What is Mistletoe?
European mistletoe (Viscum album) is a plant that grows on a variety of trees. It is sometimes recommended to people with cancer as an integrative or complementary treatment. The plant is extracted into a liquid that can be used as an injection (subcutaneous) or an intravenous (IV) infusion. Mistletoe should only be used under the guidance of a qualified healthcare provider.
What is Mistletoe Used For?
Mistletoe is used in supportive cancer care to help:
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Enhance the immune system
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Support quality of life
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Alleviate cancer and cancer treatment-related symptoms and side effects
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Improve treatment outcomes or slow progression
Mistletoe is not used as a cure for cancer. Mistletoe should not be considered an alternative to cancer treatments such as chemotherapy or radiation therapy.
Which Symptoms Can Mistletoe Improve?
Research studies have found that those using mistletoe have improved:
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Appetite
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Energy
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Immunity
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Weight
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Digestion (less diarrhea, nausea, vomiting)
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Pain
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Sleep
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Nerve health (less neuropathy)
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Physical function
Are There Studies and Trials on Mistletoe Therapy?
Yes, efficacy and tolerability of mistletoe therapy has been tested in more than 150 clinical trials. Several of these trials confirm the positive effect of mistletoe therapy on the patients’ quality of life. Mistletoe contains over 1,000 constituents that together appear to help strengthen the immune system, activate the body’s defenses, and improve general well being.
Breast Cancer
In Pelzer et al.'s study from 2018, they looked at 95 breast cancer patients who had surgery. Some got mistletoe injections (Helixor A or Iscador M) along with chemotherapy, while others only had chemotherapy. The mistletoe group had better functioning in different aspects like emotions, pain, and digestion compared to the group without mistletoe. There were no major side effects, except for some skin reactions. Troger et al. in 2014 studied 65 breast cancer patients after surgery. Some received mistletoe injections (Helixor A) along with chemotherapy, and others only had chemotherapy. Mistletoe significantly improved several aspects of their quality of life, such as emotions, social interactions, and pain. Overall, mistletoe was safe, with only a few people experiencing minor skin reactions. Semiglasov et al. (2004) conducted a randomized placebo-controlled double-blind study with 272 participants with breast cancer. The mistletoe group received mistletoe injections alongside chemotherapy, while the control group received placebo injections. The mistletoe group showed significant improvements in quality of life, including a higher CD4 count and CD4/CD8 ratio (a measure of the part of the immune system that kills cancer cells). Adverse events were minimal, mainly local reactions. Semiglazov et al. (2006) continued with a randomized placebo-controlled study involving 352 participants with breast cancer. The mistletoe group received mistletoe injections alongside chemotherapy, while the control group received placebo injections. The mistletoe group showed improved quality of life scores and tolerated the treatment well, with local reactions occurring in 17.6% of participants. Troger et al. (2009) conducted a randomized controlled open study with 61 non-metastatic breast cancer patients. The mistletoe group received Iscador M injections alongside adjuvant chemotherapy, while the control group received adjuvant chemotherapy alone. The mistletoe group showed significantly better quality of life across various endpoints compared to the control group, with clinically relevant changes noted in nine endpoints. Neutropenia occurred non-significantly less in the mistletoe group.
Osteosarcoma
Longhi et al. in 2020 compared mistletoe with conventional therapy to conventional therapy plus a chemotherapy drug called etoposide. They looked at how long people went without their disease getting worse (Progression-Free Disease Survival or PRDFS) and overall survival rates. In the mistletoe group, the time without disease progression was much longer at 106 months compared to 7 months in the etoposide group. Also, 5 out of 9 people in the mistletoe group didn't experience a relapse, while everyone in the etoposide group did. The estimated overall survival rates after 10 years were 64% for mistletoe and 33% for etoposide, although they didn't do a statistical analysis to confirm these differences. Longhi et al. (2014) studied 20 people with relapsed osteosarcoma. One group got mistletoe injections (Iscador P) three times a week for a year, and the other group got oral chemotherapy. The mistletoe group had a higher chance of being disease-free after a year (55.6% compared to 12%). They also reported feeling better in terms of their quality of life, and mistletoe had very few side effects.
