Transcriber: Matt Chan Reviewer: Emma Gon
Thank you, thank you for your time here today.
I want to talk a little bit about cancer research today,
which is a topic you may or may not be interested in.
I kind of want to make a wild guess, sort of an assumption,
that everyone here has somehow been impacted by cancer.
Whether it's been a friend, perhaps a family member,
or I can guarantee you that there're some courageous survivors in this audience.
I mean that's how rampant cancer is.
That's what we're dealing with.
How are we going to stop this,
what are we going do about this as a human race?
So I kind of want to throw out some statistics to you,
that are kind of scary for me, kind of frightening.
Men, one in two, half the men here will develop cancer;
one in four will die of cancer.
Ladies, one in three will develop;
one in five will die of cancer.
I mean that really frightens me.
We've done a lot, but clearly there is a lot more that we can do.
So I am cancer biologist, I like to study little cancer cells.
They are small, you can't see them.
They are a fraction of a millimeter. We use microscopes to see them.
I try to figure out how they behave, how they function these cancer cells.
Today I really wanted to talk to you about hope.
Where does hope live for this dreadful disease?
What are we going to do about this?
I'd like to talk to you a little bit
about what my laboratory is contributing to this.
And I'd like to talk to you about how us,
as an international cancer research community are handling this.
We have been very interested in understanding the biology behind cancer.
We have been very fascinated by this for a while.
And I want to kind of set a context for you,
I want to set a stage for you
to understand how we have been treating cancer,
and how we thought about cancer for a really long time.
I could use a little of a personal story.
So I am going to work one day, I am leaving the front door.
I am running out, trying to catch a meeting or whatever.
I close the door, wave goodbye to my kids through the window,
and hustle into the car, and I got to start the car up, right?
And turn the key, and the car doesn't start.
I look up, and there is now smoke coming out of the hood of my car.
Look up again, my kids that were once waving
are now laughing at me,
because what could be funnier than dad's car with smoke coming out of it?
I think about, I got to do something here, I got to do something about it.
What am I going to do, and I want to go lift up the hood.
About ten minutes later, I find the hood release.
I go to the front, I know nothing about cars,
so I lift it up, and indeed, there is smoke coming out of the car.
But I think, I am not a mechanic,
but I think that smoke is probably not the cause of the problem.
There is probably something wrong behind it.
Maybe the engine is broken,
maybe the carburetor fell off,
or the steering wheel is turned the wrong way, I don't know.
But I can guarantee you that it's not the smoke,
there is something else.
The smoke is here, but there is an underlying cause.
That's really an analogy for how we've understood cancers for a while.
We've understood the symptoms for instance, of cancer.
What's going on at the surface?
But we haven't understood really the underlying cause,
I mean at the molecular level,
what is driving the cancer at the molecular level?
We've known the symptoms,
but what's happening at the molecular level?
So what are the symptoms I am talking about?
I am going to show you some videos.
So my laboratory makes videos of cancer cells,
and we look at how they function, these are sort of one-of-the-kind,
and what you have in front of you is a video of breast cancer cells.
These are 20 breast cancer cells, watch what happens over three days.
Look how the grow.
They proliferate.
I mean this is scary, right?
That's sort of the same feeling that I have.
Look at them go, they proliferate quickly.
This is a symptom we will say of cancer,
proliferation or growth.
So, what's fascinating about this
is that people that have cancer
don't actually die from the growth, it's actually not that.
We actually look at the movement of cancer.
This is another symptom, most people die from the spread.
Watch these lung cancer cells, they are on the bottom-left and top-right,
and there is gap in between.
Watch how they move.
This is over night underneath a microscope.
This is known as metastasis, this is known as the spread of cancer.
When you hear malignancy, this is what we are talking about.
These are the symptoms, we have growth, and we have spread or movement.
But again, what is the underlying cause of this?
What is happening at the molecular level
that is causing this to happen?
I want to start with a little bit of history,
I think this is really helpful.
These are your chromosomes, we have 46 of them, 23 pairs.
