Wednesday, February 01, 2006

Iscador / Mistletoe / Viscumalbum / Plenosol / Helixor / Iscucin

The role of your cancer health professional is to create an environment of openness and trust, and to help in making informed decisions about alternative/complementary therapies. Collaboration will improve the safe integration of all therapies during your experience with cancer. The "Summary" and "Professional Evaluation / Critique" sections of this Unconventional manual are cited directly from the medical literature, and are intended to help in the objective evaluation of alternative/complementary therapies.
Summary"Although there is laboratory evidence of biological activity that may be beneficial to cancer patients, the evidence of clinical benefit from human studies remains weak and inconclusive. Because of the absence of serious side effects and the limited evidence that mistletoe products may offer some therapeutic advantages, further research is warranted." (Kaegi)
There have been recent studies published that show that mistletoe extracts can inhibit metastasis, reduce size, and cause necrosis of induced tumours in rodents. These studies suggest that by stimulating the cells of the immune system the mistletoe extracts have this prophylactic effect. No evidence has been published to date showing that mistletoe extracts are effective in treating cancer in humans. (Yoon) (Weber) (Zarkovic) (Antony) (Kutton)
"Because the extract has relatively weak antineoplastic activity, it may be useful as an adjuvant therapy with surgery or radiotherapy. ... Some components have shown antineoplastic activity. However, additional clinical investigation is required to assess the plant's efficacy and long-term safety profile. Because I.V. mistletoe preparations are not standardized in the United States, it is unlikely that mistletoe will be considered for use as an antineoplastic agent in the near future." (Fetrow)
Description / Source / Components"Iscador is the trade name of the most commonly available brand of an extract of Viscum album, a European species of mistletoe, which differs from the North American species. Mistletoe is a semi-parasitic plant that lives symbiotically with several tree species, including oak, pine, elm and apple." (Kaegi)
"Iscador consists of fermented extracts of European mistletoe (Viscum album), some forms of which are combined with small amounts of metals to produce certain desired, anticancer effects." (Diamond)
"Sterilization should be achieved by the addition of oligodynamic silver." (Hauser)
Some Iscador preparations also include metal, e.g. silver, mercury, and copper. (U.S. Congress)
"The mistletoe is harvested in December, January, and February, when it bears ripe berries. The entire plant is flash-frozen and ground into fine powder, which is mixed with water and mild detergent to extract a purified lectin mix suitable for patients." (Anonymous)
"A sterile solution, available commercially, is injected either intravenously or into the tumor itself to provide palliative treatment for certain types of cancer... Such use of mistletoe extracts has led to identification in the plant of three lectins, that is, proteins which agglutinate red blood cells. Many plant lectins are highly cytotoxic, and research is currently being conducted to determine their potential in cancer chemotherapy." (Tyler)
"...laboratory research using cell cultures and a variety of animal systems had identified the 2 key components of mistletoe preparations: viscumin (also known as mistletoe lectin I, ML-I or VAL) and viscotoxin. ...In addition to viscumin and viscotoxin, extracts of mistletoe contain polysaccharides and alkaloids, some of which have been shown to have biological activity." (Kaegi)
"Iscador is usually given by injection. However, it can also be taken orally. The injection treatment typically lasts 14 days with one injection each day." (Ontario)
"A typical course of treatment lasts several weeks and requires that injections be given early in the morning 3-7 times per week, with gradual increases in concentration of Iscador in accordance with a protocol set by Steiner. A long term maintenance dose may be recommended depending on the person's health and tumour status." (Kaegi)
HistoryIscador was first proposed for the treatment of cancer in 1920, by Rudolf Steiner, PhD, (1861-1925), founder of the Society for Cancer Research, in Arlesheim, Switzerland and introduced in the treatment of human cancer as early as 1921. (CA) (U.S. Congress)
"Steiner founded anthroposophy, a conceptual framework that blends spiritual and scientific principles and applies them to healing practices with a focus on cancer treatment." (Kaegi)
"It has been approved for use in Austria, Switzerland and West Germany; it apparently is also being used in France, Holland, Eastern Europe, Britain and Scandinavia." (Wilson)
"At present, mistletoe preparations are advocated mainly by Swiss and German physicians practicing Anthroposophic medicine." (U.S. Congress)
Proponent / Advocate Claims "Steiner theorized that the human body is subject to various forces, some of which result in cell growth and multiplication ('lower organizing forces') and some of which control and organize cell growth to form tissues and organs ('higher organizing forces'). Steiner believed that the balance between these forces determined an individual's susceptibility to cancer, with a serious imbalance promoting the development of cancer. He considered mistletoe to have a number of characteristics that suggested it could resist natural forces, and he therefore proposed that mistletoe preparations would stimulate the 'higher organizing forces' that he believed were deficient in cancer patients." (Kaegi)
Proponents claim that "Iscador can correct the imbalance in cell division and growth, and may enhance the immune system and inhibit tumour cell growth." (Ontario)
"According to the proponents, Iscador is recommended for treatment of inoperable tumors, preoperative treatment of tumors, as the adjuvant therapy of solid tumors, and for precancerous conditions when indicated." (CA)
