順天堂大学 医学部 2016問題４ 解答解説全訳

【問題】：２０１６年　問題４
【形式】：適語補充＋文章理解
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【作者】：
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【目安時間】：２０分

【大問４　読解問題】

次の英文を読み,下記の設問に答えなさい。

①　（　　A　　）Two new studies published in the New England Journal of Medicine provide further evidence that immunotherapy — the use of drugs to stimulate immune response – is highly effective against the disease.

➁　Recently presented at the ２０１５ American Society for Clinical Oncology annual meeting, one study revealed that a drug combination of ipilimumab and nivolumab (an immune therapy drug) reduced tumor &l size in almost ６０% of individuals with advanced melanoma — the (a)deadliest form of skin cancer — compared with (only １９% for) ipilimumab alone, while another study found nivolumab reduced the risk of lung cancer death by more than ４０%.

③　Nivolumab is a drug already approved by the Food and Drug Administration (FDA) for the treatment of metastatic melanoma in patients who have not responded to ipilimumab or other medications. It is also approved for the treatment of non-small cell lung cancer (NSCLC) that has metastasized during or after chemotherapy.

（　　１　　）

④　According to cancer experts, however, the results of these latest studies indicate that nivolumab and other immune therapy drugs could one day become standard treatment for cancer, (b)replacing chemotherapy.

➄　Prof. Roy Herbst, chief of medical oncology at Yale Cancer Center in New Haven, CT, believes this could happen in the next ５ years. "I think we are seeing a paradigm shift in the way oncology is being treated,” he told The Guardian. “The potential for long-term survival, effective cure, is definitely there."


Nivolumab plus ipilimumab reduced tumor size by at least a third for almost １ year


⑥　Nivolumab belongs to a class of drugs known as "checkpoint inhibitors." It works by blocking the activation of PD-L１ and PD-１ — proteins that help cancer cells hide from immune cells, avoiding attack.

➆　In a phase ３ trial, Dr. Rene Gonzalez, of the University of Colorado Cancer Center, and colleagues tested the effectiveness of nivolumab combined with ipilimumab – a drug that stimulates immune cells to help fight cancer — or ipilimumab alone in ９４５ patients with advanced melanoma (stage II or stage IV) who had received no prior treatment.

⑧　While １９% of patients who received ipilimumab alone experienced a reduction in tumor size for a period of ２.５ months, the tumors of ５８% of patients who received nivolumab plus ipilimumab reduced by at least a third for almost a year.

⑨　Commenting on these findings, study co-leader Dr. James Larkin, of the Royal Marsden Hospital in the UK, told BBC News： "By giving these drugs together you are effectively taking two brakes off the immune system rather than one, so the immune system is able to recognize tumors it wasn't previously recognizing and react to that and destroy them.”

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⑩　Dr. Gonzalez and colleagues also demonstrated the effectiveness of another immune therapy drug called pembrolizumab in patients with advanced melanoma.

⑪　While １６% of １７９ patients treated with chemotherapy alone experienced no disease progression after ６ months, the team found that disease progression was (c)halted for ３６% of ３６１ patients treated with pembrolizumab after ６ months.

⑫　Dr. Gonzalez notes that while a combination of nivolumab and ipilimumab shows greater efficacy against advanced melanoma than pembrolizumab, it also presents greater toxicity #５ Around ５５% of patients treated with nivolumab plus ipilimumab had severe side effects, such as fatigue and colitis #６, with around ３６% of these patients discontinuing treatment.

⑬　Dr. Gonzalez says such treatment may be better for patients whose cancer does not involve overexpression &? of the PD-L １ protein.

⑭　“Maybe PD-L １-negative patients will benefit most from the combination, whereas PD-L １-positive patients could use a drug targeting that protein with equal efficacy and less toxicity,” he adds. “In metastatic melanoma, all patients and not just those who are PD-L １-positive may benefit from pembrolizumab."

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Nivolumab almost doubled patient survival from NSCLC


⑮　In another study, Dr. Julie Brahmer, director of the Thoracic Oncology Program at the Johns Hopkins Kimmel Cancer Center, and colleagues tested the effectiveness of nivolumab against standard chemotherapy with the drug docetaxel among ２６０ patients with NSCLC.

