,
terkenal yang berkata,
00:24
"If you come to a fork
in the road, take it."
in the road, take it."
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"Jika bertemu jalan bercabang,
ambil keputusan."
ambil keputusan."
00:27
Researchers had been,
for more than a century,
for more than a century,
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Selama lebih dari satu abad,
peneliti telah
peneliti telah
00:30
studying the immune system
as a way to fight cancer,
as a way to fight cancer,
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mempelajari sistem imun
sebagai cara melawan kanker,
sebagai cara melawan kanker,
00:34
and cancer vaccines have,
unfortunately, been disappointing.
unfortunately, been disappointing.
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dan vaksin kanker, sayangnya,
mengecewakan.
mengecewakan.
00:37
They've only worked in cancers
caused by viruses,
caused by viruses,
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Vaksin hanya ampuh pada kanker
yang disebabkan virus,
yang disebabkan virus,
00:40
like cervical cancer or liver cancer.
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seperti kanker serviks atau kanker hati.
00:45
So cancer researchers basically
gave up on the idea
gave up on the idea
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Jadi, sebenarnya peneliti
tidak lagi mengandalkan konsep
tidak lagi mengandalkan konsep
00:47
of using the immune system
to fight cancer.
to fight cancer.
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penggunaan sistem imun
untuk melawan kanker.
untuk melawan kanker.
00:52
And the immune system, in any case,
did not evolve to fight cancer;
did not evolve to fight cancer;
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Dan sistem imun, apa pun itu,
tidak berkembang untuk melawan kanker,
tidak berkembang untuk melawan kanker,
00:56
it evolved to fight pathogens
invading from the outside.
invading from the outside.
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tapi untuk melawan patogen
yang menyerang dari luar.
yang menyerang dari luar.
00:59
So its job is to kill
bacteria and viruses.
bacteria and viruses.
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Jadi, tugasnya membunuh
bakteri dan virus.
bakteri dan virus.
01:03
And the reason the immune system
has trouble with most cancers
has trouble with most cancers
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Dan alasan sistem imun sulit
memerangi sebagian besar kanker
memerangi sebagian besar kanker
01:06
is that it doesn't invade
from the outside;
from the outside;
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adalah karena kanker tidak
menyerang dari luar,
menyerang dari luar,
01:10
it evolves from its own cells.
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tapi berkembang dari selnya sendiri.
01:14
And so either the immune system does
not recognize the cancer as a problem,
not recognize the cancer as a problem,
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Jadi, sistem imun bisa jadi tidak
mengenali kanker sebagai masalah,
mengenali kanker sebagai masalah,
01:18
or it attacks a cancer
and also our normal cells,
and also our normal cells,
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atau justru menyerang sel kanker
sekaligus sel normal kita,
sekaligus sel normal kita,
01:21
leading to autoimmune diseases
like colitis or multiple sclerosis.
like colitis or multiple sclerosis.
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menimbulkan penyakit autoimun
seperti kolitis atau sklerosis multipel.
seperti kolitis atau sklerosis multipel.
01:26
So how do you get around that?
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Jadi, bagaimana cara mengatasinya?
01:28
Our answer turned out to be
synthetic immune systems
synthetic immune systems
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Jawaban kami adalah
sistem imun buatan
sistem imun buatan
01:33
that are designed to recognize
and kill cancer cells.
and kill cancer cells.
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yang dirancang untuk mengenali
dan membunuh sel kanker.
dan membunuh sel kanker.
01:37
That's right -- I said
a synthetic immune system.
a synthetic immune system.
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Benar, saya bilang sistem imun buatan.
01:42
You do that with genetic engineering
and synthetic biology.
and synthetic biology.
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Anda melakukannya dengan
rekayasa genetika dan biologi sintetis.
rekayasa genetika dan biologi sintetis.
01:47
We did it with the naturally occurring
parts of the immune system,
parts of the immune system,
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Kami dengan komponen sistem imun
yang terjadi secara alami,
yang terjadi secara alami,
01:50
called B cells and T cells.
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yang disebut sel B dan sel T.
01:52
These were our building blocks.
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Inilah komponen dasar kami.
01:55
T cells have evolved to kill
cells infected with viruses,
cells infected with viruses,
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Sel T berkembang untuk membunuh
sel yang terinfeksi virus,
sel yang terinfeksi virus,
01:59
and B cells are the cells that make
antibodies that are secreted
antibodies that are secreted
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sedangkan sel B membentuk
antibodi yang dikeluarkan
antibodi yang dikeluarkan
02:03
and then bind to kill bacteria.
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untuk kemudian membunuh bakteri.
02:07
Well, what if you combined
these two functions
these two functions
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Bagaimana jika kedua fungsi
ini digabungkan
ini digabungkan
02:11
in a way that was designed
to repurpose them to fight cancer?
to repurpose them to fight cancer?
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dalam cara yang dirancang
untuk melawan kanker?
untuk melawan kanker?
02:15
We realized it would be possible
to insert the genes for antibodies
to insert the genes for antibodies
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Kami sadar bukan hal mustahil
menyisipkan gen penghasil antibodi
menyisipkan gen penghasil antibodi
02:19
from B cells into T cells.
