Mistletoe

Extracts of Mistletoe extracts (Viscum album) are widely used in Europe as a component of complementary treatment of cancer.1  Its use began in 1920, and since that time there have been a number of studies of its effectiveness against tumors in plants, animals, and humans.

Pharmacologically active compounds include mistletoe lectins (ML I, II and III), viscotoxins, oligo- and poly- saccharides, and lipophilic extracts.  These exert their effect through two mechanisms—direct and immune-mediated.  Direct cytotoxic effects are due to the apoptosis-inducing mistletoe lectins, and viscotoxin induction of necrotic cell death.  Immune-modulating activity involves activation of onocytes/macrophages, granulocytes, natural killer (NK) cells, T-cells (especially T-helper-cells) and the induction of various cytokines.2

Clinical effectiveness of mistletoe extracts in the treatment of oncological disease has been widely studied, although many published studies have been of small size or lacked randomized controlled design.  A 2011 review of 20 clinical trials of use of mistletoe in cancer found some with evidence of increased survival, some without survival impact, and most with improvement in quality of life—well-being or reduction in chemotherapy side effects.  None showed any adverse impact on chemotherapy.3  A 2013 randomized study found increased duration of survival in patients with metastatic pancreatic cancer (4.8 v 2.7 months).4

Mistletoe is used clinically through subcutaneous injection of Iscador, which is a fermented extract made from the leaves and berries of the plant.  Although approved in a number of European countries, it has not been approved for use in the United States by the FDA.

At Integrative Health Practices, we offer mistletoe therapy to patients with cancer who are seeking potential improvement in quality of life.  Patients receive an initial exam by an integrative physician or physician assistant, and an integrative treatment plan is developed, which may include mistletoe, acupuncture, nutritional counseling, and other complementary therapies.  Patients receiving mistletoe are taught by our nurse to self-administer it beginning on a low dose via subcutaneous injection, with increasing doses to a point at which local immune response is demonstrated, following which maintenance injections are provided.

Patients receiving mistletoe therapy pay the IHP concierge fee and the costs of the mistletoe solutions.  Encounters with the physician/PA and nurse are billed to insurance.

References

  1. Molassiotis, A., P. Fernandez-Ortega, D. Pud, G. Ozden, J. A. Scott, V. Panteli and et al., Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol Advance Access published online on February 2, doi:10.1093/annonc/mdi110 (2005).
  2. Die Mistel. Mistletoe in cancer – clinical studies. http://wissenschaft.mistel-therapie.de/index.php5?page=44&lang=1 (Accessed March 24, 2015)
  3. Bar-Sela G. White-Berry Mistletoe (Viscum album ) as complementary treatment in cancer: Does it help? Euro J Int Med 2011;3(2):e55-e62
  4. Troger W et al. Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: A randomised clinical trial on overall survival European Journal of Cancer 49 (2013) 3788–3797.