"Although there have been few claims that Iscador reduces tumour size, proponents believe that it stimulates the immune system, promotes the reversion of cancerous cells to more differentiated forms, improves general well-being and may improve survival, especially in patients with cancer of the cervix, ovary, breast, stomach, colon and lung. Proponents also recommend its use in patients who have certain conditions that place them at increased risk of cancer, such as ulcerative colitis dysplasia, leukopenia, Crohn's disease, papillomatosis of the bladder or colon, and senile keratosis. ... Proponents advise that Iscador is compatible with chemotherapy and radiotherapy." (Kaegi)
"Although their mode of action is still unclear, an antitumor effect has been postulated and demonstrated in animal models. There is growing evidence that mistletoe preparations and some of their components exert cytotoxic as well as immunostimulatory activities. In several in vitro [in an artificial environment] and in vivo [in a living body] studies, activation of NK-cells [natural killer cells], monocytes/macrophages, T-cells, especially T-helper cells, cytokine release, induction of apoptosis [programmed cell death], protection against sister chromatid exchange inducing DNA damage were demonstrated, effects which are valued to be beneficial for tumor defense." (Stein)
"A strong immunoprotective/immunostimulatory effect was induced by the treatment of glioma patients with ML -1 standardized mistletoe extract which correlated with an improved quality of life, as determined by a standard questionnaire." (Lenartz)
"Principal proponents of Iscador are Rita Leroi, MD, President of the Society for Cancer Research, Arlesheim, Switzerland; its authorized American agent, Marvin I. Weinberger, Belmont, Massachusetts; and Henning Schramm, MD of Weleda, Switzerland, the pharmaceutical company in Switzerland that packages and markets Iscador." (CA)
Professional Evaluation / Critique"Increases in a number of indices of immune function have been reported in animals studies, but the extent to which these effects are of clinical significance in humans is unknown. Some animal studies have suggested that mistletoe has antitumour activity. ... Several studies indicated an improvement in immune function, quality of life and even survival. However, most of the studies had significant design limitations, making it difficult to interpret their results and seriously limiting the value of their findings." (Kaegi)
"Mistletoe preparations contain a number of biologically active constituents, but these vary widely depending on whether the extract is crude or fermented, on the host species from which the mistletoe has been obtained, and on the season during which it was harvested. These variations make it difficult to predict the likely effects of non-standardized mistletoe preparations." (Kaegi)
"The drug has not been approved for use in the United States." (Tyler)
Freiss and associates conducted a phase I/II study to evaluate the effects of mistletoe treatment in pancreatic cancer. They evaluated 16 patients (7 women, 9 men) with histologically verified ductal pancreatic carcinoma. No partial or complete remission was observed. The results of the study indicated that mistletoe was not able to significantly influence tumour growth in advanced pancreatic carcinomas. (Freiss)
Kunze and associates conducted an experiment in order to study the effect of galactoside-specific lectin from mistletoe on chemically induced tumor development in the urinary bladder of rats. "After a total experimental time of 15 months the incidence of epithelial bladder tumors was 29.3% in controls versus 27.9% in rats additionally receiving the lectin and thus not significantly different in both experimental groups. ... In conclusion, the present data provide no evidence for a modifying or even inhibitory effect of the immunomodulatory galactoside-specific mistletoe lectin on experimental urothelial carcinogenesis." (Kunze)
"Proof of an immunomodulating effect of the lectin ML-I on mononuclear blood cells does not automatically verify its clinical efficacy against cancer." (Hauser 1993)
"The available clinical studies are contradictory and have not, as yet, shown any definite proof of the effect of Iscador, based on current scientific criteria." (Swiss Society for Oncology)
"No preclinical studies have been published on iscucin. In the clinical field, only individual case histories are available, 4 of which have minimal documentation, and results that can be explained without iscucin." (Hauser)
Toxicity / Risks"German sources now maintain that the berries, but not the leaves, of European mistletoe have only slight toxicity, if any. Until more definitive information is forthcoming, use of either type of mistletoe as a home remedy or as a beverage should definitely be avoided." (Tyler)
"Do not attempt to make your own mistletoe preparation as they can be very poisonous." (Ontario)
"Spiller and co-workers surveyed 92 people who had used this treatment, finding 11 patients symptomatic from the mistletoe treatment. The symptoms included gastrointestinal tract upset (six patients), mild drowsiness (two), eye irritation (one), ataxia [a failure of muscular coordination] (one child), and seizure (one child). Medical intervention was required in only one of these patients."(Spiller) (Spencer)
"There are pointers that high concentrations of mistletoe preparations subcutaneously injected can have a growth-promoting action on cells of a centrocytic lymphoma." (Hagenah)
"Mistletoe may interfere with existing cardiac, immunosuppressant, hypo/hypertensive, antidepressant, and anticoagulant/coagulant therapies." (Newall)
"According to a report of the Swiss Cancer League, fermented Iscador products contain large numbers of both dead and live bacteria and some yeast." (U.S. Congress)
"There is some local inflammation at the injection site and an increase in body temperature that is sometimes accompanied by headache and chill. The review of the literature revealed no other evidence of toxic effects from mistletoe preparations when used as directed. However, ingestion of the plant or intravenous administration of some of the constituents may cause seizures, bradycardia [slowness of the heartbeat] and even death." (Kaegi)
Costs"Iscador is generally given as part of a larger treatment program and cost may vary from one place to another." (Ontario, 1994)
ReferencesAnonymous. Kiss of Life. New Scientist 1996 Dec 21/28:23.