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dari sel B ke dalam sel T.
02:21
So how do you do that?
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Bagaimana caranya?
02:24
Well, we used an HIV virus
as a Trojan horse
as a Trojan horse
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Kami memanfaatkan virus HIV
sebagai kuda troya
sebagai kuda troya
02:28
to get past the T cells' immune system.
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untuk melewati sistem imun sel T.
02:32
The result is a chimera,
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Hasilnya adalah chimera,
02:34
a fantastic fire-breathing creature
from Greek mythology,
from Greek mythology,
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makhluk fantastis penyembur api
dalam mitologi Yunani,
dalam mitologi Yunani,
02:38
with a lion's head, a goat's body
and a serpent's tail.
and a serpent's tail.
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dengan kepala singa, tubuh kambing,
dan ekor ular.
dan ekor ular.
02:42
So we decided that the paradoxical
thing that we had created
thing that we had created
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Jadi, kami memutuskan benda
paradoksal ciptaan kami ini,
paradoksal ciptaan kami ini,
02:46
with our B-cell antibodies,
our T cells carrier
our T cells carrier
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dengan antibodi sel B,
pengangkut sel T,
pengangkut sel T,
02:50
and the HIV Trojan horse
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serta kuda troya HIV,
02:52
should be called "Chimeric Antigen
Receptor T cells," or CAR T cells.
Receptor T cells," or CAR T cells.
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dinamai "sel T reseptor
antigen chimeric", atau sel T CAR.
antigen chimeric", atau sel T CAR.
02:58
The virus also inserts genetic information
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Virus itu juga menyisipkan
informasi genetik
informasi genetik
03:01
to activate the T cells and program them
into their killing mode.
into their killing mode.
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untuk mengaktifkan sel T dan
memprogramnya sebagai pembunuh.
memprogramnya sebagai pembunuh.
03:05
So when CAR T cells are injected
into somebody with cancer,
into somebody with cancer,
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Jadi, ketika sel T CAR disuntikkan
ke pengidap kanker,
ke pengidap kanker,
03:10
what happens when those CAR T cells
see and bind to their tumor target?
see and bind to their tumor target?
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apa yang terjadi begitu sel T CAR
melihat target tumornya?
melihat target tumornya?
03:14
They act like supercharged killer
T cells on steroids.
T cells on steroids.
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Ia bertindak seperti sel T pembunuh
ganas terhadap steroid.
ganas terhadap steroid.
03:19
They start this crash-defense
buildup system in the body
buildup system in the body
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Sel T CAR memulai sistem penguatan
pertahanan dalam tubuh
pertahanan dalam tubuh
03:22
and literally divide
and multiply by the millions,
and multiply by the millions,
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dan secara harfiah terus membelah
dan menggandakan diri,
dan menggandakan diri,
03:25
where they then attack and kill the tumor.
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lalu menyerang dan membunuh tumor.
03:28
All of this means that CAR T cells
are the first living drug in medicine.
are the first living drug in medicine.
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Ini artinya sel T CAR adalah obat hidup
pertama di bidang kedokteran.
pertama di bidang kedokteran.
03:34
CAR T cells break the mold.
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Sel T CAR membuka jalan baru.
03:35
Unlike normal drugs that you take --
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Tidak seperti obat biasa
yang Anda konsumsi,
yang Anda konsumsi,
03:38
they do their job and get metabolized,
and then you have to take them again --
and then you have to take them again --
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yang bekerja dan dimetabolisme,
lalu harus diminum lagi,
lalu harus diminum lagi,
03:42
CAR T cells stay alive
and on the job for years.
and on the job for years.
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Sel T CAR hidup dan terus bekerja
selama bertahun-tahun.
selama bertahun-tahun.
03:46
We have had CAR T cells stay
in the bodies of our cancer patients
in the bodies of our cancer patients
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Ada pasien kanker kami dengan
sel T CAR yang menetap di tubuhnya
sel T CAR yang menetap di tubuhnya
03:51
now for more than eight years.
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hingga lebih dari delapan tahun.
03:54
And these designer
cancer T cells, CAR T cells,
cancer T cells, CAR T cells,
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Dan sel T rancangan ini, sel T CAR,
03:57
have a calculated half-life
of more than 17 years.
of more than 17 years.
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diperkirakan memiliki
waktu paruh lebih dari 17 tahun.
waktu paruh lebih dari 17 tahun.
04:01
So one infusion can do the job;
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Jadi, dengan infus satu kali saja,
04:03
they stay on patrol
for the rest of your life.
for the rest of your life.
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sel T CAR akan terus
berpatroli seumur hidup.
berpatroli seumur hidup.
04:06
This is the beginning
of a new paradigm in medicine.
of a new paradigm in medicine.
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Inilah awal paradigma baru
di bidang kedokteran.
di bidang kedokteran.
04:10
Now, there was one major challenge
to these T-cell infusions.
to these T-cell infusions.
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Sekarang, ada satu tantangan besar
pada infus sel T ini.
pada infus sel T ini.