Pancreatic Cancer
Troger et al. (2013) studied 220 people with pancreatic cancer, split into two groups. One group received mistletoe injections (Iscador Q) three times a week for up to a year, and the other group only received standard care. The mistletoe group lived 77% longer compared to the standard care group. The mistletoe group also had fewer side effects, and they reported less pain, weight loss, nausea, and anxiety. Troger et al. (2014) extended this study, showing that mistletoe improved overall health and reduced symptoms like pain and fatigue, and patients gained more weight. Reif et al. (2019) looked at pain and medication use in the mistletoe group from Troger et al. (2013). They found that mistletoe patients needed fewer and less strong pain medications than those who didn't get mistletoe.
Gastric (Stomach) Cancer
Kim et al. (2012) conducted a study with 32 patients with gastric cancer, comparing mistletoe injections to standard treatment alone. Mistletoe injections improved the quality of life for patients, showing better global health status, less pain, improved eating ability, and reduced hair loss. Additionally, the mistletoe group had higher white blood cell counts and eosinophil counts, indicating potential immune system enhancement. No serious adverse events were linked to mistletoe.
Esophageal Cancer
Enesel et al. (2005) studied 70 individuals with mixed gastroesophageal and abdominal cancers in a randomized controlled trial. The mistletoe group received Isorel A injections alongside surgery, while the control group had surgery alone. The mistletoe group exhibited enhanced immune markers and significantly higher white blood cell counts, lymphocytes, complement, immunoglobulins, and NK cells. Many of these cells help kill off cancer cells.
Lung Cancer
Bar-Sela et al. (2013) carried out a Phase II randomized study with 72 patients with non-small cell lung cancer (NSCLC), comparing mistletoe (Iscador Q) to chemotherapy alone. The mistletoe group experienced fewer chemotherapy dose reductions, lower rates of severe toxicities, hospitalizations, and peripheral neuropathy compared to the control group.
Colon Cancer
In a study by Bar-sela et al. (2004), 25 individuals with metastatic colorectal cancer, resistant to standard chemotherapy, received mistletoe injections (Abnoba-viscum Q) in a phase II trial. 40% of participants reported symptomatic relief for symptoms like nausea, vomiting, diarrhea, constipation, fatigue, and dyspnea. Adverse events were generally mild, including local reactions, and only two participants had mild transient temperature elevation.
Various Cancers
Mansky et al. (2013) conducted a Phase I uncontrolled study with 44 patients with various cancers (colorectal, breast, pancreatic, lung) in Stage IV. They used mistletoe (Helixor A) in combination with gemcitabine. The study found that mistletoe did not negatively impact gemcitabine's effectiveness. Adverse events related to mistletoe were generally mild, with injection site reactions being the most common. The maximum tolerated dose (MTD) for mistletoe was determined to be 250 mg. Clinical responses were similar to those seen with gemcitabine alone, with some patients achieving partial response or stable disease. Piao et al. (2004) conducted a randomized controlled open-label study with 233 participants having breast, ovarian, or non-small cell lung cancer. The intervention group received mistletoe (Helixor) injections alongside conventional chemotherapy, while the control group received chemotherapy alone. The mistletoe group showed significant improvements in key performance and functional living index scores compared to the control group. There were fewer adverse events in the mistletoe group.
How Does Mistletoe Work?
There are two ways in which it is thought mistletoe works:
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Enhancing immune function – mistletoe appears to increase types of white blood cells called lymphocytes including natural killer cells, certain compounds called cytokines, and mistletoe antibodies.
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Directly killing cancerous cells (cytotoxicity) – mistletoe may trigger cell death which may reduce cancers ability to grow and spread.
Studies on mistletoe therapy demonstrate benefits to quality of life in people with cancer and reduced side effects from chemotherapy. Results are mixed for tumor response and survival. Some inconsistency may be due to the range of mistletoe preparations, cancer types, and cancer stages evaluated in these studies.
Impact on Immunity
In several studies mistletoe has been found to increase certain white blood cells called lymphocytes including natural killer cells. Mistletoe treatment seems to decrease the immunosuppressive effects of surgery. Mistletoe does not appear to help increase neutrophils.
