Rationale: Metastatic pancreatic cancer has a dismal prognosis. Many patients seek integrative care as an add-on to their conventional cancer treatment. Viscum album extracts (VAE)—widely used as an adjunct to cancer treatment—have cytotoxic, apoptogenic, and immune stimulatory properties. A statistically significant survival benefit has been demonstrated for VAE in advanced pancreatic cancer. Patient concerns and diagnosis: A 28-year old patient presented with painless jaundice and was subsequently diagnosed as pancreatic adenocarcinoma with liver metastases.

Interventions: He was treated with FOLFIRINOX/Mitomycin, hyperthermia and fever-inducing VAE.

Outcomes: Subsequently, the liver metastases regressed. Surgical intervention involved successful R0-resection of the primary tumor, as well as an atypical liver resection. A relapse was again treated with FOLFIRINOX/Mitomycin and hyperthermia. As of publication of this report, 49 months after initial diagnosis, the patient exhibits good condition, and is unrestricted in quality of life (till publication).

Lessons: This case demonstrates the favorable outcome of a patient with metastatic pancreatic cancer following treatment with chemotherapy, integrative medicine, and surgical excision. As other positive outcomes in pancreatic cancer patients are related to inflammatory events, we presume the immunologic effects of VAE to have contributed to the favorable outcome here. Based on this case, and the other positive results of VAE use in pancreatic cancer, further investigations seem highly worthwhile. Abbreviations: CT = computed tomography, FOLFIRINOX = folinic acid, fluorouracil, irinotecan, oxaliplatin, FOLFOX = folinic acid, fluorouracil, oxaliplatin, ML = mistletoe lectin, PC = pancreatic cancer, UICC = Union for International Cancer Control, VAE = viscum album axtracts.

Keywords: fever, integrative medicine, mistletoe, pancreatic cancer, Viscum album

Citation: Werthmann, P. G., Inter, P., Welsch, T., Sturm, A.-K., Grützmann, R., Debus, M., Sterner, M.-G., & Kienle, G. S. (2018). Long-term tumor-free survival in a metastatic pancreatic carcinoma patient with FOLFIRINOX/Mitomycin, high-dose, fever inducing Viscum album extracts and subsequent R0 resection: A case report. Medicine, 97(49), e13243. https://doi.org/10.1097/MD.0000000000013243