Mistletoe’s big season may have just ended, but its role as an anticancer agent could be just getting started. An oncologist at Johns Hopkins successfully treated a patient who had advanced colon cancer with an extract of the seasonal botanical, sparking interest in the plant’s anticancer properties.
The Smithsonian Institution describes mistletoe as a semiparasitic plant in the order of flowering plants known as Santalales. There are approximately 1,300 species that grow mostly in temperate or tropical areas throughout the world. The two types that are commonly sold during the Christmas season are Phoradendron serotinum, the North American mistletoe, and Viscum album, the European variety.1 Scientists are interested in the latter type for medical applications.
Europe and Asia Although mistletoe is poisonous when ingested, doctors outside the United States have been processing it into an injectable extract to treat patients with cancer for a number of years; and with increasingly positive results.2 In fact, German physicians recently published a paper demonstrating how treatment with mistletoe apparently led to the complete regression of an adenoma in the colon of a 78-year-old man who had refused chemotherapy for a cancer relapse 5 years after surgery.3
United States Physicians in the United States, however, have not been so eager to use the substance, and the National Institutes of Health (NIH) discourages its use outside of clinical trials, despite citing some success. According to the National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse
“Laboratory studies have found that mistletoe kills cancer cells and stimulates the immune system.
“The use of mistletoe to treat cancer has been studied in Europe in more than 30 clinical trials. Although improvements in survival or quality of life have been reported, almost all of the trials had major weaknesses in their design that raise doubts about the findings. For example, many of the studies had a small number of participants or did not have a control group.”4
Studies from Europe have shown benefits for patients with cancer of the colon, breast, pancreas, and even for those with melanoma, but the results of treating other types of cancer with mistletoe have not been so positive. Now, researchers at Johns Hopkins will study mistletoe as a cancer treatment thanks to one patient’s success story, her open-minded oncologist, and his colleague, a physician specializing in alternative and complimentary medicine.
In 2008, Luis Diaz, MD, an associate professor of oncology at the Johns Hopkins School of Medicine, treated Ivelisse Page, a 37-year-old woman with stage IV cancer of the colon. Despite resection of 15 inches of colon and 28 lymph nodes, the cancer progressed to her liver. After a second surgery in which 20% of her liver was removed, Peter Hinderberger, MD, a physician on Page’s health care team, suggested trying mistletoe. A specialist in using complementary therapies, Hinderberger had seen patients respond favorably to injections of the substance. Diaz, also the director of translational medicine at the Ludwig Center for Cancer Genetics and Therapeutics at the Johns Hopkins Kimmel Cancer Center, reviewed the literature on mistletoe studies from Europe, and decided to initiate the therapy. He noted, “… as soon as she went on it, she started feeling better. That’s a universal feature I’ve seen in all patients who get mistletoe.”5
Whether it was the surgery, diet and exercise, or the mistletoe therapy, Page has been free of cancer since her liver surgery.6 She and her husband formed a nonprofit organization, Believe Big, to bring the mistletoe extract from Europe, where it is manufactured, to the United States for clinical trials. They also hope to use their organization to connect cancer patients with doctors who use nonconventional therapies.6 Channing Paller, MD, is principal investigator for the Johns Hopkins research on the use of mistletoe in cancer. An assistant professor of oncology at the School of Medicine, she theorizes that the effectiveness of mistletoe could lie in its apparent ability to boost the immune system and increase patients’ tolerance of traditional chemotherapy. That would mean that patients could receive higher doses of chemotherapy, enhancing the effect but with fewer consequences.
Germany and other countries have approved prescribing mistletoe for palliation, but not for chemotherapy.7 Studies have shown the plant’s derivatives have led to enhanced quality of life, concentration, and mood. Patients on chemotherapy report that they have more energy, and they experience less nausea and discomfort while taking mistletoe. Researchers in the United States are hoping to achieve similar positive effects while proving the extract’s anticancer activity.
REFERENCES
1. Mistletoe facts from a Smithsonian Botanist. Smithsonian Science Web site. http://smithsonianscience.org/2011/12/mistletoe-facts-from-a-smithsonian-botanist/. Accessed January 7, 2015.
2. Wrotek S, Skawiński R, Kozak W. Immunostimulatory properties of mistletoe extracts and their application in oncology [in Polish]. Postepy Hig Med Dosw (Online). 2014;68:1216-1224.
3. von Schoen-Angerer T, Goyert A, Vagedes J, et al. Disappearance of an advanced adenomatous colon polyp after intratumoural injection with Viscum album (European mistletoe) extract: a case report. J Gastrointestin Liver Dis. 2014;23(4):449-452.
4. European mistletoe. Side effects and cautions. NIH National Center for Complementary and Alternative Medicine (NCCAM) Web site. http://nccam.nih.gov/health/mistletoe#cautions. Accessed January 7, 2015
5. Sugarman J. Are mistletoe extract injections the next big thing in cancer therapy? Johns Hopkins Magazine. http://hub.jhu.edu/magazine/2014/spring/mistletoe-therapy-cancer. Published Spring 2014. Accessed January 7, 2015
6. Ivelisse’s Story. Believe Big Web site. https://believebig.org/WhoWeAre.html. January 7, 2015.
7. Handwerk B. Medical mistletoe: Can the holiday plant really fight cancer? Smithosonian.com Web site. http://www.smithsonianmag.com/science-nature/medical-mistletoe-can-holiday-plant-really-fight-cancer-180953551/?no-ist. Published December 8, 2014. Accessed January 7, 2015.
original story source: https://www.oncologynurseadvisor.com/home/departments/issues-in-cancer-survivorship/mistletoe-the-holiday-plant-is-making-headlines-as-an-alternative-cancer-treatment/
Ivelisse Page is on a mission.
