ABSTRACT: – Cancer has become one of the most feared ailments worldwide. As conventional treatment is not too effective or often associated with several side effects. Such side effects of conventional treatment can be reduced in greater extent by using iscador preparations. Though iscador preparations are also expensive but recent in-vitro researches in several cancer cells have opened a new pathway for the world in management of cancer patients either by using homoeopathic medicine, Viscum album, or using iscador therapy as an adjuvant with conventional treatment.
KEYWORDS: – Iscador therapy, cancer, homoeopathy, Viscum album, mistletoe
Abbreviations: – PAMPs (pathogen associated molecular patterns), HRQoL (health related quality of life), Qol (quality of life), VAD (Viscum album dilution), MTT (3- [4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide)
Cancer is leading cause of death worldwide. In 2018, incidence rate of cancer was reported to be around 18.1 million and mortality rate is 9.5 million worldwide. Cancer disease has high prevalence in developed countries but some cancer such as cervical, oesophagus, etc. have high prevalence in developing countries. By 2040, it is expected that disease burden may rise to 29.5 million cases and disease mortality may rise to 16.4 million.1
Iscador therapy is a complementary therapy for management of cancer frequently prescribed in Europe by medical doctors including oncologists in addition to the conventional cancer therapies, radiation, surgery, and chemotherapy.
Rudolph Steiner, an Austrian natural scientist, founded anthroposophy, he worked in collaboration with Dr Ita Wegman, a Dutch physician to employ an injection made up of mistletoe preparation in cancer patients in 1917 and later iscador therapy established in 1926. Iscador, manufactured from the leaves, berries and stems of white berried mistletoe (Viscum album) as a fermented aqueous extract injected subcutaneously.2
There are about 1400 mistletoe species round the globe, and they are hemi parasitic evergreen shrub growing stem of other trees, generally woody plants. The name mistletoe referred for the species Viscum album (European mistletoe, of the family santalaceae) to treat cancer. It is named according to the host tree on which plant grows such as, Iscador M is from apple trees, Iscador P comes from pine trees, Iscador Qu is from oak trees, Iscador U comes from elm tree.3
Mistletoe extracts composed of various constituents with anti-tumoral effects. Two chief mechanisms considered for anti-carcinogenic action of mistletoe extracts. Firstly, immunomodulating effect leading our own body’s immune system by recognising and combating tumor cells. Secondary action on tumor growth.2
Mistletoe contains two group of toxins: viscotoxins and mistletoe lectins. Viscotoxins have cytolytic action, i.e. they dissolve cancer cells. The mistletoe lectins are related to castor oil plant lectins; they have cytostatic properties, i.e. they inhibit the growth of cancer cells.4
The immune system’s ability to destroy the tumor cells is the principle. Homoeopathy also works in similar principle of immunomodulation. The source of mistletoe extract is natural and prepared according to homoeopathic principles.4 In India following training in iscador therapy homoeopaths have begun to use iscador in cancer cases.
In addition to immunomodulating action, it also has cytotoxic effect on tumor cells. After the induction of immunogenic tumor cell death, multiple tumor antigens and PAMPs (pathogen associated molecular patterns), activates antigen presenting dendritic cells or macrophages and present to cytotoxic T cells. In the sequel of the above events tumor specific T lymphocytes are activated which possess specific cytotoxic effects.
- Malignant tumours also with accompany impairment of haematopoietic organs
- Benign tumors
- Pre-cancerous conditions, carcinoma in situ
- Reducing the risk of tumour recurrence after surgery
- In advance malignant tumours, reduces chances of metastasis.
- As a combination with standard therapies such as chemotherapy, radiotherapy, hormones/ anti-hormonal therapy
- Non-allergic to mistletoe preparations
- Acute inflammatory diseases or high fever
- Chronic granulomatous diseases, florid auto-immune diseases and diseases treated with immune-suppressive drugs
- Hyperthyroidism with tachycardia
CLINICAL EFFECTS OF ISCADOR: –
- Improvement in quality of life- improves physical generals of patient such as; appetite, sleep, body-weight, etc.
- Reduction in adverse events of conventional therapy such as; chemotherapy and radiotherapy.
