List of References
Overview Table
Mistletoe in Cancer
Single-arm Cohort Studies and Case Series
40 single-arm cohort studies or case series investigated the influence of mistletoe therapy on the tumour disease (see Overview Table). 18 of the studies are prospective, the remaining ones either retrospective or not clearly defined. In 39 of these 40 cohort studies a total of 1311 patients were treated with mistletoe preparations. The average number of patients per study was 33.6 patients (3 - 270 patients). One study gave no precise number of patients. The studies were carried out in university hospitals, large communal hospitals, specialised oncology centres and oncology practices.
Diagnoses 
In these cohort studies and case series, mistletoe therapy was examined in the treatment of: breast carcinoma (n = 4), cervical intraepithelial neoplasia (CIN) (n = 1), ovarian carcinoma (n = 1), various genital carcinomas (n = 1), prostate gland carcinoma (n = 1), renal carcinoma (n = 1), bladder carcinoma (n = 1), stomach carcinoma (n = 1), colon carcinoma (n = 2), rectum carcinoma (n = 1), primary liver cell carcinoma (n = 4), pancreas carcinoma (n = 2), anal condyloma (n = 2), liver metastases (n = 2), lung carcinoma (n = 1), head and neck tumours (n = 1), brain tumours (n = 1), melanoma (n = 1), various carcinomas (n = 5), lymphomas (n = 2), plasma cell myeloma (n = 1), malignant effusions (pleural effusions, n = 3; ascites, n = 4; pericardial effusions, n = 1). The tumour disease was mostly advanced, metastasised and mostly pretreated conventionally (surgical resection, chemotherapy, radiation therapy) or inoperable.
Endpoints
Tumour remissions (n = 32), quality of life (n = 19), survival time (n = 2), and haematopoiesis (n=1) were examined.
Therapy
Iscador® was used in 15 studies, Helixor in 15 studies, Abnobaviscum® in 11 studies, and Isorel® in 2 studies; one study analysed various mistletoe extracts without further specification. In most cases the mistletoe extracts were administered subcutaneously. Other application methods, either alone or in addition to subcutaneous applications, were: into or around the tumour (intra-or peritumourally) in 7 studies, intrapleurally (3 studies), intraperitoneally (4 studies), intravenous infusion (2 studies), arterially (one study), and intrapericardially (one study). Concomitant conventional oncological treatments were applied in 10 studies: for all study patients or only for part of them [4, 4b, 5, 8, 9, 14-16, 21, 25, 37]. Tumour remission was assessed in 8 of these 10 studies, whereby the influence of the conventional treatment was usually taken into account.
Results
The results of these studies are summarised in the Overview Table.
Tumour remissions: Partial or complete tumour remissions after mistletoe treatment were observed in 29 of 32 studies investigating this issue (see Table), one study showed an inhibition of tumour growth (doubling of the re-occlusion time after stent implantation). In these studies mistletoe extracts were often applied locally and/or at a high dose. In three studies no remission was observed.
- 24 of these 32 studies assessed tumour regression in various tumours (including CIN in one study and condyloma in two others), hereby 21 remissions were reported.
- The tumour remissions occurred in: primary liver cell carcinoma (4 of 4 studies), liver metastases (intratumoural, 1 of 1 study), breast carcinoma, (2 of 2 studies), brain tumours (1 of 1 study), CIN (1 of 1 study), anal condyloma (2 of 2 studies), melanoma (1 of 1 study), prostate carcinoma (1 of 1 study), pancreas carcinoma (1 of 1 study), bladder carcinoma (1 of 1 study), ovarian carcinoma (1 of 1 study), lymphoma (2 of 2 studies), multiple myeloma (1 of 1 study), various carcinomas (3 of 3 studies).
- No response was observed in: liver metastases (intraarterial, 1 of 1 study), renal cell carcinoma (1 of 1 study), 5-Fu-resistent colorectal carcinoma (1 of 1 study).
- 8 studies described the intracavital treatment of malignant effusions: 3 studies addressed the intrapleural treatment of malignant pleural effusions and show a high degree of remissions that was comparable to conventional procedures, but with markedly less side effects (see for instance Stumpf 1994). 4 studies examined the intraperitoneal application in ascites. All three studies showed a decrease of the effusions, although poor tolerability was described in one study [24]. 1 case series dealed with the local treatment of pericardial effusions. Here, too, remissions occurred.
Quality of life: An improvement in quality of life was documented in 18 studies; a worsening in one study, due to progressive disease.
Survival time: One study emphasised an unusually long survival time on mistletoe treatment, which differed substantially from the other experiences of that clinic specialised in lung tumours (Heidelberg-Rohrbach Thorax Surgery Clinic). One further study calculated a survival benefit of 3.2 months in patients with inoperable pancreatic carcinoma and treated with intralesional mistletoe injections (matched-pair analysis; currently available only as an abstract) [25].
Haematopoiesis: In one study the stimulation or improvement of haematopoiesis was observed, but details were not given.
Summary and comments
In the case series and cohort studies tumour remissions are frequently described in connection with mistletoe therapy. In some studies the magnitude of tumour remissions is comparable with that of chemotherapy in the respective tumour entity, but with substantially lower toxicity. Nevertheless, the overall frequency with which tumor remission occurs in response to mistletoe therapy cannot be estimated on the basis of the available literature. Probably, tumor remission depends on dosage and application methods; they seem to be rather exceptions under the generally used normal dosage. The case series and cohort studies mostly stem from practicing physicians (from practices and hospitals) who wanted to describe and evaluate their therapy; the documentation is partly good, partly it offers only insufficient information quality.
For a detailed assessment of the quality of the case series and cohort studies and further details on them see [12, 13]; some of the important studies (Mabed 2004, Mahfouz 1999, Bar Sela 2004, and Stumpf 1994) are described in the following in detail as examples.
Table in English as PDF-download
Gunver S. Kienle, MD
Last Modified:
May 2010
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