Modu Ruijin Hospital Pancreatic Surgery Intensive Care Unit, six in the morning.
Forty-nine-year-old patient Mr. Shen Guohua lies on the hospital bed, his abdon is swollen with a large amount of ascites, resembling a woman seven months pregnant. His skin and whites of the eyes have turned yellow; this is obstructive jaundice caused by the pancreatic tumor pressing on the bile duct. The numbers on the monitor are not optimistic: heart rate at 112 beats/min, blood oxygen saturation at 92%, body temperature at 38.5℃.
His wife, Ms. Zhou Min, holds his thin hand, her eyes red and swollen. Over the past three months, they have been to Beijing and Shanghai, and the conclusion is always the sa: late-stage pancreatic cancer with liver tastasis, an expected survival of three to six months, and no effective treatnt. Mr. Shen has wasted away from 160 pounds to less than 100 pounds.
"Mr. Shen, Ms. Zhou." Departnt Director, Director Chen, walked in with a young doctor, "This is Dr. Li, who just returned from further training at Nandu Sanbo Hospital. He has brought a new plan that might be effective."
Might be effective?
To Mr. Shen, this is a lifesaving straw.
Dr. Li is one of the first Chinese trainees of the K Therapy training program at Sanbo, and he explained in detail the treatnt principle, possible immune reactions, and most crucially: the success rate.
"K Therapy has no precedent for treating pancreatic cancer, and only recently has it shifted towards it. The actual success rate is unknown, and based on current theoretical data, the overall efficacy rate of K Therapy for pancreatic cancer is about 35%, with a complete remission rate of less than 5%. Mr. Shen’s situation is more complicated, with liver tastasis and jaundice already present, making the efficacy rate possibly even lower, estimated between 15% to 20%." Dr. Li spoke calmly and honestly, "Furthermore, because the adenovirus needs to be tabolized by the liver, your current liver function condition may affect the drug distribution and efficacy."
Mr. Shen’s voice was weak but clear: "If I don’t do it, how long do I have?"
"It’s difficult to predict accurately, but per past experiences, possibly one to two months; this is also a theoretical prediction."
"If I do it, what is the best outco?"
"If effective, the tumor might shrink, jaundice might improve, and the pain lessen. The best case might be getting the opportunity for surgery, but the probability is very low." Dr. Li didn’t sugarcoat it, "The worst case is that treatnt is ineffective, or it triggers a severe immune reaction, accelerating the progress of the illness."
Ms. Zhou’s tears flowed again, "Dr. Li, we are willing to try, no matter the cost..."
"Cost is not an issue." Dr. Li interrupted her, "Mr. Shen, as a refractory case, your treatnt cost is covered by their research fund. What we need to decide now is whether to treat or not."
Mr. Shen stared at the ceiling, silent for a full minute, with the beeping of the monitor particularly clear in the ward.
"Treat!" he finally said, "A 15% chance is better than waiting for death, better to give it a shot."
"Alright, I’ll arrange it for you!" Dr. Li said.
Mr. Shen’s hemoglobin is only 78g/L, albumin 28g/L, with multiple abnormal liver function indicators. The overall situation is very unfavorable, unsuitable for any physically strenuous treatnt.
However, compared to other treatnt plans, K Therapy has very low requirents for patient tolerance, and K Therapy requires a large number of patients to verify where its ultimate boundaries lie.
Noon, twelve o’clock, Nandu Sanbo Research Institute remote consultation center.
Yang Ping, Song Zimo, Xu Zhiliang, Tang Shun, Lu Xiaolu, and Academician Chen Yongnian from far at Tsinghua conducted a joint consultation via video connection. All the data of Mr. Shen: genetic sequencing, imaging data, biochemical indicators were synchronously displayed on the large screen.
"The tumor cells indeed highly express that rare receptor, which is good news." Yang Ping pointed to the target detection data, "The bad news is, his neutralizing antibody test shows a high titer pre-existing immunity to adenovirus type 5. If the standard formulation is used, most of the vectors might be cleared before reaching the tumor."
Academician Chen brought up the mixed vector library data: "He is also seronegative for adenovirus type 26 and 35 antibodies. We can use the type 26 vector, which is one of our best versions in terms of targeting. But the problem is that the production process of the type 26 vector is still being optimized, and currently, we only have laboratory-grade production, enough for one treatnt."
"One opportunity." Song Zimo pondered, "If it fails, there is no possibility for a second attempt."
Xu Zhiliang supplented, "Moreover... the new vector... lacks long-term safety data, although... animal experints show good results, human... application is still the first ti."
Everyone faced the most common ethical dilemma in dical innovation: use immature new technology to save a patient with almost no other hopes, or wait for more verification, though the patient might not hold on until then?
"Professor Yang, you decide." Academician Chen finally said, "This is your patient, your technology."
As for the new K Therapy, Academician Chen felt he was just a supplier of "raw materials."
Yang Ping looked at the image data of Mr. Shen on the screen; the tumor is like an evil octopus, entrenched in the head of the pancreas, with its tentacles extending towards the liver, invading the blood vessels. This is a typical, textbook case of late-stage pancreatic cancer, representing one of the strongest fortresses in solid tumor treatnt.
"Use the new vector." Yang Ping’s voice was very calm, "Need to prepare immunosuppressive plans in advance to prevent a possible cytokine storm; inform the patient and family that this is the world’s first instance of treatnt using this vector, with unknown risks."
After the decision was made, Academician Chen imdiately arranged for the only two bottles of type 26 vector formulation in the laboratory to be sent to Nandu by a special plane, preserved in a liquid nitrogen tank at minus 80 degrees, Sanbo Research Institute will use the type 26 vector for gene recombinant K formulation.
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