04:15
The only source of T cells
that will work in a patient
that will work in a patient
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Satu-satunya sumber sel T
yang akan bekerja di tubuh pasien
yang akan bekerja di tubuh pasien
04:20
are your own T cells,
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adalah sel Anda sendiri,
04:21
unless you happen to have
an identical twin.
an identical twin.
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kecuali Anda memiliki kembar identik.
04:24
So for most of us, we're out of luck.
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Sebagian besar dari kita kurang beruntung.
04:28
So what we did was to make CAR T cells.
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Jadi, yang kami lakukan adalah
membuat sel T CAR.
membuat sel T CAR.
04:32
We had to learn to grow
the patient's own T cells.
the patient's own T cells.
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Kami belajar menumbuhkan
sel T milik pasien sendiri.
sel T milik pasien sendiri.
04:35
And we developed a robust
platform for this in the 1990s.
platform for this in the 1990s.
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Dan kami mengembangkan platform
yang kuat untuk ini pada 1990-an.
yang kuat untuk ini pada 1990-an.
04:39
Then in 1997, we first tested
CAR T cells in patients
CAR T cells in patients
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Lalu pada 1997, untuk pertama kalinya
kami menguji sel T CAR pada pasien
kami menguji sel T CAR pada pasien
04:43
with advanced HIV-AIDS.
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dengan HIV-AIDS stadium lanjut.
04:46
And we found that those CAR T cells
survived in the patients
survived in the patients
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Kami menemukan sel T CAR
bertahan di tubuh pasien
bertahan di tubuh pasien
04:49
for more than a decade.
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selama lebih dari sepuluh tahun.
04:50
And it improved their immune system
and decreased their viruses,
and decreased their viruses,
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Dan sistem imun mereka meningkat
dan virus mereka menurun,
dan virus mereka menurun,
04:54
but it didn't cure them.
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tapi mereka tidak sembuh.
04:55
So we went back to the laboratory,
and over the next decade
and over the next decade
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Jadi kami kembali ke laboratorium,
dan dekade berikutnya
dan dekade berikutnya
04:58
made improvements
to the CAR T cell design.
to the CAR T cell design.
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terus menyempurnakan
rancangan sel T CAR.
rancangan sel T CAR.
05:01
And by 2010, we began treating
leukemia patients.
leukemia patients.
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Pada 2010, kami mulai mengobati
pasien leukemia.
pasien leukemia.
05:05
And our team treated three patients
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Tim kami mengobati tiga pasien
05:08
with advanced chronic
lymphocytic leukemia in 2012.
lymphocytic leukemia in 2012.
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dengan leukemia limfosit kronis
stadium lanjut pada 2012.
stadium lanjut pada 2012.
05:11
It's a form of incurable leukemia
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Itu sejenis leukemia yang
tidak bisa disembuhkan
tidak bisa disembuhkan
05:14
that afflicts approximately 20,000 adults
every year in the United States.
every year in the United States.
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yang setiap tahun menyerang sekitar
20.000 orang dewasa di Amerika Serikat.
20.000 orang dewasa di Amerika Serikat.
05:19
The first patient that we treated
was a retired Marine sergeant
was a retired Marine sergeant
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Pasien pertama kami seorang
pensiunan sersan angkatan laut
pensiunan sersan angkatan laut
05:24
and a prison corrections officer.
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dan petugas lapas.
Usianya tinggal
hitungan minggu
hitungan minggu
05:26
He had only weeks to live
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05:28
and had, in fact, already paid
for his funeral.
for his funeral.
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dan dia bahkan telah membayar
biaya pemakamannya.
biaya pemakamannya.
05:33
The cells were infused,
and within days, he had high fevers.
and within days, he had high fevers.
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Sel itu dimasukkan, dan dalam
beberapa hari dia demam tinggi.
beberapa hari dia demam tinggi.
05:37
He developed multiple organ failures,
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Dia mengalami kegagalan multi organ,
05:39
was transferred to the ICU
and was comatose.
and was comatose.
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dipindahkan ke ICU, dan koma.
05:41
We thought he would die,
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Kami mengira dia akan meninggal,
05:43
and, in fact, he was given last rites.
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dan dia bahkan menerima sakramen terakhir.
05:45
But then, another
fork in the road happened.
fork in the road happened.
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Tapi kemudian, jalan
kembali bercabang.
kembali bercabang.
05:50
So, around 28 days after
the CAR T cell infusion,
the CAR T cell infusion,
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Sekitar 28 hari setelah
infus sel T CAR,
infus sel T CAR,
05:53
he woke up,
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dia siuman,
05:54
and the physicians finally examined him,
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dan dokter memeriksanya,
05:57
and the cancer was gone.
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dan kankernya hilang.
05:58
The big masses that
had been there had melted.
had been there had melted.
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Massa besar yang tadinya ada
telah hancur.
telah hancur.
