03 Mistletoe information

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https://hdl.handle.net/20.500.14430/4

Mistletoe is the English common name for over 1200 species of a semi-parasitic plant that grows on trees worldwide, though only viscum album (European or common mistletoe) is used in the treatment of cancer and inflammatory conditions. References to mistletoe as a sacred plant and remedy appear throughout history and date as far back as the writings of Hippocrates (c. 460 - c. 370) and Pliny the Elder (AD 23-79), but it was only through the indications of Rudolf Steiner, in the early 1920's, that it became known that mistletoe could be used for the treatment of cancer. It was then developed as an injection.

Since that time, European oncologists have been using the liquid extract of the mistletoe plant with the goal to improve survival in patients with cancer and to improve quality of life by reducing the side-effects of chemotherapy and radiation, such as nausea, vomiting and lack of appetite, as well as diminishing tumor-related pain. Mistletoe injections are currently among the most widely used complementary cancer treatments in Europe. It is approved for palliative care use in several European countries, but not yet in the United States. Until further clinical testing is done in the US, oncologists cannot offer this treatment as standard of care for cancer patients. Mistletoe is being administered in the US by complementary medicine practitioners, but mistletoe is not approved by the FDA for cancer treatment.

The clinical effectiveness of mistletoe extracts in cancer has been investigated in a great number of studies and clinical trials, primarily in Europe. A clinical trial is currently being conducted in the US at Johns Hopkins School of Medicine.

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Browsing 03 Mistletoe information by Author "Axtner, Jan"

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    Adverse Drug Reactions and Expected Effects to Therapy with Subcutaneous Mistletoe Extracts (Viscum album L.) in Cancer Patients
    (2014) Steele, Megan L.; Axtner, Jan; Happe, Antje; Kröz, Matthias; Matthes, Harald; Schad, Friedemann

    Background. In Europe, mistletoe extracts are widely used as a complementary cancer therapy. We assessed the safety of subcutaneous mistletoe as a conjunctive therapy in cancer patients within an anthroposophic medicine setting in Germany. Methods. A multicentre, observational study was performed within the Network Oncology. Suspected mistletoe adverse drug reactions (ADRs) were described by frequency, causality, severity, and seriousness. Potential risk factors, dose relationships and drug-drug interactions were investigated. Results. Of 1923 cancer patients treated with subcutaneous mistletoe extracts, 283 patients (14.7%) reported 427 expected effects (local reactions <5 cm and increased body temperature <38°C). ADRs were documented in 162 (8.4%) patients who reported a total of 264 events. ADRs were mild (50.8%), moderate (45.1%), or severe (4.2%). All were nonserious. Logistic regression analysis revealed that expected effects were more common in females, while immunoreactivity decreased with increasing age and tumour stage. No risk factors were identified for ADRs. ADR frequency increased as mistletoe dose increased, while fewer ADRs occurred during mistletoe therapy received concurrent with conventional therapies. Conclusion. The results of this study indicate that mistletoe therapy is safe. ADRs were mostly mild to moderate in intensity and appear to be dose-related and explained by the immune-stimulating, pharmacological activity of mistletoe.

    Citation: Steele, M. L., Axtner, J., Happe, A., Kröz, M., Matthes, H., & Schad, F. (2014). Adverse Drug Reactions and Expected Effects to Therapy with Subcutaneous Mistletoe Extracts (Viscum album L.) in Cancer Patients. Evidence-Based Complementary and Alternative Medicine, 2014, e724258. https://doi.org/10.1155/2014/724258