In 2011, Page launched Believe Big, a nonprofit foundation that helps cancer patients and their families through this traumatic, life-changing diagnosis. Based on her own experience as a colon cancer survivor, Page aims to educate the cancer community about the importance of combining conventional and complementary approaches to treatment.
To that end, Believe Big is the primary backer of a clinical trial of mistletoe extract, an alternative therapy Page underwent, slated to begin at Johns Hopkins Medicine’s Sidney Kimmel Comprehensive Cancer Center within the next six months.
Page attributes her current health condition to conventional surgery and complementary mistletoe extract, a therapy widely used in Europe as an alternative cancer treatment.
Through dinners, fees from walking/running events and donations, Believe Big has raised $100,000 of the $300,000 needed for the first phase of the three-phase trial, even though nonprofits don’t usually initiate clinical trials. The treatment, using mistletoe extract, is barely known in the United States.
However, her doctor, Peter Hinderberger, of the Ruscombe Mansion Community Health Center near Sinai Hospital, though, is well versed in the treatment.
Through her own research and through the recommendations of friends, Page became acquainted with Hinderberger’s work in complementary medicine.
He’s one of two physicians in Baltimore — and 50 total in the U.S. — allowed to prescribe mistletoe for certain cases. Hinderberger, now a board member of Believe Big, first learned about the treatment in the 1970s when he worked at a cancer clinic in Switzerland that specialized in alternative treatment.
Hinderberger describes mistletoe extract as the “backbone” of his cancer protocol, the specifics depending on the patient’s kind of cancer, current stage and treatment — surgery, chemotherapy or radiation.
While mistletoe is not approved by the federal Food and Drug Administration (FDA). It falls under the category of homeopathy and is paid for out-of-pocket, at a cost of $100 to $150 per month, depending on the extract intensity and number of injections.
Page, a slim, vibrant woman who runs Believe Big out of her home in Reisterstown, has had an equally improbable journey.
Five years ago, the 37-year-old mother of four, was found to have Stage 4 colon cancer that eventually spread to her liver, dropping her survival rate chances after two years to just 8 percent.
That’s why after her surgery, Page searched for an alternative to standard chemotherapy treatment.
“As I was going through this process, I saw people who were in such a hopeless state. I wanted to help them, to let them know about treatments other than the traditional ones,” said Page, who added that she is now cancer-free.
At first blush, Page was taken aback by the thought of being cured by mistletoe extract, which is sold under the brand names Iscador, Helixor and a handful of others, in liquid form in injectable vials.
“I’m like, ‘mistletoe, what’s that? That’s what I see at Christmastime,’ she said. ‘Why haven’t I been told about this before?'”
According to the institute, several trials of mistletoe have been undertaken and are under way in Europe for those countries’ official approval. In the U.S., the institute lists two mistletoe trials besides Hopkins, although the sites are not given and the results not yet published.
Still, after Hinderberger explained that mistletoe contains viscotoxin, a poisonous substance that actively and directly kills cancer cells and boosts patients’ cancer-fighting immune system via special proteins called lectins, Page became very interested. Once he added that the substance also prevents new blood-vessel formation in cancers and promotes natural cell death, she was all in.
“When I found out from my oncologist that I only had a 10 percent better chance of survival by taking chemo(therapy), I decided to burn the boats and not look back,” she said. “Why would I want to destroy everything in my body for just a 10 percent chance?”
From clinical studies and his personal experience, “mistletoe prolongs survival time and improves the quality of life,” Hinderberger said.
Page is the link between Hinderberger and Dr. Luis Diaz, an associate professor of oncology at Hopkins’ Kimmel Cancer Center, who is conducting the mistletoe trial. Diaz is also a board member of Believe Big.
“Dr. Diaz followed my progress” on mistletoe therapy, Page said. “Once I hit the one-year mark, I told him, ‘We need to make this available.’ At the three-year mark, he was willing to do the trial. He told me that being cancer-free three years after surgery is unbelievable.”
Apparently, she and the mistletoe also made a big believer of Diaz.
“She showed me research on mistletoe. I saw other patients through her who seemed to be thriving,” said Diaz, who also researched the topic. “It sounds like it’s very common in Europe, but hasn’t hit the mainstream in the U.S.”
The mistletoe trial’s three phases will take between five to eight years and involve patients with different kinds of cancers and ultimately cost in the millions. Diaz expects that once the trial begins, it will attract other funding. Weleda Group, the Swiss manufacturer of Iscador, is providing the extract free for the trial.
“At the end, if we improve outcomes, if mistletoe becomes one of the ingredients in that cocktail, we’ll be pleased,” Diaz said.
To Page, the ultimate goal of the Hopkins’ trial is FDA approval, which would make mistletoe an acceptable “standard of care.”
“As of now, mistletoe is considered alternative medicine, even though it is used all over the world,” she said, noting that she met with representatives of European mistletoe extract developers Sept. 5 and will continue to promote the treatment through Believe Big. “FDA approval would allow it to be used by cancer institutes, and that’s why we’re working through the process now with the FDA.”
original story source: https://www.baltimoresun.com/maryland/baltimore-county/ph-om-believe-big-0905-20130911-story.html