06:01
Bone marrow biopsies found
no evidence of leukemia,
no evidence of leukemia,
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Biopsi sumsum tulang tak
menemukan jejak leukemia,
menemukan jejak leukemia,
06:04
and that year, in our first
three patients we treated,
three patients we treated,
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dan tahun itu, dari tiga pasien
pertama yang kami obati,
pertama yang kami obati,
06:07
two of three have had durable remissions
now for eight years,
now for eight years,
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dua mencapai remisi selama
delapan tahun sampai sekarang,
delapan tahun sampai sekarang,
06:10
and one had a partial remission.
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dan satu lagi remisi parsial.
06:13
The CAR T cells had attacked
the leukemia in these patients
the leukemia in these patients
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Sel T CAR menyerang leukemia
di tubuh ketiga pasien ini
di tubuh ketiga pasien ini
06:16
and had dissolved between 2.9
and 7.7 pounds of tumor in each patient.
and 7.7 pounds of tumor in each patient.
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dan menghancurkan antara 1,3 dan 3,5
kilogram tumor dalam setiap pasien.
kilogram tumor dalam setiap pasien.
06:24
Their bodies had become veritable
bioreactors for these CAR T cells,
bioreactors for these CAR T cells,
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Tubuh mereka menjadi
bioreaktor nyata untuk sel T CAR,
bioreaktor nyata untuk sel T CAR,
06:29
producing millions
and millions of CAR T cells
and millions of CAR T cells
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yang menghasilkan jutaan sel T CAR
06:32
in the bone marrow,
blood and tumor masses.
blood and tumor masses.
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di sumsum tulang, darah,
dan massa tumor.
dan massa tumor.
06:36
And we discovered that these CAR T cells
can punch far above their weight class,
can punch far above their weight class,
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Dan kami lihat sel T CAR sanggup
bertarung di kelas yang lebih tinggi,
bertarung di kelas yang lebih tinggi,
06:40
to use a boxing analogy.
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menggunakan analogi tinju.
06:42
Just one CAR T cell can kill
1,000 tumor cells.
1,000 tumor cells.
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Satu sel T CAR saja dapat membunuh
1.000 sel tumor.
1.000 sel tumor.
06:47
That's right -- it's a ratio
of one to a thousand.
of one to a thousand.
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Benar, rasionya satu berbanding seribu.
06:50
The CAR T cell and
its daughter progeny cells
its daughter progeny cells
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Sel T CAR dan sel-sel keturunannya
06:53
can divide and divide
and divide in the body
and divide in the body
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dapat membelah dan
terus membelah dalam tubuh
terus membelah dalam tubuh
06:56
until the last tumor cell is gone.
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hingga sel tumor terakhir menghilang.
06:58
There's no precedent for this
in cancer medicine.
in cancer medicine.
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Belum ada preseden untuk ini
dalam pengobatan kanker.
dalam pengobatan kanker.
07:01
The first two patients
who had full remission
who had full remission
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Kedua pasien pertama yang
mencapai remisi penuh
mencapai remisi penuh
07:04
remain today leukemia-free,
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bebas leukemia hingga hari ini,
07:07
and we think they are cured.
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dan kami pikir mereka sembuh.
07:09
These are people
who had run out of options,
who had run out of options,
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Mereka orang-orang yang
tak lagi punya pilihan,
tak lagi punya pilihan,
07:13
and by all traditional methods they had,
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dan dengan semua metode
tradisional yang dicoba,
tradisional yang dicoba,
07:15
they were like modern-day Lazarus cases.
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mereka bagaikan Lazarus versi modern.
07:18
All I can say is: thank goodness
for those forks in the road.
for those forks in the road.
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Saya hanya bisa bilang: syukurlah
ada banyak jalan bercabang.
ada banyak jalan bercabang.
07:23
Our next step was to get permission
to treat children with acute leukemia,
to treat children with acute leukemia,
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Langkah kami berikutnya adalah mendapat
izin mengobati anak pasien leukemia akut,
izin mengobati anak pasien leukemia akut,
07:27
the most common form of cancer in kids.
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bentuk kanker paling umum pada anak.
07:30
The first patient we enrolled
on the trial was Emily Whitehead,
on the trial was Emily Whitehead,
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Pasien pertama kami untuk
uji coba ini adalah Emily Whitehead,
uji coba ini adalah Emily Whitehead,
07:33
and at that time, she was six years old.
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dan saat itu dia berumur 6 tahun.
07:35
She had gone through
a series of chemotherapy
a series of chemotherapy
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Dia telah menjalani
serangkaian kemoterapi
serangkaian kemoterapi
07:38
and radiation treatments
over several years,
over several years,
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dan pengobatan radiasi
selama beberapa tahun,
selama beberapa tahun,
07:40
and her leukemia had always come back.
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tapi leukemia selalu datang lagi,
07:42
In fact, it had come back three times.
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bahkan sampai tiga kali.
07:45
When we first saw her, Emily was very ill.
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Ketika kami pertama kali melihatnya,
Emily sakit parah.
Emily sakit parah.
07:51
Her official diagnosis
was advanced, incurable leukemia.
was advanced, incurable leukemia.
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Diagnosis awalnya leukemia stadium
lanjut yang tidak bisa disembuhkan.
lanjut yang tidak bisa disembuhkan.
