Pangaea Clinic of Naturopathic Medicine
interventional natural medicine for rapid, lasting health
Pangaea Clinic of Naturopathic Medicine
#120 - 12011 Second Ave
Richmond, BC
V7E 3L6
(604) 275 - 0163
(604) 677 - 5910 (fax)
The information presented within this web site is solely for education. It is copyrighted and protected as intellectual property. As all physicians have their unique opinions, this information is not to be taken as the opinion of any association or regulatory body.  This website is not a substitute for personalized care by Dr Eric Chan or Dr Tawnya Ward; liability is excluded for misuse.
Articles for your browsing. These are past newsletters emailed to our patients and also responses for requests for information. If you have a specific topic you'd like a comment on, please email us.

Mistletoe / Iscador / Viscum album Mistletoe / Iscador / Viscum album

The plant mistletoe, also known as viscum album, has been widely used in adjunctive and naturopathic treatment of cancer patients for many decades. In this setting, the most commonly used brand is by Helixor and is called Iscador. I have used it here in Vancouver as a naturopathic doctor for the last 5 years.

Iscador / mistletoe is even more commonly used in Europe. In Germany for example, it is the most commonly used oncology medication. This is likely because of its popularity as an adjunctive treatment to conventional therapy. Remember that conventional chemotherapy treatment of cancer uses specific chemotherapy drugs for specific types of cancer, where when we are concerned with adjunctive care we are often interested in optimizing the immune system. Having a healthy immune system that can fight cancer, reduce recurrence, and reduce metastasis is a logical goal and is the goal of naturopathic cancer treatment with Iscador.

There are numerous clinical trials to support the use of Iscador and/or mistletoe as a naturopathic medication in cancer. There are also tissue studies, not clinical trials, that investigate and confirm that Iscador strongly stimulates the immune system, including the cells responsible for fighting cancer. This is particularly important in reducing cancer recurrence, and thus I largely use it after conventional therapy, or therapy with intravenous vitamin C, has been completed.

The most comprehensive summary of clinical trials and studies of Iscador was published in Alternative Therapies in Health and Medicine in 2001 (May-June).  In summary, this study reviewed clinical trials and showed that Iscador treatment prolonged survival time of patients with cancer of the colon, rectum, stomach, breast,  lung (small and non-small type). The numbers involved the assessment of 10, 226 cancer patients, which included 1668 cancer patients who had been treated with Iscador / mistletoe, and 8475 who had never been treated with Iscador /mistletoe and served as controls. Survival was roughly 40% longer than the control groups, and the difference was statistically significant. 

This review of clinical studies of Iscador also asked the important question of "is long term treatment with Iscador justified?"  Keeping in mind that when I use Iscador, we are thinking of stimulating the immune system in order to decrease the likelihood of recurrence, we usually think of long term treatment.  Here are the results...

Pretty convincing to me. The greatest increase in percentage of survival time was when Iscador was used continuously. There was less survival increase when Iscador was used for shorter periods of time. Generally I would consider use of Iscador long term (as the subcutaneous injections are taught and self administered, after the first few weeks done in the office to watch for adverse events), especially in conjunction with nutritional support and occasional ozone treatment to further stimulate the immune system.

This review of clinical studies on Iscador was quite comprehensive. The authors did not stop at simply looking at their pool of 10 000 patients, asking who was using Iscador and who was not. They then took 49 pairs of patients (matched for disease characteristics and health) from the group who had never used Iscador. They asked one patient of each pair to start Iscador, and the other to serve as a control.

The above figure shows the difference, with the line on the right showing increased survival time. It appears that the difference started to be noticeable after 3 years of Iscador use.

Now the authors tried to get a bit more specific. In effect, they did a randomized clinical study on Iscador use in breast cancer patients with spread to the axilla (underarm).  This part of the study involved 17 pairs of patients.

Again, in this (admittedly small) group of patients, the difference in survival became apparent at just before 3 years of use.

Despite the thoroughness of this clinical study on Iscador / mistletoe, there are drawbacks to this study. The most important is that there was no discussion on the route of administration, frequency of treatment. The main focus was the question "is the Iscador being used."  Now by far the most common method of application is subcutaneous injection, and that is what I use in my patients for prevention of recurrence. However, I (and other doctors) use Iscador also intravenously when we are actively trying to treat cancer, and if a tumor is superficial, injecting the Iscador around the tumor as well. Particularly, intravenous therapy has more risks of adverse events, but far less than conventional therapy. Intravenous use of Iscador may more strongly stimulate the immune system globally. The did not differentiate between modes of application.

Comparison with chemotherapy in recurrence of disease

The European Journal of Integrative Medicine in early 2009 reported on the use of Iscador in a clinical study to reduce the recurrence of osteosarcoma. Osteosarcoma is an aggressive cancer that often recurs.

This study looked at patients who had already relapsed once and were treated, and subsequently had a second relapse. With the second relapse, the clinical study compared use of a conventional oral chemotherapy drug, etoposide, vs injection of Iscador or mistletoe 3 x weekly for 12 months.

The average etoposide disease free survival was 3 months, while the Iscador treatment was 9.5 months.

Drug resistance is a large problem in chemotherapy use. When a round of chemotherapy is done and partially effective, microscopic disease that remains may consist of cells more resistant to chemotherapy. (This does not discount the utility of chemotherapy, but is simply a problem with most effective therapies.) When we are engaged in using the immune system to prevent recurrence, resistance is less of a problem as the immune system's NK cells (natural killer cells) of course do not use "drugs" that cancer cells can become resistant to. Unfortunately the flip side is that cancer cells are adept at evading the immune system, and thus the need for a naturopathic therapy like Iscador to further stimulate the immune system.

The author's did note a few important limitations. For one, there was no control group where no therapy was given. However, given that this clinical study showed that Iscador was roughly 3 times better than the conventional chemotherapy drug, it could be assumed that a control group with no therapy would do no better than, or worse, than the chemotherapy group. This may be important in other types of cancer though, as one clinical study looked at melanoma recurrence, comparing conventional interferon therapy with Iscador / mistletoe. The Iscador / mistletoe and interferon group had roughly equal outcome, but unfortunately that outcome was similar to no therapy at all.

Larger trials should clear up the picture. But given the low toxicity of the subcutaneously administered injection, I feel as a naturopathic doctor that mistletoe in the form of Iscador has tremendous potential as an adjunctive therapy in cancer.

Further, in more aggressive treatment of cancer, the intravenous use can be considered as well. The Annals of Oncology in 2004 reviewed a preliminary dose finding study that showed that intravenous Iscador had stable disease (no growth, but unfortunately no shrinkage) in 11 patients out of 45, for a duration of 6 to 24 weeks when the injection was given twice weekly. It is unknown if higher doses or if other adjunctive therapies would be helpful. I tend to use the therapy as a subcutaneous injection as well, in patients receiving intravenous therapy.

As a naturopathic doctor in Vancouver, I treat many patients from the local area but do get many email requests for information, including for information on Iscador treatment. I usually briefly describe the use of intravenous vitamin C as an adjunct, and discuss the use of Iscador after conventional therapy (treatment during conventional therapy is only discussed with patients on an individual basis). Iscador can be tremendously useful in preventing recurrence and prolonging survival, and can be easily self-administered. Cost of the medication itself is around $80 for 7 vials, which generally lasts 2-4 weeks, depending on the response and dose needed for subcutaneous injection. Intravenous or peri-tumoral treatment may also be useful in more aggressive treatment, in conjunction with other naturopathic therapies as well.