title: NCCAM/NCI Phase 1 Study of Mistletoe Extract and Gemcitabine in Patients with Advanced Solid Tumors.
abstract: OBJECTIVE
  European Mistletoe (Viscum album L.) extracts (mistletoe) are commonly used for cancer treatment in Europe. This phase I study of gemcitabine (GEM) and mistletoe in advanced solid cancers (ASC) evaluated: (1) safety, toxicity, and maximum tolerated dose (MTD), (2) absolute neutrophil count (ANC) recovery, (3) formation of mistletoe lectin antibodies (ML ab), (4) cytokine plasma concentrations, (5) clinical response, and (6) pharmacokinetics of GEM.
  
  
  METHODS
  
  
  
  METHODS
  increasing mistletoe and fixed GEM dose in stage I and increasing doses of GEM with a fixed dose of mistletoe in stage II. Dose limiting toxicities (DLT) were grade (G) 3 nonhematologic and G4 hematologic events related to platelets and granulocytes only [corrected]; MTD was reached with 2 DLTs in one dosage level. Response in stage IV ASC was assessed with descriptive statistics. Statistical analyses examined clinical response/survival and ANC recovery.
  
  
  RESULTS
  DLTs were G4 neutropenia, G4 thrombocytopenia, G4 acute renal failure, and G3 cellulitis, attributed to mistletoe. GEM 1300 mg/m(2) [corrected] and mistletoe 250 mg combined were the MTD. Of 44 patients, 24 developed nonneutropenic fever and flu-like syndrome. GEM pharmacokinetics were unaffected by mistletoe. All patients developed ML3 IgG antibodies. ANC showed a trend to increase between baseline and cycle 2 in stage I dose escalation. 6% of patients showed partial response, 42% stable disease. Median survival was 200 days. Compliance with mistletoe injections was high.
  
  
  CONCLUSIONS
  GEM plus mistletoe is well tolerated. No botanical/drug interactions were observed. Clinical response is similar to GEM alone.
authors.affiliation: The Cancer Team at Bellin Health, 1580 Commanche Avenue, Green Bay, WI 54313, USA ; National Center for Complementary and Alternative Medicine, NIH, Bethesda, MD, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Mansky
authors.forename: Dawn B
authors.initials: DB
authors.lastname: Wallerstedt
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Sannes
authors.forename: Jamie
authors.initials: J
authors.lastname: Stagl
authors.forename: Laura Lee
authors.initials: LL
authors.lastname: Johnson
authors.forename: Marc R
authors.initials: MR
authors.lastname: Blackman
authors.forename: Jean L
authors.initials: JL
authors.lastname: Grem
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Swain
authors.forename: Brian P
authors.initials: BP
authors.lastname: Monahan