NationalCancerInstitute

attheNationalInstitutesofHealth

MistletoeExtracts(PDQ)
PatientVersion

QuestionsandAnswersAboutMistletoe
1. Whatismistletoe?
Mistletoeisasemiparasiticplantthatgrowsonseveraltypesoftrees,includingapple,oak,maple,elm,
pine,andbirch.Ithasbeenusedforcenturiestotreatmedicalconditionssuchasepilepsy,
hypertension,headaches,menopausalsymptoms,infertility,arthritis,andrheumatism.
Mistletoeisoneofthemostwidelystudiedcomplementaryandalternativemedicinetherapiesfor
cancer.IncertainEuropeancountries,extractsmadefromEuropeanmistletoeareamongthemost
prescribedtherapiesforcancerpatients.Theseproductsaremadeandsoldunderbrandnames
including:
Iscador(alsocalledIscar).
Helixor.
Iscucin.
Lektinol(alsocalledPlenosol).
abnobaVISCUM.
BrandnamesincludingEurixor,Isorel,andVysorelarenolongersold.
ThissummarydiscussesresearchdonemainlywiththeEuropeanmistletoespecies.
Thechemicalmakeupofmistletoeproductsvaries,dependingonmanyfactors,including:
Thetypeofhosttreeonwhichthemistletoeplantgrows.
Thetimeofyeartheplantisharvested.
Theexactspeciesofmistletoe.
Whethertheextractisfermentedorunfermented.
Whethertheextractispreparedwithhomeopathicmethods.
Thecompanythatmakestheproduct.
Mistletoeextractsarepreparedaswaterbasedsolutionsorsolutionsofwaterandalcohol.Mistletoe
productsmaybenamedaccordingtothetypeofhosttreeonwhichtheplantgrows.Forexample,
IscadorMisfromappletrees,IscadorPcomesfrompinetrees,IscadorQuisfromoaktrees,and
IscadorUcomesfromelmtrees.Someusersbelievethatthetypeofmistletoeextractchosenshould
dependonthetypeoftumorandthesexofthepatient.
2. Whatisthehistoryofthediscoveryanduseofmistletoeasacomplementaryor
alternativetreatmentforcancer?
MistletoewasusedbytheDruidsandtheancientGreeks,andappearsinlegendandfolkloreasa

panaceaor"cureall".Moderninterestinmistletoeasapossibletreatmentforcancerbeganinthe
1920s.
Extractsofmistletoehavebeenshowntokillcancercellsinthelaboratoryandtoboosttheimmune
system(thecomplexgroupoforgansandcellsthatdefendsthebodyagainstinfectionordisease).For
thisreason,mistletoehasbeenclassifiedasatypeofbiologicalresponsemodifier(asubstancethat
stimulatesthebody'sresponsetoinfectionanddisease).Extractsofmistletoehavealsobeenshownin
thelaboratorytopreventthegrowthofnewbloodvesselsneededfortumorstogrow.
Ingredientsinmistletoethathavebeenstudiedfortheirusefulnessintreatingcancerinclude:
Alkaloids.
Viscotoxins.
Polysaccharides.
Lectins.
3. Whatisthetheorybehindtheclaimthatmistletoeisusefulintreatingcancer?
Mistletoeextractisstudiedasapossibleanticanceragentbecauseithasbeenshownto:
Haveeffectsontheimmunesystem.
Killmouse,rat,andhumancancercellsinthelaboratory.
ProtecttheDNAinwhitebloodcellsinthelaboratory,includingcellsthathavebeenexposedto
DNAdamagingchemotherapydrugs.
SeethePDQhealthprofessionalsummaryonMistletoeExtractsformoreinformationontheory.
4. Howismistletoeadministered?
Mistletoeextractsareusuallygivenbyinjectionundertheskin(subcutaneous).Lesscommonwaysto
givemistletoeincludebymouth,intoavein(intravenousorIV),intothepleuralcavity,orintothe
tumor.Inmostreportedstudies,injectionsundertheskinweregiven2to3timesaweekforvarious
lengthsoftime.
5. Whatpreclinical(laboratoryoranimal)studieshavebeenconductedusingmistletoe?
Manylaboratoryandanimalstudieshavebeendonewithmistletoe,eitheraloneorcombinedwith
otheragents.Laboratorystudieshavesuggestedthatmistletoemaysupporttheimmunesystemby
increasingthenumberandactivityofvarioustypesofwhitebloodcells.OnetypeofEuropean
mistletoe(IscadorQu)usedina2004laboratorystudyshowedastronganticancereffectoncertain
typesofcancercellsbutnoanticancereffectonothertypesofcancercells.Whileonelaboratorystudy
reportedthatmistletoeextractcausedseveraltypesofhumancancercellstogrowfaster,thiswasnot
foundinotherrecentlabstudies.
Studiestestingmistletoe'sabilitytostopcancercellgrowthinanimalshaveyieldedmixedand
inconsistentresults,dependingontheextractused,thedosetested,thewayitwasgiven,andthetype
ofcancerstudied.Resultsofafewanimalstudieshavesuggestedthatmistletoemaybeusefulin
decreasingthesideeffectsofstandardanticancertherapy,suchaschemotherapyandradiation
therapy,andthatitcounteractstheeffectsofdrugsusedtosuppresstheimmunesystem,suchas
cortisone.
6. Haveanyclinicaltrials(researchstudieswithpeople)beenconductedusingmistletoe?

