Mistletoe Treatments & Benefits As A Cancer Support & Prevention Therapy

The following information is geared towards:
  • Patients who are actively living with cancer – those who have been diagnosed with cancer and are currently or about to undergo conventional treatments.
  • Patients who are palliative – maybe conventional medicine doesn’t have any other answers for them and they are looking for an alternative.
  • Patients who have survived a cancer diagnosis and who would like to prevent a recurrence.
  • Patients who have a long family history of cancer and would like to prevent it.
Note- Although mistletoe is approved for injectable use in other jurisdictions, it is not approved for such use in Canada.  It is still officially registered and considered as an off-label use by specialists.

What is Mistletoe?
Mistletoe AKA viscum album has a long history (over 2,000 years) of safe use in traditional medicine.   It grows on oak trees which are considered sacred in many cultures. The mistletoe that we use at the clinic is from a company called Helixor and its trade name is Viscosan.  It is considered a supportive cancer treatment and it can positively improve quality of life of people during and after conventional therapy.  It decreases side effects of chemotherapy and/or radiation without interfering with the effects of these conventional therapies. Unlike what some doctors may tell you, mistletoe therapy is one of the most researched integrative cancer therapeutics.  Studies show that it will positively impact:
  • Quality of life
  • Side effects of conventional therapy
  • Overall survival

Mistletoe injections were first administered in the 1950s using the products called Iscador (TN) or Viscosan (trade name for Mistletoe from Helixor which is what we use at the clinic).  The clinical experience is largely based on treatment performed at two centres, Herdecke Community Hospital (Prof. Dr. med. M. Schietzel) (1) and Ludwig-Boltzmann-Institute for Clinical Oncology in Vienna (2).  A prospective clinical trial disclosed no evidence of acute or chronic toxicity in association with high-dose infusions of Viscosan (3).
The sometimes expressed hypothesis that high doses of Viscosan might lead to immunosuppression could not be confirmed by research.  On the contrary, an increase in the number of juvenile granulocytes and monocytes has been seen the day after infusion, and a significant rise in the activated T-cell count has been observed 1 week after treatment (4).
Although a decline in lymphocytes and all lymphocyte subsets has occasionally been observed in peripheral blood in association with doses in excess of 600 mg, the fact that this phenomenon was accompanied by an increased cellular immune score as well as by tumour regression indicates that there was no immunosuppression and suggests that the lower lymphocyte count was due to a shift of lymphocytes from the blood to the tumour tissue (5).

Indication
The main indication for Viscosanâ IV infusion therapy is progressive metastatic cancer if other effective therapies for cancer inhibition and improvement of quality of life are not available. Especially cancer pain is clearly better responding to IV infusion therapy than to standard subcutaneous treatment (6).
In addition, cancer patients with rapid deterioration of their quality of life may profit from this treatment (*).
Tumor regression on high-dose infusion therapy has been demonstrated in some cases showing progressive disease in spite of subcutaneous Viscosanâ treatment (5).
Among 33 cancer patients treated with high-dose Viscosanâ infusion, cancer response could be achieved in 9%, no-change over a period of 6-12 months in 36%, and a retardation of tumor progression in 27%, going along with a preserved quality of life for at least 6 months (7).
Another study involving 60 cancer patients revealed a decline in ESR and tumor markers in 23% and 17%, respectively, which can be considered to be objective signs of clinical improvement (8).
Given immediately before and during high-dose 5-FU chemotherapy, Viscosanâ infusion may result in an excellent tolerance of chemotherapy and in an improved quality of life (9).
Considering the higher risk of allergic or pseudoallergic reaction to Viscosanâ IV infusion in contrast to subcutaneous injection, administration of Viscosan infusion should be strictly restricted with advanced metastatic disease.

Contraindications
  • Acute inflammation or high fever: The treatment should be interrupted until inflammation has subsided -
  • Allergy to mistletoe preparations -
  • Chronic granulomatous diseases, florid autoimmune disorders (also during immunosuppressive treatment) -
  • Hyperthyroidism with tachycardia -
  • Pregnancy (studies and clinical experience on the impact of Viscosanâ IV infusion on pregnancy and fetal development do not exist)

Administration and Dosage
  • For exclusion of a very rare true allergy to mistletoe preparations we recommend an intracutaneous test injection of 0.1 ml out of Viscosan 1mg. In case of a positive reaction (marked local urticarial, systemic symptoms) Viscosan should not be administered.
  • If subcutaneous is chosen then it is normally given 3 x week but in more advanced cases it can be administered daily.
  • If intravenous method is chosen, then the first infusion is at either a dose of 50 mg or 100 mg in a 250 mls of saline solution (unless mixed with high dose of Vitamin C treatment). The infusion needs to be a slow drip and it should take at least 2.5 hours to administer. The dose is increased in small steps in subsequent infusions in patients who tolerate the mistletoe therapy well until there is a marked improvement in general health (in respect to performance, appetite, weight, sleep, cancer pain, depression), a rise in body temperature (distinct increase in temperature during or shortly after completing the infusion, possibly with shivering, general malaise, headache or limb pain), or slight eosinophilia in blood tests.  Please note that we will need to do blood tests every 4-6 weeks.  Infusions can be given once, twice or 3 x week depending on how fast the deterioration of the general condition is.  Even a transient daily administration for 1-2 weeks might be beneficial.

  • In addition, a combination of subcutaneous injections and intravenous injections may be given. First experiences showed an enhanced inflammatory and fever stimulating effect with simultaneous SC injection at the infusion day, going along with an increased immune-mediated anti-tumoral effect (10).

