Breast cancer progression and therapy resistance remain difficult to explain within a single framework despite major advances in molecular classification, targeted therapy and immuno-oncology. Metabolic reprogramming, molecular heterogeneity, immune evasion and mechanical remodeling are typically studied as partially independent domains, which limits integrative understanding of how tumors adapt, resist therapy and maintain aggressive behavior. This paper introduces the Triadic Oncology Ledger, a three-domain open-system framework that organizes breast cancer as a coupled system of tumor-environment exchange across metabolic-energy flux, informational disorder and mechanical-boundary remodeling. The three domains are represented as Φ∞, Ψ∞ and Π∞. Φ∞ refers to metabolic-energy flux, including nutrient acquisition, glycolytic reprogramming, lactate export and hypoxic adaptation. Ψ∞ refers to informational disorder, including transcriptional heterogeneity, signaling entropy, phenotypic plasticity and immune checkpoint dynamics. Π∞ refers to mechanical-boundary interaction, including extracellular matrix remodeling, stromal architecture, mechanotransduction and physical barrier formation. The purpose of this paper is not to replace existing cancer models or introduce new molecular mechanisms. Instead, it provides a minimal organizing structure for integrating current findings across tumor metabolism, tumor immunology, spatial transcriptomics and mechanobiology. The informational-disorder term is grounded in prior work on signaling entropy as a quantifiable property of single-cell transcriptomes, giving Ψ∞ a biological basis beyond analogy. The mechanical term is grounded in extracellular matrix remodeling, YAP/TAZ-associated mechanotransduction and stromal exclusion. The metabolic term is grounded in Warburg metabolism, hypoxia, lactate-mediated immune suppression and tumor nutrient competition. The framework emphasizes coupling. Tumor progression is treated as an emergent property of interacting flux domains rather than as the result of isolated pathways. Metabolic stress can reshape immune signaling; mechanical remodeling can alter transcriptional and epigenetic states; informational disorder can support metabolic flexibility and immune escape. This coupled structure helps explain why single-domain therapies often fail, since suppression of one domain may be offset by compensatory adaptation in the others. The paper further applies the framework to therapy resistance and solid-tumor cellular therapy. In particular, CAR-T and CAR-NK limitations in solid tumors are interpreted as the combined result of metabolic suppression, immune evasion and physical exclusion. The Triadic Oncology Ledger predicts that durable responses will be more likely when treatment strategies disrupt multiple coupled domains simultaneously or target coupling nodes that connect metabolism, immune plasticity and mechanical remodeling. This manuscript serves as Paper 1 of the Triadic Oncology Ledger series. It establishes the conceptual scaffold for later computational papers that operationalize Φ∞, Ψ∞ and Π∞ as transcriptomic proxy indices, map tumors into triadic state-space and test whether breast cancer and other solid tumors occupy distinct metabolic-informational-mechanical configurations.
Cromwell, Tami Marie Cromwell, Tammy Marie Stomberg, Tami Stomberg (Tue,) studied this question.