07:55
Cancer had invaded her bone marrow,
her liver, her spleen.
her liver, her spleen.
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Kanker menyerang sumsum tulang,
hati, dan limpanya.
hati, dan limpanya.
08:00
And when we infused her
with the CAR T cells
with the CAR T cells
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Ketika kami menginfusnya
dengan sel T CAR
dengan sel T CAR
08:03
in the spring of April 2012,
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pada musim semi April 2012,
08:05
over the next few days,
she did not get better.
she did not get better.
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selama beberapa hari berikutnya,
dia tidak membaik.
dia tidak membaik.
08:08
She got worse, and in fact, much worse.
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Kondisinya memburuk, dan
bahkan jauh lebih buruk.
bahkan jauh lebih buruk.
08:11
As our prison corrections
officer had in 2010,
officer had in 2010,
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Seperti petugas lapas
pasien kami pada 2010,
pasien kami pada 2010,
08:14
she, in 2012, was admitted to the ICU,
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Emily, tahun 2012, dimasukkan ke ICU,
08:17
and this was the scariest fork
in the whole road of this story.
in the whole road of this story.
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dan ini cabang paling
menakutkan dalam kisah ini.
menakutkan dalam kisah ini.
08:21
By day three, she was comatose
and on life support
and on life support
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Pada hari ketiga, Emily koma
dan butuh alat penopang hidup
dan butuh alat penopang hidup
08:26
for kidney failure, lung failure and coma.
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karena gagal jantung, paru-paru, dan koma.
08:30
Her fever was as high
as 106 degrees Fahrenheit for three days.
as 106 degrees Fahrenheit for three days.
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Demamnya mencapai 41 derajat Celsius
selama tiga hari.
selama tiga hari.
08:35
And we didn't know
what was causing those fevers.
what was causing those fevers.
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Kami tidak tahu penyebab
demam itu.
demam itu.
08:38
We did all the standard
blood tests for infections,
blood tests for infections,
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Kami lakukan semua tes darah
standar untuk infeksi,
standar untuk infeksi,
08:41
and we could not find
an infectious cause for her fever.
an infectious cause for her fever.
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tapi tidak bisa menemukan
infeksi yang menyebabkan demamnya.
infeksi yang menyebabkan demamnya.
08:44
But we did find something
very unusual in her blood
very unusual in her blood
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Tapi kami menemukan
kejanggalan dalam darahnya
kejanggalan dalam darahnya
08:48
that had never been seen
before in medicine.
before in medicine.
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yang belum pernah ada
di dunia pengobatan.
di dunia pengobatan.
08:51
She had elevated levels of a protein
called interleukin-6, or IL-6,
called interleukin-6, or IL-6,
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Dia mengalami peningkatan level protein
bernama interleukin-6, atau IL-6,
bernama interleukin-6, atau IL-6,
08:56
in her blood.
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dalam darahnya.
08:57
It was, in fact, more than a thousandfold
above the normal levels.
above the normal levels.
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Bahkan lebih dari seribu kali lipat
di atas normal.
di atas normal.
09:03
And here's where yet another
fork in the road came in.
fork in the road came in.
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Di sinilah jalan bercabang
kembali muncul.
kembali muncul.
09:08
By sheer coincidence,
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Sungguh kebetulan,
09:10
one of my daughters has a form
of pediatric arthritis.
of pediatric arthritis.
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salah satu putri saya
mengidap artritis anak.
mengidap artritis anak.
09:16
And as a result, I had been
following as a cancer doc,
following as a cancer doc,
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Akibatnya, sebagai dokter kanker,
saya mengikuti perkembangan
saya mengikuti perkembangan
09:19
experimental therapies
for arthritis for my daughter,
for arthritis for my daughter,
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terapi eksperimental untuk
artritis bagi putri saya,
artritis bagi putri saya,
09:23
in case she would need them.
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sekiranya dibutuhkan.
09:24
And it so happened that just months
before Emily was admitted to the hospital,
before Emily was admitted to the hospital,
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Kebetulan, hanya beberapa bulan
sebelum Emily masuk rumah sakit,
sebelum Emily masuk rumah sakit,
09:29
a new therapy had been approved by the FDA
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sebuah terapi baru disetujui FDA
09:32
to treat elevated levels of interleukin-6.
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untuk mengobati peningkatan
level interleukin-6.
level interleukin-6.
09:34
And it was approved for the arthritis
that my daughter had.
that my daughter had.
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Obat ini disetujui untuk artritis
yang diidap anak saya.
yang diidap anak saya.
09:37
It's called tocilizumab.
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Namanya tocilizumab.
09:40
And, in fact, it had just been added
to the pharmacy at Emily's hospital,
to the pharmacy at Emily's hospital,
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Bahkan obat ini baru saja ditambahkan
di apotik rumah sakit Emily,
di apotik rumah sakit Emily,
09:45
for arthritis.
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untuk artritis.