Duration of Therapy
The duration of infusion therapy depends entirely on the individual patient's needs. Patients with a long-term remission can finish the infusion therapy while subcutaneous treatment is continued. In other cases infusion therapy may be continued without risk for as long as dictated by the patient's state of health and the course of the disease.

Adverse Drug Reactions
Toxicity on bone marrow, liver, kidneys and other organ systems has never been observed in association with either high-dose Viscosanâ infusion up to a maximum dose of 8 g, not even during long-term therapy (1;3) or with extremely high doses of recombinant mistletoe lectin up to 6 µg/kg body weight (12). Note that at the clinic we have only used a maximum of 1 g to 1.2 g per infusion.
441 patients treated with Viscosanâ IV infusion have been documented within the Network Oncology between January 1996 and June 2012 (11). One or more adverse drug reactions occurred in 5.9% of patients: Fever (n = 15), allergic skin reaction (n = 9), dyspnea (n = 4), and gastrointestinal complaints (n = 5) like nausea and stomach-ache have been most frequently reported.
Febrile reactions usually occur already during infusion or in the first 30 minutes afterwards. Fever is actually a beneficial pharmacological effect induced by mistletoe and, if possible, should not be treated with antipyretics. However, if fever of more than 38° C puts a strain to the patient, it can be avoided by reducing the dose.
Transient malaise on infusion day with fatigue, dizziness, headache and limb pain will usually have disappeared by the next day. If these symptoms persist for longer than 24 hours or cause the patient great discomfort, they could be indicative of relative overdosage, which can be handled by reducing the dose.
The risk of allergic and pseudoallergic reactions (urticaria, Quincke's edema, bronchospasm) is much higher with IV infusion therapy than with subcutaneous treatment. Whereas such reactions occur in only 0.1% of patients treated subcutaneously, it can occur in 1% of patients being treated intravenously. However, such reactions have only been observed in case of a too high drip speed and a too short infusion time of less than three hours, respectively. As a rule, these are low grade reactions (e.g. generalised itching) and mostly show spontaneous regression when the IV infusion has been stopped after the first symptoms. Occasionally, former SC injection site reactions can be reactivated by IV infusion.
According to clinical experience with high-dose IV infusions of recombinant mistletoe lectins, anaphylactic reactions only occurred in patients who were subcutaneously pretreated with mistletoe products (12).

References
(1)Schietzel M, Scholz G. Retrospektive Bewertung der Toxizität von Helixor® bei hochdosierten Infusionen. [Retrospective evaluation of the toxicity of high-dose infusions of Helixor®]. Herdecke: Interner Bericht des Gemeinschaftskrankenhauses; 1987.
(2) Salzer G, Hellan J, Babits R, Engelhard I, Günczler P. Die Mistel am Ludwig Boltzmann-Institut für klinische Onkologie. [Mistletoe at the Ludwig Boltzmann Institute for Clinical Oncology]. DZO 1987; 19 (3): 59-63.
(3) Böcher E, Stumpf C, Büssing A, Schietzel M. Prospektive Bewertung der Toxizität hochdosierter Viscum album L.-Infusionen bei Patienten mit progredienten Malignomen. [Prospective evaluation of the toxicity of high-dose Viscum album L infusions in patients with progressive malignant disease]. Zeitschrift für Onkologie 1996; 28
(4): 97-106. (4) Büssing A, Stumpf C, Stumpf RT, Wutte H, Schietzel M. Therapiebegleitende Untersuchung immunologischer Parameter bei Tumor-Patienten nach hochdosierter intravenöser Applikation von Viscum album L.-Extrakten. [On-treatment study of immunological variables in cancer patients following high-dose intravenous administration of Viscum album L. extracts]. Zeitschrift für Onkologie 1996; 28 (2): 54-9.
(5) Kalden M. Klinische Erfahrungen mit Viscum album bei fortgeschrittenen Tumoren. [Clinical experience of Viscum album in advanced cancer]. Erfahrungsheilkunde 1994; 43
(6): 315-21. (6) Friedrichson U. Die Wirkung der Misteltherapie auf Tumorschmerzen. [The effects of mistletoe therapy on cancer pain]. Erfahrungsheilkunde 1995; 44 (10a): 664.
(7) Steinkellner W. Hochdosis-Misteltherapie. Eigendruck 1997; 1-3.
(8) Sarkadi A. Mistelinfusionstherapie in der Onkologie - eine klinische Verlaufsbeobachtung. [Mistletoe Infusion Therapy in Oncology - A Clinical Report]. Erfahrungsheilkunde 1995; 44 (6): 426-9.
(9) Zerm R et al. Intravenöse Misteltherapie zu Ardalan-Chemotherapie bei einer Patientin mit metastasiertem Kolonkarzinom. [Intravenous mistletoe and the Ardalan chemotherapy regimen in the treatment of a patient suffering from advanced colorectal carcinoma]. In: Scheer R et al. (Hrsg.). Fortschritte in der Misteltherapie. Essen: KVC Verlag; 2005. S. 465- 75.
(10) Orange M et al. The importance of the primary dosage in mistletoe therapy. [Die Bedeutung der Anfangsdosis in der Misteltherapie]. In: Scheer R et al. (Hrsg.). Die Mistel in der Tumortherapie 2. Essen: KVC Verlag; 2009. S. 385-400.
(11) Schad F et al. Safety report for Helixorâ from the Network Oncology Clinical Database. Forschungsinstitut Havelhoehe, Berlin, January 25th 2013
(12) Schöffski P, Breidenbach I, Krauter J, Bolte O, Stadler M, Ganser A, et al. Weekly 24 h infusion of aviscumine (rViscumin): A phase I study in patients with solid tumors. European Journal of Cancer 2005; 41 (10): 1431-8.