title: Mistletoe Plant Extract in Patients with Nonmuscle Invasive Bladder Cancer: Results of a Phase Ib/IIa Single Group Dose Escalation Study.
abstract: OBJECTIVE
  We determined the maximum tolerated dose, safety and effectiveness of intravesical instillation of mistletoe extract after transurethral resection of nonmuscle invasive bladder cancer.
  
  
  METHODS
  In this single group dose escalation study patients with nonmuscle invasive bladder cancer were treated with weekly instillations of mistletoe extract for 6 weeks. Four weeks before instillation therapy all patients underwent transurethral resection of bladder tumors. During this procedure a marker tumor was left. At 12 weeks after the start of instillation therapy transurethral resection of the marker tumor or biopsy of the former marker tumor location was done so that patients were tumor free when entering followup until week 48. During the followup clinical assessment laboratory tests for safety and cystoscopy were done every 12 weeks.
  
  
  RESULTS
  A total of 36 patients were treated with increasing doses of mistletoe extract. We found no dose limiting toxicity up to a dose of 675 mg of plant extract. Besides local reactions we saw hints that pyrexia may develop. All adverse events were well manageable. At 12 weeks a marker tumor remission rate of 55.6% (95% CI 38.1 to 72.1) was achieved. At 1 year a recurrence rate of 26.3% (95% CI 9.1 to 51.2) was observed.
  
  
  CONCLUSIONS
  In this study intravesical instillation of mistletoe extract as treatment in patients with nonmuscle invasive bladder cancer was shown to be safe and well tolerated. Promising data on efficacy were observed and will be further investigated in a phase III study.
authors.affiliation: Department of Urology, HELIOS Marien Klinik, Duisburg, Germany. Electronic address: achim.rose@helios-kliniken.de.
authors.forename: Achim
authors.initials: A
authors.lastname: Rose
authors.affiliation: Theodor Bilharz Research Institute, Cairo, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: El-Leithy
authors.affiliation: Department of Urology, HELIOS Marien Klinik, Duisburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: vom Dorp
authors.affiliation: Theodor Bilharz Research Institute, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zakaria
authors.affiliation: Praxis Urologie Rhein/Ruhr, Mülheim an der Ruhr, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eisenhardt
authors.affiliation: Department of Urology, University Hospital of Essen, Essen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Tschirdewahn
authors.affiliation: Department of Urology, University Hospital of Essen, Essen, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Rübben
mesh_terms: D000283:Administration, Intravesical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014784:Mistletoe; D009361:Neoplasm Invasiveness; D008517:Phytotherapy; D010936:Plant Extracts / Q000008:administration & dosage*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D010936:Plant Extracts
keywords: abnoba viscum; administration; intravesical; mistletoe; treatment outcome; urinary bladder neoplasms