09:47
So when we found Emily had
these very high levels of IL-6,
these very high levels of IL-6,
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Jadi, ketika kami menemukan
level IL-6 Emily sangat tinggi,
level IL-6 Emily sangat tinggi,
09:50
I called her doctors in the ICU and said,
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saya menghubungi dokternya
di ICU dan berkata,
di ICU dan berkata,
09:53
"Why don't you treat her
with this arthritis drug?"
with this arthritis drug?"
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"Kenapa dia tidak diobati
dengan obat artritis saja?"
dengan obat artritis saja?"
09:56
They said I was a cowboy
for suggesting that.
for suggesting that.
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Mereka bilang saran saya nekat.
09:59
And since her fever and low blood pressure
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Tapi karena demam dan
tekanan darahnya yang rendah
tekanan darahnya yang rendah
10:01
had not responded to any other therapy,
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tidak merespons terapi apa pun,
10:05
her doctor quickly asked permission
to the institutional review board,
to the institutional review board,
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dokternya segera meminta izin
dewan peninjau ulang institusional,
dewan peninjau ulang institusional,
10:08
her parents,
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orang tua Emily,
10:09
and everybody, of course, said yes.
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dan semuanya, tentu saja,
mengizinkan.
mengizinkan.
10:11
And they tried it,
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Dan mereka mencobanya,
10:12
and the results were nothing
short of striking.
short of striking.
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dan hasilnya hampir mengesankan.
10:16
Within hours after treatment
with tocilizumab,
with tocilizumab,
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Beberapa jam setelah diobati
dengan tocilizumab,
dengan tocilizumab,
10:19
Emily began to improve very rapidly.
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Emily mulai menunjukkan
peningkatan pesat.
peningkatan pesat.
10:22
Twenty-three days after her treatment,
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Dua puluh tiga hari setelah pengobatan,
10:26
she was declared cancer-free.
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dia dinyatakan bebas kanker.
10:28
And today, she's 12 years old
and still in remission.
and still in remission.
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Dan sekarang, dia berusia 12 tahun
dan masih dalam remisi.
dan masih dalam remisi.
10:34
(Applause)
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(Tepuk tangan)
10:44
So we now call this violent reaction
of the high fevers and coma,
of the high fevers and coma,
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Jadi, sekarang kami menyebut reaksi kuat
demam tinggi dan koma ini,
demam tinggi dan koma ini,
10:50
following CAR T cells,
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yang mengikuti
sel T CAR,
sel T CAR,
10:51
cytokine release syndrome, or CRS.
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sindrom pelepasan sitokin, atau CRS.
10:54
We've found that it occurs in nearly
all patients who respond to the therapy.
all patients who respond to the therapy.
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Kami lihat ini terjadi pada hampir semua
pasien yang merespons terapi tersebut.
pasien yang merespons terapi tersebut.
10:58
But it does not happen
in those patients who fail to respond.
in those patients who fail to respond.
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Tapi tidak pada pasien
yang gagal merespons.
yang gagal merespons.
11:01
So paradoxically,
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1658
Jadi uniknya,
11:04
our patients now hope
for these high fevers after therapy,
for these high fevers after therapy,
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pasien kami sekarang mengharapkan
demam tinggi ini setelah terapi,
demam tinggi ini setelah terapi,
11:08
which feels like
"the worst flu in their life,"
"the worst flu in their life,"
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yang rasanya seperti
"flu terparah seumur hidup,"
"flu terparah seumur hidup,"
11:11
when they get CAR T-cell therapies.
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saat menjalani
terapi sel T-CAR.
terapi sel T-CAR.
11:13
They hope for this reaction
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Mereka mengharap
reaksi ini
reaksi ini
11:14
because they know it's part
of the twisting and turning path
of the twisting and turning path
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karena tahu ini bagian
dari titik balik
dari titik balik
11:18
back to health.
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untuk kembali sehat.
11:19
Unfortunately, not every patient recovers.
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Sayangnya, tidak setiap pasien sembuh.
11:22
Patients who do not get CRS
are often those who are not cured.
are often those who are not cured.
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Pasien yang tidak mengalami CRS
sering kali tidak sembuh.
sering kali tidak sembuh.
11:27
So there's a strong link now between CRS
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Jadi, ada kaitan kuat antara CRS
11:30
and the ability of the immune system
to eradicate leukemia.
to eradicate leukemia.
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3041
dan kemampuan sistem imun
untuk membasmi leukemia.
untuk membasmi leukemia.
11:33
That's why last summer,
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Maka, musim panas lalu,
11:35
when the FDA approved
CAR T cells for leukemia,
CAR T cells for leukemia,
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saat FDA menyetujui
sel T CAR untuk leukemia,
sel T CAR untuk leukemia,
11:41
they also co-approved the use
of tocilizumab to block the IL-6 effects
of tocilizumab to block the IL-6 effects
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mereka juga menyetujui penggunaan
tocilizumab untuk memblokir efek IL-6
tocilizumab untuk memblokir efek IL-6
11:47
and the accompanying CRS
in these patients.
in these patients.
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3011
dan CRS yang mengiringinya
pada para pasien ini.
pada para pasien ini.
11:50
That was a very unusual event
in medical history.
in medical history.
