02 Case studies in cancer

Introduction: Metastatic malignant cutaneous melanoma (MCM)—a highly immunogenic cancer—typically has a poor prognosis. Viscum album extracts (VAEs) have strong immune-stimulating, apoptogenic, and cytotoxic effects.

Case presentation: A 66-year-old MCM patient with newly diagnosed lymph node metastases opted for sole VAE treatment. VAEs were initially applied subcutaneously, and then later in exceptionally high, fever-inducing doses, both intravenously and intralesionally. The metastases shrunk over the following months, and after 2 years, all lesions had completely remitted (regional and hilar lymph nodes). The patient has been tumor free for 3.5 years at the time of publication (and for 5 years since initiation of intensified VAE treatment). Besides fever and flu-like symptoms, no side effects occurred.

Discussion: We presume that VAE triggered an increased release of tumor-associated antigens, enhanced immunologic recognition, and increased immune response against the tumor tissue and induced tumor remission.

Abbreviations: AJCC = American Joint Committee on Cancer, BRAF = rapidly growing fibrosarcoma type B gene, FDG = Fludeoxyglucose (18F), MCM = malignant cutaneous melanoma, ML = mistletoe lectin, PET-CT = positron emission tomography–computed tomography, UICC = Union internationale contre le cancer, VAE = Viscum album extracts, VT = viscotoxin.

Keywords: complete remission, fever, malignant cutaneous melanoma, Mistletoe, Viscum album extract

Citation: Werthmann, P. G., Hintze, A., & Kienle, G. S. (2017). Complete remission and long-term survival of a patient with melanoma metastases treated with high-dose fever-inducing Viscum album extract: A case report. Medicine, 96(46), e8731. https://doi.org/10.1097/MD.0000000000008731

Rationale: Carcinoma in situ (CIS) of the uterine cervix is a premalignant condition of squamous epithelium. The standard treatments are excision and ablation procedures; for women with positive margins, hysterectomy is recommended.

Patient concerns: A 47-year-old Peruvian woman with recurrent candidal vaginitis had been diagnosed with colpocervicitis and squamous metaplasia 8 years ago, which were not treated.

Diagnoses: The patient was diagnosed with CIS after cervical conization procedure. She refused radical hysterectomy and opted for integrative medicine treatment.

Interventions: She was treated with intralesional and subcutaneous Viscum album L. extract (VAE) injections. VAE is a widely used herbal cancer treatment with cytotoxic, apoptogenic, and immunological effects, but it has not been investigated in cervical CIS.

Outcomes: Ending month 5 of treatment, complete remission of cervical CIS was observed. The patient is still in remission after 30 months (until publication).

Lessons: This is the first report on complete remission of cervical CIS after intralesional and subcutaneous injection with VAE. Prospective studies should evaluate to what degree the treatment effect is reproducible.

Abbreviations: CIN = cervical intraepithelial neoplasia, CIS = carcinoma in situ, HPV = human papillomavirus, IL = interleukin, ML = mistletoe lectins, Pap = Papanicolaou, VAE = Viscum album L. extract.

Keywords: case report, cervical carcinoma in situ, cervical intraepithelial neoplasia, complete remission, european mistletoe, fraxini, Viscum album L

Citation: Reynel, M., Villegas, Y., Kiene, H., Werthmann, P. G., & Kienle, G. S. (2018). Intralesional and subcutaneous application of Viscum album L. (European mistletoe) extract in cervical carcinoma in situ: A CARE compliant case report. Medicine, 97(48), e13420. https://doi.org/10.1097/MD.0000000000013420