On the chromosomes is our DNA code, 3 billion letters, 3 billion letter code.
Well, back in the 1990s, the United States government said:
"I want to sequence the entire DNA code, all 3 billion letters."
And this entire code is known as the genome,
so the project was called the Human Genome Project.
This got a lot of fanfare in media press.
It took about two decades to do this,
two decades, and it cost about 3 billion dollars.
So about a dollar a letter in the code, basically.
it took quite a while.
And we've learned a lot of biology for sure, we learned a lot about it.
Fast forward to today, right now, the technology that we have right now,
instead of costing 3 billion dollars, it cost a few thousand dollars.
And instead of taking a couple of decades, now it takes a couple of weeks.
This is a major jump in technology.
This is great, we can do this quicker and faster,
it's only going to get better.
We are going to do it for under 1,000 dollars,
and it's going to take a few days.
Perhaps, we may not even do one human genome,
we could do many at the same time.
This is great, we have this great technology.
But what about cancer, what does this mean for cancer?
This is the important point.
If we could sequence normal cells, we can sequence cancer cells.
It's obvious, it's logical.
So Imagine this scenario, every patient who comes into clinic
could have their specific cancer sequenced.
And this is really important,
because by understanding the sequence of the cancer,
we could then uncover the molecular changes
that occur in their specific cancer.
These changes are known as mutations.
So we can uncover the molecular mutations for everybody's cancer.
This has serious therapeutic implications,
which I am going to get to.
But there are also challenges, so we paint a very nice picture,
but like everything else, there are challenges.
There are challenges that range from how we are going to store this big data
- it's a popular topic - to privacy, to biology.
And that's one of those things we work on,
is that we are trying to contribute to this as cancer biologists,
to contribute to this international effort.
So what are we doing?
Well, this here is a real lung cancer,
this is what happens when someone gets a biopsy,
and it goes to a pathologist, this is what it looks like.
If you look at it, it's not all the same.
There are cancer cells in there, there are those patterns that form.
there are normal cells around it,
the cancer is in the middle on that pattern.
If we are going to sequence the entire tumor, the entire cancer,
what about the small cancer cells, the really rare cancer cells
that we know are extremely important?
They are just going to get lost in the greater population.
How do I go in and say, I want this cancer cell?
These guys are tiny like a fraction of a millimeter.
How do I pick what I want?
How do I know which is the bad cancer cell?
How do I know which is the ringleader?
That's what we are trying to do here.
This is a model that we create,
these are cancer cells,
it's a big ball of cancer cells with all the cells coming out of it,
and you could see they form these finger-like patterns.
Let me frame one more time.
Look how they spread out: there are some cells come out first
- these we call leader cells, or pioneer cells -
there are some cells that come out behind - we call them follower cells -
and there are some cells that never come out.
We know those leader cells at the front are really important.
They may in fact drive the spread in the metastasis.
So it's logical that we need to know what changes occur,
we need to know what changes occur to target them, to treat them.
I will show you how smart this guys are.
Watch, here comes out a single leader cell,
and watch what it does,
it comes out, and watch; it makes a U-turn to go get its followers.
it makes a U-turn, it communicates with other cells.
Let me frame one more time.
It comes out, and it'll make a U-turn.
It wants to have followers,
but what makes this cell special, what makes it important,
and how do I pick these cells and pull them out?
This is kind of fascinating for us.
So this is a cool technology, this is something we just developed.
We did it in the past year.
It combines existing technologies in a novel way.
This is a palette of cancer cells.
It's a green palette;
they have a special protein that comes from a jellyfish
that someone won the Nobel Prize for about five or seven years ago.
All the cells here, there are a couple hundred of cells,
they are green because of the special protein,
but it's a rarely unique green.
If we shine laser light on it, it could turn red.
So we could precisely define an area, the size of a cell
- even smaller if we want it to -
and turn that specific cell red.
What we have created it is an optical highlighter,
just like you would highlight a book,
and say I want this word, I want this letter.