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Ini kejadian yang sangat langka
dalam sejarah kedokteran.
dalam sejarah kedokteran.
11:54
Emily's doctors have now
completed further trials
completed further trials
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Kini dokter Emily menyelesaikan
uji coba lanjutan
uji coba lanjutan
11:59
and reported that 27 out of 30 patients,
the first 30 we treated,
the first 30 we treated,
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dan melaporkan 27 dari 30 pasien,
30 orang pertama yang kami rawat,
30 orang pertama yang kami rawat,
12:04
or 90 percent,
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atau 90 persen,
12:05
had a complete remission
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mencapai remisi lengkap
12:08
after CAR T cells, within a month.
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2203
setelah terapi sel T CAR,
dalam sebulan.
dalam sebulan.
12:10
A 90 percent complete remission rate
in patients with advanced cancer
in patients with advanced cancer
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Angka remisi lengkap 90 persen
pada pasien kanker stadium lanjut
pada pasien kanker stadium lanjut
12:15
is unheard of
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1156
belum pernah terdengar
12:16
in more than 50 years of cancer research.
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selama lebih dari 50 tahun
penelitian kanker.
penelitian kanker.
12:19
In fact, companies often declare
success in a cancer trial
success in a cancer trial
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4765
Bahkan perusahaan kerap mengumumkan
keberhasilan uji coba kanker
keberhasilan uji coba kanker
12:24
if 15 percent of the patients
had a complete response rate.
had a complete response rate.
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3548
jika 15 persen pasien
memiliki angka respons lengkap.
memiliki angka respons lengkap.
12:28
A remarkable study appeared in the
"New England Journal of Medicine" in 2013.
"New England Journal of Medicine" in 2013.
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4469
Sebuah studi luar biasa muncul di
Jurnal Kedokteran New England pada 2013.
Jurnal Kedokteran New England pada 2013.
12:32
An international study
has since confirmed those results.
has since confirmed those results.
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Sebuah studi internasional juga
mengonfirmasi hasil ini.
mengonfirmasi hasil ini.
12:36
And that led to the approval by the FDA
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3572
Dan hasilnya, persetujuan FDA
12:40
for pediatric and young adult
leukemia in August of 2017.
leukemia in August of 2017.
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untuk leukemia anak dan remaja
pada Agustus 2017.
pada Agustus 2017.
12:45
So as a first-ever approval
of a cell and gene therapy,
of a cell and gene therapy,
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3427
Jadi, sebagai terapi sel dan gen
pertama yang disetujui,
pertama yang disetujui,
12:48
CAR T-cell therapy
has also been tested now
has also been tested now
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2216
terapi sel T CAR kini
juga diuji coba
juga diuji coba
12:50
in adults with refractory lymphoma.
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terhadap orang dewasa dengan
limfoma kambuhan.
limfoma kambuhan.
12:53
This disease afflicts about 20,000
a year in the United States.
a year in the United States.
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Penyakit ini menyerang sekitar
20.000 orang setahun di Amerika Serikat.
20.000 orang setahun di Amerika Serikat.
12:58
The results were equally impressive
and have been durable to date.
and have been durable to date.
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Hasilnya juga mengesankan
dan bertahan hingga hari ini.
dan bertahan hingga hari ini.
13:02
And six months ago, the FDA approved
the therapy of this advanced lymphoma
the therapy of this advanced lymphoma
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4877
Dan enam bulan lalu, FDA menyetujui
terapi limfoma stadium lanjut ini
terapi limfoma stadium lanjut ini
13:07
with CAR T cells.
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1432
dengan sel T CAR.
13:08
So now there are many labs and physicians
and scientists around the world
and scientists around the world
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Jadi, sekarang banyak lab dan dokter
dan ilmuwan di seluruh dunia
dan ilmuwan di seluruh dunia
13:14
who have tested CAR T cells
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2097
yang menguji sel T CAR
13:16
across many different diseases,
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784136
2810
untuk berbagai macam penyakit,
13:18
and understandably, we're all thrilled
with the rapid pace of advancement.
with the rapid pace of advancement.
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4437
dan jelas kami gembira
dengan kemajuannya yang pesat.
dengan kemajuannya yang pesat.
13:23
We're so grateful to see patients
who were formerly terminal
who were formerly terminal
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3603
Kami sangat bersyukur para pasien
yang tadinya tidak mungkin sembuh
yang tadinya tidak mungkin sembuh
13:27
return to healthy lives, as Emily has.
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3143
kini kembali sehat, seperti Emily.
13:30
We're thrilled to see long remissions
that may, in fact, be a cure.
that may, in fact, be a cure.
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Kami gembira melihat remisi panjang
yang bahkan mungkin sembuh.
yang bahkan mungkin sembuh.
13:34
At the same time, we're also concerned
about the financial cost.
about the financial cost.
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3809
Di sisi lain, kami mengkhawatirkan
masalah keuangan.
masalah keuangan.
13:38
It can cost up to 150,000 dollars
to make the CAR T cells for each patient.
to make the CAR T cells for each patient.