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    Safety of Intravenous Application of Mistletoe (Viscum album L.) Preparations in Oncology: An Observational Study
    (2014) Steele, Megan L.; Axtner, Jan; Happe, Antje;; Kröz, Matthias; Matthes, Harald; Schad, Friedemann
    Background. Traditional mistletoe therapy in cancer patients involves subcutaneous applications of Viscum album L. preparations, with doses slowly increasing based on patient responses. Intravenous infusion of high doses may improve therapeutic outcomes and is becoming more common. Little is known about the safety of this “off-label” application of mistletoe. Methods. An observational study was performed within the Network Oncology. Treatment with intravenous mistletoe applications is described. The frequency of adverse drug reactions (ADRs) to intravenous mistletoe applications was calculated and compared to ADR data from a study on subcutaneous applications. Results. Of 475 cancer patients who received intravenous infusions of Helixor, Abnoba viscum, or Iscador mistletoe preparations, 22 patients (4.6%) reported 32 ADRs of mild (59.4%) or moderate severity (40.6%). No serious ADRs occurred. ADRs were more frequently reported to i.v. mistletoe administered alone (4.3%), versus prior to chemotherapy (1.6%). ADR frequency differed with respect to preparation type, with Iscador preparations showing a higher relative frequency, compared to Abnoba viscum and Helixor. Overall, patients were almost two times less likely to experience an ADR to intravenous compared to subcutaneous application of mistletoe. Conclusion. Intravenous mistletoe therapy was found to be safe and prospective studies for efficacy are recommended. Citation: Steele, M. L., Axtner, J., Happe, A., Kröz, M., Matthes, H., & Schad, F. (2014). Safety of Intravenous Application of Mistletoe (Viscum album L.) Preparations in Oncology: An Observational Study. Evidence-Based Complementary and Alternative Medicine, 2014, e236310. https://doi.org/10.1155/2014/236310
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    Use and Safety of Intratumoral Application of European Mistletoe (Viscum album L) Preparations in Oncology
    (2014) Steele, MeganL.; Axtner, Jan; Happe, Antje; Kröz, Matthias; Matthes, Harald; Schad, Friedemann

    Abstract

    Background. Intratumoral (IT) injection of European mistletoe (Viscum album L) preparations might induce local tumor response through combined cytotoxic and immunomodulatory actions of the preparations. Although promising in vitro and in vivo data, along with clinical case studies suggest the need for validation of this hypothesis in prospective trials, the safety of IT mistletoe injections has yet to be thoroughly assessed. Methods. The present study summarizes the practice and safety of off-label IT mistletoe therapy within the Network Oncology, a conjoint clinical registry of German hospitals and outpatients specialized in anthroposophic and integrative medicine. Demographic, diagnosis and treatment data of cancer patients who received IT mistletoe applications between 2007 and 2013 were assessed. Suspected adverse drug reactions (ADRs) were analyzed in terms of type, frequency, severity, seriousness and potential risk factors. Results. A total of 123 cancer patients received 862 IT mistletoe injections (preparations from Abnoba, Helixor and Iscucin). The most commonly applied preparations were Abnoba viscum Fraxini (71 patients) and Helixor Mali (54 patients). Of the total patients, 26 patients (21.1%) experienced 74 ADRs. All ADRs were in response to either Abnoba viscum Fraxini (25.4% of exposed patients) or Helixor Mali (18.5% of exposed patients). ADRs were mostly body temperature or immune related and of mild (83.8%) or moderate (14.9%) intensity. Only one possible ADR was described as severe (hypertension) and no serious ADRs occurred. The frequency of ADRs to IT mistletoe injections was 3 times and 5 times higher than has previously been found for subcutaneous and intravenous applications of mistletoe, respectively. Conclusion. IT injection of mistletoe preparations resulted in a relatively high frequency of ADRs. Nearly all ADRs were mild to moderate however, and no serious ADRs occurred. Furthermore, it is possible that immune-related ADRs such as pyrexia and local inflammatory reactions might be critical for tumor response. In light of these results, IT mistletoe therapy seems to be safe and prospective trials are recommended.

    Keywords: Viscum album, mistletoe, cancer, safety, adverse drug reactions, adverse events, Anthroposophic Medicine, intratumoral

    Citation: Steele, M. L., Axtner, J., Happe, A., Kröz, M., Matthes, H., & Schad, F. (2015). Use and Safety of Intratumoral Application of European Mistletoe (Viscum album L) Preparations in Oncology. Integrative Cancer Therapies, 14(2), 140–148. https://doi.org/10.1177/1534735414563977

None of the information provided on Mistletoe should be interpreted as an endorsement or position of PAAM to use Mistletoe in the clinical setting. These materials are for research and educational purposes only. Mistletoe is not FDA approved for treatment of cancer or any disease. It is the sole responsibility of clinicians to offer this supplement in their practice. PAAM does not recommend mistletoe as a replacement for treatments prescribed by trained and board certified oncologists. Only licensed clinicians can prescribe mistletoe. They should be fully trained in its adjuvant or supplemental use and potential side effects, drug interactions, contraindications and appropriate indications.