HEALTH Chemotherapy in the soup

Can a Chinese herb cocktail improve the lives of cancer patients? Sandy Sulaiman reports
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THE NOTION of finding a single magic-bullet cure for cancer, prevalent through the post-war years, is still strong in the public mind. But it is no longer so among those researching in the field. Professor Karol Sikora, a leading clinical oncologist, told the Pharmaceutical Society's annual conference that it was unlikely the rest of this century would see any further significant developments in anti-cancer drugs. One in three people currently die of cancer. In 15 years' time this will have risen to one in two. In the face of these figures, Professor Sikora concluded that, for the timebeing at least, the battle against the disease is being lost.

In the long term, using gene therapy to counter the molecular changes that lead to cancer is likely to deliver major advances in its treatment. But with Western anti-cancer drugs at a developmental plateau in the meantime, some doctors are looking to reinforce the battery of anti-cancer treatments they can offer their patients by dipping into a Chinese medical tradition that goes back 2,000 years.

As progress in developing anti-cancer drugs in the West has slowed, doctors in China who are trained in both disciplines have been applying Western- style scientific trials. Their aim is to demonstrate what, if anything, the Chinese pharmacopoeia can offer to improve the quality and the quantity of life of cancer sufferers when combined with Western treatments.

It is not easy reconciling two traditions when they are based on such fundamentally divergent principles. The Chinese tradition recognises six pulse points in each wrist, for example, leading to furrowed brows among Western doctors who are used to one. Many Western practitioners also have trouble entertaining notions such as the need for harmony or balance between the body's organs and the existence of the unifying mental and physical energy known as Chi.

"The Chinese approach to treating cancer, known as Fu Zheng, emphasises supporting the host or patient rather than suppressing the growth," said Gilbert Shia of the Oxford-based Dao Fellowship. In Western medicine, a resonance with this approach to terminal illness has become more noticeable, most obviously in the treatment of HIV and Aids where, in the absence of a cure, efforts are focused on supporting ability to live with the virus.

Dr Shia, born in Hong Kong, is qualified as a practitioner in both Western and traditional Chinese medicines. He set up the Oxford-based Dao Fellowship in 1991, with the aim of promoting research into their complementary use. Some of mainland China's leading clinicians gathered recently for the first time in the UK to present their latest research findings, at a conference organised by Dr Shia's organisation and held at Green College, Oxford. Among them was Professor G Q Yu. As the senior oncologist at the Academy of Traditional Chinese Medicine in Beijing, he presented research highlighting areas where Western and Chinese disciplines could each be used to plug gaps left by the other.

Lung cancer is one such area; a hot topic in Beijing, where the authorities ended 1994 by announcing a ban on smoking in public p1aces in an attempt to curb one of the country's biggest killers. Radiotherapy is widely used to treat lung cancer - but, as Professor Yu explained, "The effect of the therapy is limited by the cells in the tumour that are known as hypoxic cells, which are lacking in oxygen. These cells are insensitive to the radiation. One of the main areas of research we have focused on has been using Chinese herbs to increase the radiation sensitivity of those cells."

Using a cocktail of 10 Chinese herbs, ranging from asparagus root to safflower and wolfberry fruit, Professor Yu's team carried out a trial involving 32 patients with primary lung cancer. They were divided at random into an observed group, where radiation was supplemented with herbal treatment, and a control group receiving radiotherapy only.

The inhibitory effect on tumour growth was notably higher in the observed group. Experimental studies in cancer-bearing mice confirmed the clinical observations, according to Professor Yu, with the results showing a significant checking of cancer growth rates. This particular complementary use of Chinese medicine is, ironically, more in the Western tradition, in that it enhances the attacks on the cancer rather than, in Dr Shia's words "supporting the host". But one area coming undcr increasing examination is more in keeping with the Chinese tradition - using Chinese herbs to counter the traumatic effects of Western anti-cancer medicines on the body.

Chemotherapy, radiotherapy and the drastic surgery that some cancers require are all areas where the side-effects sometimes rival the cancer itself in the ravages they inflict on the patient's health. In a long- term piece of research, Professor Yu's team used a combination of Western surgery, chemotherapy, radiotherapy and Chinese herbs in the treatment of gastric cancer in 669 patients.

After trials lasting 17 years, Professor Yu's findings were that patients receiving a combination of Western and Chinese treatments lived longer, with a 53 per cent survival rate over five years compared with a 20 per cent survival rate over the same period using Western medicine only. The cocktail of Chinese herbs used to tackle the gastric cancers included red sage root and the innocuous-sounding grassy privet - the reported results included a reduction in the side-effects of the chemotherapy used to treat the late stages of gastric cancer, and a more robust immune system, relative to patients treated solely with Western methods.

"We're not just talking about a `feel-good' or `feel-better' factor," said Dr Shia. "The benefits to patients' well-being were measurable in that they actually lived longer and their bone marrow, for example, appeared healthier. This is vital in maintaining a strong immune system."

Western-style trials carried out in China, such as Professor Yu's, are helping to erode resistance to the idea of employing complementary Chinese medicines. But the form these medicines take can still be a stumbling block. Western medicine isolates active ingredients from plants or other sources, whereas Chinese medicine lets the patient consume cocktails of parts of the plants themselves - usually the root and often in powdered form, drunk as a soup. This frustrates Western medicine's need to know exactly which element or elements within the mix are working, and how - knowledge vital to the commercial development of drugs and to the drug- licensing process.

From Arizona to Tokyo, work is going on to isolate the active ingredients in Chinese herbs to the satisfaction of licensing authorities. But this route to assimilating Chinese treatments into Western medicine is by its nature a long process: more than 400 medicinal plants are recognised by traditional practitioners.

While the toxicologists and pharmacologists spend years isolating the active ingredients in Chinese herbs, practitioners such as Dr Shia will continue to use the two disciplines side by side. "I tell my patients that complementary Chinese herbs will help their symptoms and improve their well-being - but I would never use the word `cure'." !