⑯　All patients had been treated for the disease previously, but the cancer had returned and spread.

⑰　The team found that patients who received nivolumab had longer overall survival than those treated with standard chemotherapy, at ９.２ months versus ６ months.

⑱　At １ year after treatment, the researchers found nivolumab almost doubled patient survival. Around ４２% of patients who received nivolumab were alive after １ year, compared with only ２４% of patients who received chemotherapy

⑲　The study results also demonstrated a longer period of halted disease progression for patients who received nivolumab compared with those who had chemotherapy, at ３.５ months versus ２. ８ months.

⑳　Overall, the researchers estimated that, compared with patients who received chemotherapy, those who received nivolumab were at ４１% lower risk of death from NSCLC.

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㉑　Commenting on these findings, Dr. Brahmer says： “This solidifies immunotherapy as a treatment option in lung cancer. In the ２０ years that I've been in practice, I consider this a major milestone."

㉒　While both studies show promise for the use of immunotherapy in cancer treatment, experts note that such treatment would be expensive. The use of nivolumab plus ipilimumab for the treatment of advanced melanoma, for example, would cost at least $２００,０００ per patient.

㉓　As such, researchers say it is important that future research determines which cancer patients would be most likely to benefit from immunotherapy.


Honor Whiteman. Immunotherapy heralds new era for cancer treatment. ２０１５.



問１ 英文の内容に合うように,(１)~(３)の質問に対する答えとして最も適したものをそれぞれ選択肢１~４の中から選びなさい。

(１) The word (a)deadliest is in paragraph ➁. Which of the following words has the same meaning?
１. most widespread
２. most helpful
３. most dangerous
４. most recent

(２) The word (b)replacing is in paragraph ④. Which of the following words has the same meaning?
１. checking in
２. turning in
３. handing over
４. taking over

(３) The word (c)halted is in paragraph ⑪. Which of the following words has the same meaning?
１. released
２. supported
３. interrupted
４. promoted


問２ 英文の内容に合うように,(１)~(５)の各文の空所を補うものとして最も適し たものをそれぞれ選択肢１~４の中から選びなさい。

(１) According to paragraph ③, the immune therapy drug nivolumab is usually used
１. instead of chemotherapy
２. with folklore remedy
３. for clinical trials
４. as a second choice

(２) Nivolumab helps immune cells
１. hide cancer cells
２. find cancer cells
３. stimulate cancer cells
４. avoid cancer cells

(３) Dr. Gonzalez pointed out that the combination of nivolumab and ipilimumab
１. may cause patients serious side effects
２. is more effective than standard chemotherapy
３. should be the main treatment for melanoma
４. is as practical as other immune therapy drugs

(４) Dr. Brahmer and her colleagues concluded that patients who received
１. chemotherapy had their cancer controlled better than those who received other treatments
２. nivolumab had a higher rate of their cancer returning than those who received chemotherapy
３. chemotherapy had more severe side effects than those who underwent immunotherapy
４. nivolumab had significantly longer survival than those who underwent chemotherapy

(５) A disadvantage of immunotherapy in cancer treatment is that it
１. is effective only for a type of lung cancer
２. would take time to have it approved
３. would cost a large amount of money
４. is the major obstacle in treating melanoma


問３　この文章の書き出しの文として、Aコに入れるのに最も適したものを１~４の中から選びなさい。

１. A “whole new world” for the American Society for Clinical Oncology has opened up.
２. A combination of two new drugs will stimulate patients, according to experts.
３. A new standard treatment for cancer has been approved by the government.
４. A "whole new era” for cancer treatment is upon us, according to experts.


問４　次の段落は文中の（　　１　　）から（　　４　　）で示したいずれかの位置に入る。最も適した場所を１から４の中から選びなさい。

"For immunotherapies, we've never seen tumor shrinkage rates over ５０% so that's very significant to see. This is a treatment modality that I think is going to have a big future for the treatment of cancer.”

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