Survival of cancer patients treated with mistletoe extract (Iscador): A systematic literature review

Center for Integrative Medicine, Faculty of Medicine, University of Witten/Herdecke, Herdecke, Germany.
BMC Cancer (Impact Factor: 3.36). 12/2009; 9(1):451. DOI: 10.1186/1471-2407-9-451
Source: PubMed


In Europe, extracts from Viscum album (VA-E), the European white-berry mistletoe, are widely used to treat patients with cancer.
We searched several databases such as Cochrane, EMBASE, NCCAM, NLM, DIMDI, CAMbase, and Medline. Inclusion criteria were controlled clinical studies on parameters associated with survival in cancer patients treated with Iscador. Outcome data were extracted as they were given in the publication, and expressed as hazard ratios (HR), their logarithm, and the respective standard errors using standard formulas.
We found 49 publications on the clinical effects of Iscador usage on survival of cancer patients which met our criteria. Among them, 41 studies and strata provided enough data to extract hazard ratios (HR) and their standard errors (Iscador versus no extra treatment). The majority of studies reported positive effects in favour of the Iscador application. Heterogeneity of study results was moderate (I2 = 38.3%, p < 0.0001). The funnel plots were considerably skewed, indicating a publication bias, a notion which is corroborated by statistical means (AC = -1.3, CI: -1.9 to -0.6, p <= 0.0001). A random effect meta-analysis estimated the overall hazard ratio at HR = 0.59 (CI: 0.53 to 0.66, p < 0.0001). Randomized studies showed less effects than non-randomized studies (ratio of HRs: 1.24, CI: 0.79 to 1.92, p = 0.35), and matched-pair studies gave significantly better results than others (ratio of HRs: 0.33; CI: 0.17 to 0.65, p = 0.0012).
Pooled analysis of clinical studies suggests that adjuvant treatment of cancer patients with the mistletoe extract Iscador is associated with a better survival. Despite obvious limitations, and strong hints for a publication bias which limits the evidence found in this meta-analysis, one can not ignore the fact that studies with positive effects of VA-E on survival of cancer patients are accumulating. Future studies evaluating the effects of Iscador should focus on a transparent design and description of endpoints in order to provide greater insight into a treatment often being depreciated as ineffective, but highly valued by cancer patients.

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Available from: Arndt Büssing
    • "The European mistletoe obtained from deciduous trees contains mostly ML-I and, when grown on some host such as pine and fir trees, ML-III. Viscum album extract preparations have been tested in clinical trials as supporting medicines for cancer surgery , chemotherapy, or radiotherapy providing support for their therapeutically beneficial effects (Augustin et al., 2005; Bussing et al., 2005; Kienle et al., 2003; Kienle and Kiene, 2010; Klopp et al., 2005; Melzer et al., 2009; Ostermann et al., 2009; Schink et al., 2007; Troger et al., 2009, 2013, 2014a, 2014b). Functional studies suggest that VAEs, when administered to tumor-bearing animals, display growth-inhibiting and tumor-reducing effects (Büssing, 2000; Duong Van Huyen et al., 2002; Kienle and Kiene, 2003; Park et al., 2001). "
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    ABSTRACT: Toxicity of conventional chemotherapeutics highlights the requirement for complementary or alternative medicines that would reduce side effects and improve their anticancer effectiveness. European mistletoe (Viscum album) has long been used as a complementary and alternative medicine supporting cancer therapy. The aim of this study was to investigate synergistic antitumor action of V. album extract and doxorubicin during co-treatment of chemoresistant chronic myelogenic leukemia K562 cells. Combined treatment of leukemia cells led to inhibitory synergism at sub-apoptotic doxorubicin concentrations and multifold reduction of cytotoxic effects in healthy control cells. Prolonged co-treatment was associated with reduced G2/M accumulation and increased expression of early and late apoptotic markers. Our data indicate that V. album extract increases antileukemic effectiveness of doxorubicin against resistant K562 cells by preventing G2/M arrest and inducing apoptosis. Copyright © 2015 John Wiley & Sons, Ltd.
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    • "Two components of mistletoe, namely, viscotoxins and lectins, have been shown to be largely responsible for these effects [7] [8] [9]. Reports on the clinical efficacy of mistletoe therapy have been conflicting and systematic Evidence-Based Complementary and Alternative Medicine literature reviews often criticise studies for poor design [10] [11]. Although an effect of mistletoe on tumour shrinkage in vivo or overall survival might remain to be proven more thoroughly, a growing number of studies indicate beneficial effects on quality of life of cancer patients and reduction of adverse drug reactions (ADRs) associated with conventional cancer treatments [12] [13] [14] [15] [16] [17]. "

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    • "Viscum album extract has been shown to induce tumor regression by cell cycle apoptosis and activating cell death pathways. Furthermore, it can induce secretion of pro-inflammatory cytokines such as Tumor necrosis factor α, IL 1 and IL6 [7] [12]. So far, however, there has been little research about other species of mistletoe especially Southeast mistletoe. "
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    ABSTRACT: Discovery of new therapeutic agents from nature, especially plants is one of the promising approaches for treatment of various diseases. In traditional medicine Scurrula ferruginea is applied to treat some disorders. To the best of our knowledge, there are no investigations on antioxidant capacity and antimicrobial activities of S.ferruginea in Malaysia. The present study was conducted to determine total phenolic content, Fe2+ chelating activity, antioxidative and antimicrobial potential of flowers, leaves and stems of S.ferruginea extracts. Antioxidant capacity, and total phenolic content of extracts were evaluated using DPPH free radical scavenging and Folin-Ciocalteu assays. Antibacterial properties were evaluated by disc diffusion, minimum inhibitory concentration and minimum bactericidal concentration methods. Results indicated the highest total phenolic content for stem extract (309.069). All S. ferruginea extracts exhibited antioxidant activity in a dose dependent manner. Stem extract showed capacity to scavenge free radicals and it was also found to chelate Fe2+ better than others. All extracts presented moderate inhibition ability against selected bacteria. The most significant values of MIC and MBC were belonged to the stem extract. These findings suggest that acetone extracts of S. ferruginea, particularly stem extract, are potentially sources of antioxidant compounds.
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