title: Intratumoral Mistletoe (Viscum album L) Therapy in Patients With Unresectable Pancreas Carcinoma: A Retrospective Analysis.
abstract: Pancreatic carcinoma remains one of the main causes for cancer-related death. Intratumoral application of anticancer agents is discussed as a promising method for solid tumors such as pancreatic cancer. Endoscopic ultrasound provides a good tool to examine and treat the pancreas. European mistletoe (Viscum album L) is a phytotherapeutic commonly used in integrative oncology in Central Europe. Its complementary use seeks to induce immunostimulation and antitumoral effects as well as alleviate chemotherapeutic side effects. Intratumoral mistletoe application has induced local tumor response in various cancer entities. This off-label use needs to be validated carefully in terms of safety and benefits. Here we report on 39 patients with advanced, inoperable pancreatic cancer, who received in total 223 intratumoral applications of mistletoe, endoscopic ultrasound guided or under transabdominal ultrasound control. No severe procedure-related events were reported. Adverse drug reactions were mainly increased body temperature or fever in 14% and 11% of the applications, respectively. Other adverse drug reactions, such as pain or nausea, occurred in less than 7% of the procedures. No severe adverse drug reaction was recorded. Patients received standard first- and second-line chemotherapy and underwent adequate palliative surgical interventions as well as additive subcutaneous and partly intravenous mistletoe application. A median survival of 11 months was observed for all patients, or 11.8 and 8.3 months for stages III and IV, respectively. Due to the multimodal therapeutic setting and the lack of a control group, the effect of intratumoral mistletoe administration alone remains unclear. This retrospective analysis suggests that intratumoral-applicated mistletoe might contribute to improve survival of patients with pancreatic cancer. In conclusion, the application is feasible and safe, and its efficacy should be evaluated in a randomized controlled trial.
authors.affiliation: Hospital Havelhoehe, Berlin, Germany Research Institute Havelhoehe, Berlin, Germany fschad@havelhoehe.de.
authors.forename: Friedemann
authors.initials: F
authors.lastname: Schad
authors.affiliation: Research Institute Havelhoehe, Berlin, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Atxner
authors.affiliation: Hospital Havelhoehe, Berlin, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Buchwald
authors.affiliation: Research Institute Havelhoehe, Berlin, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Happe
authors.affiliation: Research Institute Havelhoehe, Berlin, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Popp
authors.affiliation: Hospital Havelhoehe, Berlin, Germany Research Institute Havelhoehe, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kröz
authors.affiliation: Hospital Havelhoehe, Berlin, Germany Research Institute Havelhoehe, Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Matthes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D019160:Endosonography; D000069347:Erlotinib Hydrochloride / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000139:chemically induced; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D017239:Paclitaxel / Q000008:administration & dosage; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D008517:Phytotherapy / Q000009:adverse effects; D010936:Plant Extracts / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D018084:Ultrasonography, Interventional; D028182:Viscum album; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D010936:Plant Extracts; C508047:abnoba viscum; D000077150:Oxaliplatin; D003841:Deoxycytidine; C027633:Helixor; D008942:Mitoxantrone; D000069347:Erlotinib Hydrochloride; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: Viscum album; endoscopic ultrasound; intratumoral; mistletoe therapy; pancreatic cancer