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4825
Biayanya mencapai 150.000 dolar untuk
pembuatan sel T CAR per pasien.
pembuatan sel T CAR per pasien.
13:43
And when you add in the cost
of treating CRS and other complications,
of treating CRS and other complications,
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3655
Dan jika ditambahkan biaya
pengobatan CRS dan komplikasi lain,
pengobatan CRS dan komplikasi lain,
13:47
the cost can reach
one million dollars per patient.
one million dollars per patient.
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3324
biayanya bisa satu juta dolar
per pasien.
per pasien.
13:51
We must remember that the cost
of failure, though, is even worse.
of failure, though, is even worse.
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3453
Tapi kita harus ingat biaya
kegagalannya jauh lebih besar.
kegagalannya jauh lebih besar.
13:55
The current noncurative therapies
for cancer are also expensive
for cancer are also expensive
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3315
Terapi non-kuratif terkini
untuk kanker juga mahal
untuk kanker juga mahal
13:58
and, in addition, the patient dies.
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2493
dan pasien tetap meninggal.
14:01
So, of course, we'd like to see
research done now
research done now
240
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2776
Jadi, tentu saja kami
menginginkan riset
menginginkan riset
14:04
to make this more efficient
241
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2820
yang menjadikan terapi ini
lebih efisien
lebih efisien
14:08
and increase affordability
to all patients.
to all patients.
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836367
2419
dan lebih terjangkau bagi
semua pasien.
semua pasien.
14:11
Fortunately, this is a new
and evolving field,
and evolving field,
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2231
Untungnya bidang ini baru
dan terus berkembang,
dan terus berkembang,
14:13
and as with many other new
therapies and services,
therapies and services,
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841431
3544
dan dengan banyaknya
terapi dan layanan baru lain,
terapi dan layanan baru lain,
14:16
prices will come down as industry learns
to do things more efficiently.
to do things more efficiently.
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844999
4253
harga akan menurun karena
industri belajar untuk lebih efisien.
industri belajar untuk lebih efisien.
14:21
When I think about
all the forks in the road
all the forks in the road
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2079
Ketika saya memikirkan
semua jalan bercabang
semua jalan bercabang
14:23
that have led to CAR T-cell therapy,
247
851840
2110
yang menghasilkan terapi sel T CAR,
14:25
there is one thing that strikes me
as very important.
as very important.
248
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2720
ada satu hal yang bagi saya amat penting.
14:29
We're reminded that discoveries
of this magnitude don't happen overnight.
of this magnitude don't happen overnight.
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857474
3579
Kami diingatkan bahwa penemuan
sebesar ini tidak terjadi dalam semalam.
sebesar ini tidak terjadi dalam semalam.
14:33
CAR T-cell therapies came to us
after a 30-year journey,
after a 30-year journey,
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861426
4326
Terapi sel T CAR muncul
setelah perjalanan 30 tahun,
setelah perjalanan 30 tahun,
14:37
along a road full of setbacks
and surprises.
and surprises.
251
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2960
menyusuri jalan yang penuh
rintangan dan kejutan.
rintangan dan kejutan.
14:41
In all this world of instant gratification
252
869093
2412
Di dunia yang menuntut
kepuasan instan,
kepuasan instan,
14:43
and 24/7, on-demand results,
253
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3048
serta hasil yang tersedia kapan saja,
14:46
scientists require persistence,
vision and patience
vision and patience
254
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4128
ilmuwan membutuhkan keuletan,
visi, dan kesabaran
visi, dan kesabaran
14:50
to rise above all that.
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untuk mengatasi semua itu.
14:52
They can see that the fork in the road
is not always a dilemma or a detour;
is not always a dilemma or a detour;
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Mereka bisa melihat jalan bercabang
tak selalu menjadi dilema atau halangan.
tak selalu menjadi dilema atau halangan.
14:57
sometimes, even though
we may not know it at the time,
we may not know it at the time,
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Terkadang, meski saat itu
kita mungkin tidak tahu,
kita mungkin tidak tahu,
15:01
the fork is the way home.
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cabang itulah jalan pulang.
15:03
Thank you very much.
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Terima kasih banyak.
15:04
(Applause)
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(Tepuk tangan)
ABOUT THE SPEAKER
Carl June - Oncologist, researcher, professorCarl June is a renowned pioneer in the fight against cancer.
Why you should listen
Carl June's revolutionary leukemia therapy, which was recently approved by the FDA, uses genetically engineered versions of a patient’s own T cells and is the first personalized cell therapy for cancer to be sanctioned in America. Developed by June and his colleagues, this method has the potential to help patients with many other types of cancers.
June is currently Director of the Center for Cellular Immunotherapies at the Perelman School of Medicine and Director of the Parker Institute for Cancer Immunotherapy at the University of Pennsylvania. A graduate of the Naval Academy in Annapolis and Baylor College of Medicine, he has published more than 350 manuscripts and is the recipient of numerous prizes and honors, including election to the Institute of Medicine in 2012 and the American Academy of Arts and Sciences in 2014, as well as being named one of TIME Magazine's 100 Most Influential People in 2018.
Carl June | Speaker | TED.com