title: Mistletoe extract reduces the surgical suppression of natural killer cell activity in cancer patients. a randomized phase III trial.
abstract: BACKGROUND
  Major surgery suppresses natural killer (NK) cell cytotoxic activity which is potentially harmful for cancer patients by favouring haematogenic tumour cell dissemination. The influence of a perioperative infusion of a standardized mistletoe extract (Iscador) on immune functions was tested in a prospective, sequential, randomized clinical trial.
  
  
  METHODS
  Colorectal cancer patients undergoing open tumour resection were randomly assigned to either mistletoe infusion or no additional therapy. We hypothesized that mistletoe infusion improves NK cell activity and increases expression of MHC class II antigen HLA-DR on monocytes 24 h and 7 days after surgery, respectively. For statistical analysis we used a sequential study design. The decision boundaries for the two triangular tests were calculated for altogether 62 patients.
  
  
  RESULTS
  The sequential study design allowed stopping the recruitment prematurely. NK cell activity differed significantly between the therapy groups 24 h after surgery (p = 0.027). The absolute number of HLA-DR molecules on monocytes did not differ 7 days after surgery. NK cell activity of patients treated with mistletoe extract did not change significantly during the course of the study (-7.9% 24 h after surgery), whereas HLA-DR expression changed significantly (-38.5% at day 7 after surgery). For control patients both parameters decreased significantly after surgery (NK cell activity: -44.4% at 24 h; HLA-DR expression: -32.9% at day 7 after surgery).
  
  
  CONCLUSIONS
  Perioperative infusion of mistletoe extracts can prevent a suppression of NK cell activity in cancer patients. The impact of this therapy on relapse and survival should be tested in further studies.
authors.affiliation: Forschungsabteilung, Verein Filderklinik e.V., Filderstadt, Germany. schink@filderklinik.de
authors.forename: Michael
authors.initials: M
authors.lastname: Schink
authors.forename: Wilfried
authors.initials: W
authors.lastname: Tröger
authors.forename: Ali
authors.initials: A
authors.lastname: Dabidian
authors.forename: Andreas
authors.initials: A
authors.lastname: Goyert
authors.forename: Heinz
authors.initials: H
authors.lastname: Scheuerecker
authors.forename: Johannes
authors.initials: J
authors.lastname: Meyer
authors.forename: Imma U
authors.initials: IU
authors.lastname: Fischer
authors.forename: Florian
authors.initials: F
authors.lastname: Glaser
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000601:surgery*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007694:Killer Cells, Natural / Q000187:drug effects / Q000276:immunology*; D008297:Male; D014784:Mistletoe / Q000737:chemistry*; D019990:Perioperative Care / Q000379:methods; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D010936:Plant Extracts