In 2000, Hanahan and Weinberg published a paper “The Hallmarks of Cancer” enumerating six acquired functional capabilities of human cells for progression into malignancies, which include sustaining proliferative signaling, evading growth suppressors, resisting apoptosis, enabling replicative immortality, inducing angiogenesis, and activating invasion and metastasis.  These crucial traits have since been the guiding principles for the development of oncologic interventions.  

The article was updated in 2011 to include two new hallmarks, reprogrammed metabolic pathways and evasion of immune destruction, and two enabling characteristics, genome instability and tumor-promoting inflammation.

In yet another revision by Hanahan in 2022, two more new functional traits, unlocking phenotypic plasticity and senescent cells, and another two enabling characteristics, non-mutational epigenetic reprogramming and polymorphic microbiomes, were further identified.  

From six hallmark properties to 14 key traits, the already intricate tapestry of cancer development has been expanded in complexity to encompass more vivid details, giving us a renewed perspective of how cancer cells sustain their growth advantage.  Indeed, the pace of knowledge acquisition and consolidation within the last two decades demonstrates how much man knows and does not know about this dreadful disease.

This trend of intensive discovery is unlikely to abate as scientists will continue to identify new pathways by which cancer cells engage to circumvent existing measures that we institute to arrest their growth.  Not to mention cancer cells are already adopting multiple-pathway and pathway-switching strategies to surmount barriers that impede their unrestrained proliferation.  

This implies that even if we successfully put the brakes on cancer growth, the likelihood is transient, as we are merely chasing the elusive tail of the cancer demon.  Tumor heterogeneity, arising from divergent evolution of the originating cells’ progeny, often results in genomic instability that fosters genetic diversity of multiple genomic clonal populations within a neoplasm.  And this is the underlying cause of drug resistance and disease relapse that makes most therapeutic interventions palliative rather than curative.

Tumor heterogeneity also causes setbacks in cancer detection in that a biopsy, the basis upon which a therapeutic choice is predicated, may capture only a fraction of tumor cells that are non-representative of the whole tumor.  

To get ahead of the curve, we therefore need “living solutions” that revive the body’s immune prowess as in CAR-T therapy.  Only then may we declare “radical remission” in cancer patients.

Hang on.  Did we just mention the collaboration of a resilient host immune system as a response to the quest of enduring cancer treatment?  It appears that we have come full circle in seeking a host-dependent mechanism for the treatment of this disease. 

Strictly, this call should not be a realisation arising from some new development but the bedrock for any cancer therapy.  And perhaps this is where TCM oncology could meaningfully complement contemporary medicine for the benefit of cancer patients.  

Let us examine how and why an East-meets-West partnership could work synergistically and seamlessly to produce superior results.  The golden rule of any stable alliance is the avoidance of clear and present internal conflicts by contributing parties having common goals and beliefs, and complementary but non-competing skills that each party plays to its strength.  

Contemporary medicine has an ever-increasing arsenal of weaponry to combat cancer in a capricious and less-than-predictable pathological landscape.  These tools, though formidable and able to stop cancer growth in its tracks, could lose efficacy after a period of use.  These interventions are excellent during aggressive stages of the disease and in fact, any stage of cancer so long as the general health of the patient remains intact. 

However, some patients for reasons of deteriorating health conditions or are not able to tolerate the harsh adverse effects of these therapies, may be forced to defer treatment indefinitely after some time.  Such hiatuses are doubtlessly dysfunctional to the treatment regime and detrimental to the patient especially when cancer cells remain active within the host.  

So therapeutic options from contemporary medicine bear tremendous strength in that they elicit rapid response but may take a toll on the patient’s general health.  There could also be occasions when the disease was brought under control after treatment but the patient was left vulnerable to other pathogens. 

This brings recollection of an NHK documentary that featured an assistant professor of surgery from a reputed Japanese university hospital who referred his post-surgical gastric cancer patient who was anorexic, emancipated, and non-ambulatory to a Kampo medicine practitioner for treatment.  The patient was able to eat his favorite udon and literary “walk in the park” after a course of herbal treatment.  And no prize for making the right guess.  The prescription was none other than the prosaic “Six Gentlemen Decoction六君子汤 ”, a TCM prescription from the Han Era.

As a healing discipline, TCM’s major shortcoming is its lack of focus at the disease level resulting in a forfeiture of specificity in its curative framework.  Be that as it may, in this ostensible weakness lies TCM’s greatest strength.  With therapeutic effort being directed at the patient instead of the disorder, TCM provides patients with balanced, moderated but holistic treatment instead of potent solutions fixated narrowly on the disease. 

Consequently, uplifting the well-being of the patient is prioritized over defeating the disease, which means TCM treatment outcome is no longer a binary event of win-lost but possibly a state of peaceful coexistence with the disease与癌共存 as a last resort.

TCM’s unique therapeutic perspective has shaped the development of debilitation recovery 补虚 as a distinctive forte across all its treatment modalities.  Debilitation is not viewed as a single point of failure but instead regarded as a state of imbalance among five lateral and interrelated organ systems by the Five Elements Concept.  This central dogma provides not only a reference for diagnosis but also a plethora of different healing permutations that dynamically change with the patient’s condition.     

Orthodox medicine’s cancer treatment, based on a philosophy of swiftly devastating constructive destruction, when combined with TCM’s forte in debilitation recovery produces astonishing results far beyond the expectations of clinicians and patients.  The exploration of PHY906 published in “Frontiers in Pharmacology” is a case in point.  For more than a decade, PHY906 has proven to enhance the therapeutic indices of a broad spectrum of anticancer agents. 

These findings are derived from clinical studies for colorectal, liver, and pancreatic cancers when PHY906 is used as an adjuvant to chemotherapy with promising results.  In another 2021 article published by Nature, YIV-906 (aka PHY906) potentiated anti-PD1 action against hepatocellular carcinoma by enhancing adaptive and innate immunity in the tumor microenvironment.  Liver cancer remains one of the most lethal, complex, and difficult-to-manage cancers.  

Indeed, PHY906 reduces chemotherapy-induced toxicities and/or increases chemotherapeutic efficacy without affecting the pharmacokinetics of the chemotherapeutic agents used.  So, what is PHY906?  It is a pharmaceutical grade Huang Qin Decoction 黄芩汤, a TCM formulation comprising four distinct herbs developed some 2000 years ago.