Antony S, et al. Effect of viscum album in the inhibition of lung metastasis in mice induced by B16F10 melanoma cells. J Exp & Clin Can Res 1997;16:159-162.
CA (Anonymous). Unproven methods of cancer management: Iscador. CA: a Cancer Journal for Clinicians 1983;33:186-188.
Diamond WJ, et al. An alternative medicine definitive guide to cancer. Tiburon: Future Medicine Publishing, Inc., 1997:830.
Fetrow CW, Avila JR. Professional's handbook of complementary and alternative medicines. Springhouse, Pennsylvania: Springhouse Corporation 1999:437-39.
Freiss H, et al. Treatment of advanced pancreatic cancer with mistletoe: results of a pilot trial. Anticancer Research 1996;16:915-20.
Hagenah W, et al. [Subcutaneous manifestations of a centrocytic non-Hodgkin lymphoma at the injection site of a mistletoe preparation.] [German] Deutsche Medizinische Wochenschrift 1998;123:1001-4.
Hauser S, Kast A. Iscusin - preparations for pre- and postoperative treatment of malignant tumours. (BCCA Cancer Information Centre search file 701)
Hauser SP. Unproven methods in cancer treatment. Current Opinion in Oncology 1993;5:646-654.
Heiny BM, Benth J. Mistletoe extract standardized for the galactoside-specific lectin (ML-1) induces B-endorphin release and immunopotentiation in breast cancer patients. Anticancer Research 1994;14:1339-1342.
Kaegi E, on behalf of the Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. Unconventional therapies for cancer: 3. Iscador. Canadian Medical Association 1998;158:1157-59.
Kunze E, et al. Lack of an antitumoral effect of immunomodulatory galctoside-specific mistletoe lectin on N-methyl-N-nitrosourea-induced urinary bladder carcinogenesis in rats. Experimental & Toxicologic Pathology 1997;49:167-80.
Kuttan G, et al. Anticarcinogenic and antimetastatic activity of Iscador. Anti-cancer Drugs 1997;8(suppl 1):S15-16.
Lenartz D, et al. Immunoprotective activity of the galactoside-specific lectin from mistletoe after tumor destructive therapy in glioma patients. Anticancer Research 1996;16:3799-3802.
Newall CA, et al. Herbal medicines: a guide for health - care professionals. London: Pharmaceutical Press, 1996:195.
Ontario Breast Cancer Information Exchange Project. Guide to unconventional cancer therapies. 1st ed. Toronto: Ontario Breast Cancer Information Exchange Project, 1994:76-79.
Spencer JW, Jacobs JJ. Complementary/alternative medicine: an evidence based approach. Toronto: Mosby, 1999:147.
Spiller HA, et al. Retrospective study of mistletoe ingestion. J Toxicol Clin Toxicol 1996;34:405.
Swiss Society for Oncology. Iscador. (BCCA Cancer Information Centre search file 701)
Stein GM, et al. Mistletoe in Immunology and the Clinic (Short Review). Anticancer Research 1998;18:3247-3250.
Tyler VE, Foster S. Tyler's honest herbal. New York: Haworth herbal press, 1999:257-259.
U.S. Congress, Office of Technology Assessment. Unconventional cancer treatments. Washington, D.C.: U.S. Government Printing Office 1990 Sept:81-86.
Weber K, et al. Effects of a standardized mistletoe preparation on metastatic B16 melanoma colonization in murine lungs. Arzneimittel-Forschung 1998;48:497-502.
Wilson BR (M.D.). Cancer quackery primer. Dallas, Oregon: The author, 1985.
Yoon TJ, et al. Prophylactic effect of Korean mistletoe (Viscum album coloratum) extract on tumour metastasis is mediated by enhancement of NK cell activity. International Journal of Immunopharmacology 1998;20:163-172.
Zarkovic N, et al. The Viscum album preparation Isorel inhibits the growth of melanoma B16F10 by influencing the tumour-host relationship. Anti-cancer Drugs 1997;8(Suppl 1):S17-22.
Revised February 2000

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