Mistletoe preparations

Pharmaceutically processed extracts from mistletoe. A distinction should be made between mistletoe preparations used in oncology—which are always administered by injection—and mistletoe preparations in drop or coated tablet form; see under *Visci herba*.

The preparations used in oncology consist of an aqueous extract of Viscum album, mistletoe. During processing, in one preparation (^Iscador®), this extract is mixed with lactic acid bacteria native to mistletoe and fermented before further processing; in other preparations (^Helixor®,^Iscucin®), no fermentation takes place. These aqueous extracts are injected intradermally or subcutaneously.

Host trees include apple, pine, oak, elm, and fir. 

Mistletoe extracts for cancer treatment have their origins in anthroposophy, which is why their approval in Germany is based on the exemptions granted for anthroposophy.

Currently, there is no recognized scientific evidence for the efficacy of mistletoe extracts in human medicine. The available data did not provide sufficient evidence of an extension in overall survival.

The TIM study (Therapeutic Instillation of a Mistletoe Extract) on the treatment of superficial bladder cancer, which included only a small number of participants, shows an effect comparable to that of mitomycin in preventing recurrence (Rexer H 2016).

Preclinical studies have demonstrated that the lectins contained in mistletoe can kill cell cultures and stimulate immune cells. 

 

Mistletoe extracts are available as approved medications in German-speaking countries (based on the monographs of Commission C and Commission E). The costs of mistletoe therapy are covered by health insurance providers (both statutory and private) only in exceptional cases, generally limited to palliative care aimed at improving quality of life.

 

Immunostimulant in malignant diseases, stimulation of bone marrow activity. Mistletoe extracts are still used today in high-risk malignant melanoma. A prospective randomized study of the EORTC melanoma group showed that treatment with the mistletoe lectin Iscador M has no influence on the prognosis compared to a non-treated control group.

see also Visci herba, use in degenerative-inflammatory joint diseases

According to the appropriate dosage scheme.

Allergic reactions up to anaphylactic shock, local inflammatory reactions at the injection site, fever, regional lymph node swelling, activation of inflammation.

Protein hypersensitivity, acute and chronic progressive infections, fever. Lactation, pregnancy and childhood.

Depending on the manufacturer, different warnings are given, e.g. for thyroid problems, intracranial pressure in the case of metastases or tumors in the brain.

Some preparations warn patients with leukemia, lymphoma, renal cell carcinoma or melanoma.

^Helixor®,^Iscador®,^{Iscucin®,abnobaVISCUM®,Isorel®};^Rubaxx® Arthro;

 

1. Kähler KC et al (2011) Adjuvant systemic therapy of melanoma. Dermatologist 62: 414-422
2. https://www.krebsinformationsdienst.de/mistel#c7463
3. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Komplement%C3%A4r/Version_2/LL_Komplement%C3%A4rmedizin_Langversion_2.0.pdf
4. https://www.krebsinformationsdienst.de/mistel#c7463

5. Rexer H (2o16) Studie zur Therapie beim nicht-muskelinvasiven Urblasenkarzinom: Eine Phase-III-Wirksamkeitsstudie zur intravesikalen Instillation von Mistelextrakt bei oberflächlichem Blasenkarzinom (TIM) - AB 40/11 der AUO [Study for the treatment of nonmuscle invasive bladder cancer: A phase III efficacy trial for intravesical instillation of mistletoe extract in superficial bladder cancer (TIM) - AB 40/11 of the AUO]. Urologist A. 55(7):963-5. German. doi: 10.1007/s00120-016-0135-0. PMID: 27272001.