Impact on Quality of Life and Symptom Management
Several systematic reviews (large summaries of research) have shown a benefit of mistletoe treatment on quality of life and symptom management across a range of cancer types. Side effects which may be improved with mistletoe include nausea, vomiting, diarrhea, appetite loss, pain, and fatigue.
Impact on Survival and Tumor Response
While several studies have found improved lifespan for people treated with mistletoe, some have not. Results are mixed for certain types of cancers and not conclusive. Additional research is needed to study potential benefit to survival.
Mistletoe is not a curative treatment for cancer and should not be used to replace other effective cancer treatments. Given the data, mistletoe should be considered primarily for support for quality of life, side effects, and immune system support.
Is Mistletoe Safe?
Mistletoe has a very good safety profile. However, there are times when mistletoe therapy may not be safe.
Mistletoe should not be used by people with a known sensitivity or allergy to mistletoe. It is also not generally recommended during pregnancy or breastfeeding because of a lack of information on safety in this context. Since mistletoe can stimulate the immune system, it should not be used in combination with immunosuppressant medications (e.g. for treatment of autoimmune conditions or after transplants).
Mistletoe should be used cautiously in people with autoimmune conditions although it is likely safe for most if not taking immunosuppressant medication. Mistletoe should be used cautiously in people with brain tumors due to the possibility of inflammation. Due to lack of information, mistletoe should be used cautiously in people with blood cancers, particularly acute leukemias.
No studies have found negative interactions with mistletoe and chemotherapy, radiation therapy, or surgery. Preliminary studies have found no harm using mistletoe alongside immunotherapies and targeted therapies, but more research is needed.
Mistletoe should only be used under the guidance of a healthcare provider to monitor for reactions, response, and to administer and/or monitor injections.
How Long has Mistletoe Therapy Been in Use?
Mistletoe products have been used successfully in integrative cancer therapy since 1917.
Where To Find More Information on Mistletoe?
To learn more, contact us or book an appointment. More information is also available at www.helixor.com.
Are There Side Effects with Mistletoe?
Mistletoe is generally well tolerated by most people. Because mistletoe strongly stimulates the immune system there are some mild side effects that are commonly expected. These may include: injection site reactions (redness, swelling, itching), fatigue, flu-like symptoms, mild fever, diarrhea, and headache. Severe local reactions at the injection site occur in less than 1% of people. Most side effects are mild and resolve on their own.
Serious reactions are rare but include angioedema, anaphylaxis, hypotension and loss of consciousness, cellulitis at injection site.
There is more research on the use and safety of subcutaneous injections of mistletoe than for IV infusions. The risk of severe adverse reactions such as anaphylaxis may be higher with IV use, but more research is needed.
How Much Does Mistletoe Cost?
Depending on the dose, the monthly cost of mistletoe injection therapy can range from $250-$350.
What is the Recommended Dose of Mistletoe?
At our clinic, mistletoe is available as subcutaneous injections. The type of mistletoe, maximum dose, and length of use varies based on the individual’s cancer type, stage, medical history, goals and preferences, and other cancer treatments. Treatment with subcutaneous mistletoe begins with a low dose to assess tolerability. If mistletoe is well tolerated the dose is increased gradually. Treatment may be used for a few months to support people during active treatment, and in some instances may be used for one or more years if well-tolerated and positive outcomes are observed.
Next Steps
If you would like to learn more about or pursue mistletoe therapy, you can reach out to Dr. Baker (ND) at our clinic.
References
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Piao BK, Wang Yx Fau - Xie GR, Xie Gr Fau - Mansmann U, Mansmann U Fau - Matthes H, Matthes H Fau - Beuth J, Beuth J Fau - Lin HS, et al. Impact of complementary mistletoe extract treatment on quality of life in breast, ovarian and non-small cell lung cancer patients. A prospective randomized controlled clinical trial. Anticancer research. 2004;24(0250-7005 (Print)):303-10.
Semiglasov VF, Stepula VV, Dudov A, Lehmacher W, Mengs U. The standardised mistletoe extract PS76A2 improves QoL in patients with breast cancer receiving adjuvant CMF chemotherapy: a randomised, placebo-controlled, double-blind, multicentre clinical trial. Anticancer research. 2004;24(2C):1293-302.
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