Efficacy and Safety of Mistletoe Preparations (Viscum album) for Patients with Cancer Diseases

Abstract

Background: Mistletoe is often used as a complementary approach in oncology. Despite experimental anti-tumour effects and several reviews there remains controversy about its clinical role. Patients and Methods: Potentially relevant trials were identified to perform a systematic review (databases: e.g. EMBASE, MEDLINE; hand search: e.g. bibliographies; search terms: e.g. mistletoe). To be included, randomised or comparative clinical trials at least had to examine mistletoe preparations standardized according to manufacturing process and to describe interventions explicitly. Additionally, cohort studies were included for reasons of external validity. Results were summarised in tables. Results: 18 clinical trials (>6,800 participants) were included. Their internal quality was mostly low. Due to heterogeneity between trials a meta-analysis was impossible. Regarding efficacy, findings were inconsistent regarding life expectancy, relation to tumour entity, dosing and treatment duration. Yet, studies indicate that quality of life (QoL) is improved. As these findings do not seem to be limited to one of the different parenteral mistletoe preparations reviewed the treatment may be summarised under the umbrella term ‘mistletoe therapy’. Regarding safety, 1 serious adverse event (AE) related to mistletoe was described; non-serious AEs were local reactions at injection site. Allergic reactions were rare. Conclusion: Supportive ‘mistletoe therapy’ seems safe and beneficial for QoL in adult patients with solid tumours. But there is an urgent need to confirm its efficacy in patient-centred care in a complex oncological setting. This has to be evaluated systematically in prospective observational trials with validated, multidimensional patient-rated QoL questionnaires and comparisons of different preparations and dosages.

Medical Online Consultation Service in CAM at the University Hospital Zurich

“…The high number of questions about sexual and psychiatric conditions underlines that the online consultation service is favored in topics that are difficult to address face to face with a doctor [14,15]. The inquiries of cancer patients reflect their search for therapies, such as mistletoe therapy [16,17] that might have a positive impact on the course of their disease and reduce chemotherapy-induced adverse effects. Patients with chronic conditions inquire about CAM therapy options because their previous treatment had failed and/or because they were afraid of the adverse effects or hoped to reduce the dose [18].…”

Postoperative adjuvante Therapie mit einem Mistelextrakt (Viscum album ssp. album) bei Hündinnen mit Mammatumoren

“…Extrakte der europäischen Weißbeerigen Mistel (Viscum album L.) (VAE) stellen hierbei die am häufigsten verschriebenen Mittel dar [20]. Nicht repräsentative Umfragen in deutschsprachigen Ländern gehen von Prävalenzen von adjuvanten Misteltherapien zur Tumorbasistherapie zwischen 29 und 77% aus [21].…”

“…Aus klinisch humanmedizinischen Studien zur Misteltherapie ergab sich ein Hinweis auf die Verbesserung der LQ [21,46]. In der vorliegenden Untersuchung zeigte sich lediglich die Erhaltung bzw.…”

“…VAE ist pflanzlichen Ursprungs, und es ist davon auszugehen, dass VAE-Präparate zu 100% biologisch abbaubar sind. Eine aktuelle Übersichtsarbeit kommt zu dem Schluss, dass die in der Humanmedizin übliche subkutane Applikation im Mittel bei 15,9% der Patienten zu lokalen und bei 1,6% zu systemischen Nebenwirkungen führt [21]. Dramatische Nebenwirkungen sind lediglich für einen einzigen Fall beschrieben [21].…”

“…Eine aktuelle Übersichtsarbeit kommt zu dem Schluss, dass die in der Humanmedizin übliche subkutane Applikation im Mittel bei 15,9% der Patienten zu lokalen und bei 1,6% zu systemischen Nebenwirkungen führt [21]. Dramatische Nebenwirkungen sind lediglich für einen einzigen Fall beschrieben [21]. Im Hinblick auf ihren Einsatz beim Tier war traditionell die Mistel sogar Viehfutter.…”