MostclinicaltrialsusingmistletoetotreatcancerhavebeendoneinEurope.Moststudyresultshave
beenpublishedinGerman.Althoughmanyofthesetrialshavereportedmistletoetobeeffective,there
aremajorweaknessesinalmostallthatraisedoubtsabouttheirfindings.Weaknesseshaveincluded
smallnumbersofpatients,incompletepatientdata,lackofinformationaboutmistletoedose,and
problemswithstudydesign.
Manystudiesinvolveusingmistletoeasadjuvanttherapyinpatientswithcancer.Oneretrospective
cohortstudydoneinEuropebetween1993and2000lookedattheuseofamistletoeextract(Iscador)
aslongtermadjuvanttherapyin800patientstreatedwithchemotherapyand/orradiationtherapyfor
colorectalcancerthathadnotspread.ThestudyfoundthatpatientstreatedwithIscadorhadfewer
adverseevents,bettersymptomrelief,andimproveddiseasefreesurvivalcomparedtopatientswho
didnotreceiveIscadorasadjuvanttherapy.
AEuropeanstudypublishedin2013lookedattheuseofIscadorQuinadvancedormetastatic
pancreaticcancer.Patientsreceivedbestsupportivecareandwererandomlyassignedtoreceiveeither
IscadorQuornoanticancertherapy.Resultsin220patientsshowedthatthosetreatedwithIscador
hadimprovedsurvivalandlessseverediseaserelatedsymptoms(includingpain,weightloss,fatigue,
nausea,diarrhea,andanxiety)comparedwiththosewhodidnotreceiveIscadorQu.
AEuropeanstudydonebetween1978and1987lookedattheuseofIscadorUandIscadorQuinnon
smallcelllungcancerthatcouldnotbetreatedwithsurgery.Patientswererandomlyassignedto
receiveoneof3treatments:(1)Iscadorinjections(2)PolyergaNeuinjections(asheepspleen
preparationsaidtostimulatetheimmunesystemandhaveantitumoreffects)or(3)placeboinjections
ofavitaminBmixture.Resultsin312patientsshowednodifferencesamongthe3groupsinsurvivalor
tumorresponse.ItwasnotedthatmorepatientsintheIscadorgroupreportedanimprovedsenseof
wellbeingcomparedwithpatientsintheothergroups.
BeforeresearcherscanconductclinicaldrugresearchintheUnitedStates,theymustfilean
InvestigationalNewDrug(IND)applicationwiththeFoodandDrugAdministration(FDA).TheFDA
doesnotmakeinformationpublicaboutINDapplicationsorapprovalsthisinformationcanbemade
publiconlybytheapplicants.Inthelastdecade,atleasttwoU.S.investigatorsweregivenapprovalto
conductclinicaltrialsofmistletoeasatreatmentforpeoplewithcancer.Theseclinicaltrialsarenow
closed.
In2002,theNationalCenterforComplementaryandAlternativeMedicine(NCCAM),incooperation
withtheNationalCancerInstitute(NCI),beganenrollingpatientsforaphaseIclinicaltrialofa
mistletoeextract(HelixorA)andgemcitabineinpatientswithadvancedsolidtumors.Thiscombination
showedlowtoxicityandnobotanicaldruginteractionswerereported.
Reviewsofmanyclinicaltrialscombined
Findingsfromover50clinicaltrialsusingmistletoeextractsinpatientswithcancerhavebeen
published.Recentreviewsofmanystudiestakentogetherhavelookedattheeffectsofmistletoeon
qualityoflife,survival,andsymptomreliefindifferenttypesofcancer:
Qualityoflifewasmeasuredinareviewthatincluded26randomizedclinicaltrials.Ofthese,22
trialsshowedpatientshadimprovedqualityoflife.All10nonrandomized,controlledclinical
trialsreviewedalsoreportedthesamebenefits.Chemotherapyrelatedfatigue,nauseaand
vomiting,depression,emotionalwellbeing,andconcentrationimproved.Someofthestudies
werewelldesigned,whileothershadweaknesses.

Tumorresponse,qualityoflife,andpsychologicaldistressweremeasuredinareviewof21
randomizedclinicaltrialsinpatientswithdifferenttypesofcancer.Avarietyofmistletoe
extractswereusedeitheralone,withchemotherapy,orwithradiationtherapy.Mostofthe
studiesreportedbenefitsforpatients,althoughthisreviewhadweaknessesindesignandsize.
Qualityoflifeandsurvivalweremeasuredinareviewof10randomizedclinicaltrialswhichused
avarietyofmistletoeextractsinpatientswithdifferenttypesofcancer.Therewasnodifference
insurvivalorqualityoflifemeasuresinpatientswhoreceivedmistletoecomparedtothosewho
didnot.
7. Haveanysideeffectsorrisksbeenreportedfrommistletoe?
Veryfewserioussideeffectshavebeenreportedfromtheuseofmistletoeextractproducts.Common
sideeffectsincludesorenessandinflammationatinjectionsites,headache,fever,andchills.
OnereviewsurveyedmanyanimalandhumanstudiesthatusedEuropeanmistletoeandmistletoe
lectins.Differentdosesandwaystogivemistletoewereused.Treatmentwasnotfoundtolessen
immunesystemresponses.Highdosesofmistletoelectinsdamagedtheliverinsomecasesthis
damagewascorrectable.Anotherreviewofclinicaltrialsreportedadverseeffectsthatincluded
increasedcirculatoryproblems,thrombophlebitis,swellingoflymphnodes,andallergicreactions.
Afewcasesofsevereallergicreactions,includinganaphylacticshock,havebeenreported.
8. IsmistletoeapprovedbytheU.S.FoodandDrugAdministration(FDA)foruseasa
cancertreatmentintheUnitedStates?
TheUnitedStatesFoodandDrugAdministration(FDA)hasnotapprovedtheuseofmistletoeasa
treatmentforcanceroranyothermedicalcondition.TheFDAdoesnotallowinjectablemistletoe
extractstobeimportedorusedexceptforclinicalresearch.
Updated:January14,2015