We say I want this cell, these guys are small.
Let me just show you a sort of...
maybe it's a little bit of gimmick, but I'll show it to you.
So you could see, we could turn those specific cells red.
And these guys are like fractions of a millimeter.
And we could pick whatever cells we want.
Look at how precise it is, none of the other cells around it turn red.
Look at that precision, and you can go back and see it.
It's extremely precise.
So what do we do with this technology besides making silly TEDx logos?
This is our cell zapping microscope.
You could see the screen on the right, we could choose what cells we want,
and we zap the cells, and they turn red like I just showed you.
Then we send it through another existing technology,
and I kind of have a little animation here about it.
Look all the green cells go through, but now we zap the red cell.
So there is our red cell, and they are very rare,
1 in 10,000 maybe.
It gives it a charge,
and that single red cell could end up by itself in a well.
It's like a filter.
We could sort out those red cells by themselves.
We could even drop a single red cell into a well by using this technology.
It's that sensitive, it's quite cool.
That's how we actually pull out the cells that we want.
What does this look like? I spoke about those leader cells.
What you have there is a leader cell in green,
and there is a white outline around the front of the cell;
and on the right side you have the red.
When we convert it to red, watch how it goes up, the red goes up.
Now it's just the red go up,
but the green color goes down at the same time.
So we can pick whatever cell that we want
- in a live cell environment,
these cells are alive at the time, and choose what we want -
and then we sequence it.
Then we are able to determine the precise DNA code of that cancer cell.
What we hope, and that's where we are right now,
what we hope is that this will reveal an entirely new signature,
a new DNA signature that we could use
to identify these cells and kill these cells.
And that's our goal.
What does all this mean? What's the bigger picture here?
1.6 million people will be diagnosed with cancer this year.
That's what we are dealing with.
I think all of this technology that I've been talking about,
that we've been doing, and other people,
has two major implications.
First off, it's going to change the way we classify cancer.
Previously, we said lung cancer, breast cancer, prostate cancer.
We thought about where it came from.
But instead, we got it classified on the molecular level.
What has changed, and this is happening right now.
We are thinking about cancers entirely differently.
We are reclassifying cancer and say,
"It's not just lung cancer,
you have lung caner with these specific mutations."
And that's really important for treatment.
And the second point is treatment, why is it so important for treatment?
We have our blue people, and we have our red people.
They are all diagnosed with lung cancer.
Previously, we said, "We treat you all the same."
All six people here are treated the same.
But that shouldn't be the case.
Because when we sequence,
we know that their cancers are not the same.
All cancers are not created alike.
They are actually different diseases.
Now, we know that the red people have changes in genes A and B.
And the blue people have changes in genes C and D.
So we know that they are different diseases.
So for people who have changes in genes A and B,
we treat it with treatment 1,
and we already have treatment 1,
and it's great, it works, and it's very, very effective.
With people with mutations in genes C and D,
we give them treatment 2,
and maybe we don't have treatment 2 yet, but we are working on it.
That's what's going to take time.
This whole concept is called personalized cancer medicine,
because we are personalizing treatment.
It also goes by the name personalized oncology as well
but this here is the biggest change we are going to make.
It's not some fantastic new treatment,
instead, we are treating people more logically than we ever had before.
In fact, we may need to bring back or resurrect fail drugs,
because maybe we weren't giving them to the right people.
Maybe we need to give them back, and give them to the right people.
I want to end on a more personal note.
This here is Jonathan Hex, he is 28 years old,
diagnosed with stage IV lung cancer.
Lung cancer has a 15% survival rate after 5 years,
only 15% people are alive.
There is no stage V.
He never smoked a day in his life.
Because of personalized cancer medicine, he has his tumor sequenced.
It was found out he had a change, and we had a treatment for it.
We have a treatment for it.
He is now alive today because of personalized cancer medicine.
He got married,
even made a short film about it called Nirvana.
This is where the promise is,
this is the next great revolution in cancer treatment.
Thank you for your time.
(Applause)