Bridging the Gap: In This Era of Cancer Immunotherapy


Series: Cancer Etiology, Diagnosis and Treatments

BISAC: MED062000

“These chapters provide an extensive review of travenous vitamin C for the treatment of cancer. The long history of vitamin C as a nutritional supplement to combat scurvy to a potential radio-chemotherapeutic agent is discussed.” – Joseph J. Cullen, Professor of Surgery, University of Iowa, USA 

Recognizing rare diseases’ impracticability of having extensive clinical trials necessary for regulatory approval, the US Orphan Drug Act appropriately facilitates the commercialization of “orphan drugs”. However, even common cancers also have rather specific but uncommon clinical situations for which extensive clinical trials are hardly practicable. Moreover, although such very costly and extensive trials often depend on industry support, uncommon situations are unattractive. Eventually, many specific treatments for designated clinical oncology situations often lack regulatory approvals merely because of suboptimal trial data. Now, this EBM (evidence-based medicine) book by expert authors with first-hand clinical experience is about off-label but acceptable treatment options. The attempt is to patch up the low response rates and considerable adverse events of novel immunotherapy. Currently, without any such off-label treatments, some cancer patients may well be left out in the cold. Although off-label treatments lack regulatory approval, they are backed by EBM and have good safety profiles. It’s inappropriate to announce “nothing else can be done” merely because all approved options have already been exhausted. In expert hands, despite the “on compassionate grounds” proviso, the safety profiles of such off-label prescriptions may even compare favorably with orthodox chemotherapy given at top doses.

Table of Contents


Chapter 1. Metformin: An Irony of Fate?
(Shiu Y. Tsao – Department of Clinical Research, Hong Kong SAR Oncology Centre, Hong Kong SAR, China)

Chapter 2. Chemotherapy Dosage: The More the Merrier?
(Shiu Y. Tsao – Department of Clinical Research, Hong Kong SAR Oncology Centre, Hong Kong SAR, China)

Chapter 3. Vitamin C – The Remarkable Story of Controversy
(Raymond C. F. Yuen – Hosanna Clinic, Singapore)

Chapter 4. The Missing Link in Cancer Treatment: High Dose Vitamin C
(Raymond C. F. Yuen – Hosanna Clinic, Singapore)

Chapter 5. Natural Medicine in Support of Orthodox Oncology
(Mark W. Houston – The Hong Kong Wellness Clinic, Hong Kong SAR, China)

Chapter 6. Tradition: The Fiddler on the Roof
(Kalina K. Wu – Alpha Chinese Medicine, Kowloon, Hong Kong SAR, China, and Shiu Y. Tsao – Department of Clinical Research, Hong Kong SAR Oncology Centre, Hong Kong SAR, China)

Chapter 7. T Cell-Based Immunotherapy for Solid Cancers
(Lei Chen and Mingjun Wang – Department of Research and Development, Shenzhen Institute for Innovation and Translational Medicine, Shenzhen, China)



“In this important and thought-provoking book I particularly enjoyed the chapter by S. Y. Tsao about low dose metronomic chemotherapy and the ways in which it can stimulate tumor immunity – making it a seemingly ideal partner for targeted immunotherapy. The discussion on the impact of chemotherapy dosage on immunogenic cell death and use of metronomic chemotherapy as a long term maintenance treatment strategy are especially timely.”  – Robert S. Kerbel, Professor, Medical Biophysics, University of Toronto, Toronto, Canada

“In Chapter 2, Dr. Tsao provides a highly relevant summary of our knowledge of current chemotherapy dosing and its implications on potential combinations with both immune checkpoint inhibitors as well as oncolytic viruses. Moreover, he has raised an important point of using metronomic chemotherapy as a potentially more effective and safer alternative to the standard chemotherapy dosing. A point made important by the current SARS-CoV-2 pandemic and known deleterious effects of standard chemotherapy on the patients’ outcomes.” – Igor Puzanov, Professor of Oncology & Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

“Although high-dose vitamin C is controversial, we have solid data and clinical experience that, given upon admission to the ICU, it may well prevent “cytokine storms”: probably the cause of acute respiratory distress of chest infections, especially viral. The known pleiotropic properties of high-dose vitamin C may well facilitate its oncology adjunct role, not the least of which is for chest infections that frequent advanced cancer patients. Dr. Yuen’s very comprehensive chapters on high-dose vitamin C provide an interesting read on its rejection to rekindling.” – Paul E. Marik, Chief, Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

“Although high dose vitamin C is a controversial subject among doctors, Dr. Yuen, author of Chapters 3 and 4, has managed to render this difficult task of providing an interesting, readable, evidence-based account of the issue: it’s worth trying for cancer patients running out of viable options. The case report of its combination with irradiation is also to be congratulated, as I have never seen reversal of vocal cord palsy due to tumor compression lasting 4 weeks, no matter how rigorous the oncology interventions.” – Kian Hian Yeoh, Clinical Professor, Department of Otolaryngology – Head & Neck Surgery, National University of Singapore, Singapore

“Here is a text that surveys biomedical horizons in oncology and is also brave enough to include reflections on a venerable medical tradition. China’s traditional medicine gets a place on the map for its application in clinical oncology due to the significant body of research suggesting this ancient Experience-Based Medicine can work alongside Evidence-Based Medicine to support patient care in the modern world. Notably, the use of acupuncture in oncology has been endorsed by the US National Institutes of Health. Without such modern evidential support the case for TCM would be weak. Contributor Mark Houston is a leading scholarly TCM physician who has worked in a supportive role alongside biomedical oncology teams for twenty-five years and here provides a measured introduction to a subject that perhaps deserves more attention.” – Charles Buck, past Chairman of the British Acupuncture Council and Author of Acupuncture and Chinese Medicine – Roots of Modern Practice (2012)

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