- Reduction of symptoms related to disease or therapy such as; pain, nausea, vomiting, diarrhoea and immune-depressions
- Inhibition of cancer related fatigue syndrome
- Reduction in hospitalisation period, prevention of recurrence and metastasis and prolongation of survival.2
EVIDENCE OF ISCADOR THERAPY IN DIFFERENT TUMOURS: –
- BREAST CANCER: – breast cancer is one of the common cancers in women worldwide and its conventional treatment currently being offered accompanied by several side-effects. Many studies have reported anti-cancer activity of mistletoe extracts on breast cancer. The cytotoxic efficacy of mistletoe extracts against cancer cells has been evaluated in numerous evidence-based researches as well in vitro and in vivo experiments in laboratory. A majority of clinical trials suggest that the beneficial effects of the therapy with positive evidence with respect to survival, HRQoL (health related quality of life), positive remission rate and reduction of chemotherapy causing side-effects for breast cancer patients.5
- LUNG CANCER: – In a randomized phase II study of iscador combined with carboplatin containing regimen was conducted in chemotherapy naïve advanced non-small cell lung cancer patients to assess its effects on chemotherapy related side-effects and QoL. Out of 72 patients 39 in control group and 33 in iscador were enrolled. It was possible to administer more chemotherapy cycles in iscador group. In control group progression free time was 4.8 months and 6 months in iscador group and overall survival period was 13.3 and 15.9 respectively. QoL measurements always showed benefits for the patients in iscador group. So, by the study it can be concluded that administration of iscador along with chemotherapy have better effects in the patients of late-stage non-small cell lung carcinoma, reducing side-effects of chemotherapy.6
- PANCREATIC CANCER: – In a retrospective study of 292 patients undergoing treatment of pancreatic cancer with iscador showed better results and survival time in the upper range as compared with stage related survival reported in the literature.7
- CANCER FATIGUE SYNDROME: – In a systematic review and meta-analysis, the impact of mistletoe extract as pharmacological treatment for the syndrome was determined. In this review, it was found that treatment with mistletoe extract showed moderate effect on cancer related fatigue.8
- SURVIVAL OF CANCER PATIENTS: – In a systematic review on survival of cancer patients being treated with mistletoe extracts (iscador) suggests that adjuvant treatment of cancer patients with the mistletoe extract is associated with better survival.9
HOMOEOPATHY is capable of treating the disease at an energy level, bringing an imbalanced defense mechanism into balance again. Anthroposophical medicine and homoeopathic medicine are prepared under the similar principle. By making the plant extract by the process of maceration of the whole plant and then fermenting in the presence of lactobacilli. Then diluting to final ampoule concentration by isotonic saline solution is the process of manufacturing of iscador preparations.2 Similarly, homoeopathic medicines are prepared by similar process of extract preparation and dilution in aqueous or alcohol base. Anthroposophic medicines is based on spiritual scientific view of a healthy human being who is in close harmony and interaction with the different level of creation and has lost this when in state of ill health, this involves a holistic approach, and hence, is compatible to other holistic system of medicine.4
In homoeopathy we use preparation of viscum album for different complaints such as metrorrhagia, endometritis, epilepsy, and rheumatic disorder and neural disorders. As per Dr Boericke, it advised to prescribe in tincture form and lower potencies.
In several in-vitro researches, homoeopathic preparation showed the effective reduction in cancer cells.
- In a study aimed to evaluate the cytotoxic action of two homoeopathic medicine prepared from viscum album extract. An osteosarcoma cell line cultured in the presence of Viscum album dilution (VAD) 3 and 30, as well as in control group (culture medium, only) viability of cell evaluated by MTT assay. The MTT assay showed that osteosarcoma cell population reduced by 50% with low concentrations of VAD 3 and VAD 30. This gives a promising result showing the action of VAD3 and VAD 30 in osteosarcoma cancer cells.10
- In another in vitro research on homoeopathic Viscum album (10.3) in human breast cancer cell line and human mesenchymal stem cells. Viscum album 3x was added to culture medium and a control group was maintained with culture medium only and viability of cell assessed by MTT assay. Homoeopathic Viscum album preparation in 3x dilution was more cytotoxic to human breast cancer cell line than to human mesenchymal stem cell. It can be concluded that Viscum album in lower concentration was capable of inducing tumour cell death and not healthy cell death. Thus, Viscum album can extensively use against cancer and use of homoeopathic form of it brings new possibilities as no or fewer adverse effects would be present.11
Iscador preparation were imported from Switzerland and Germany and they had been continued for several years, with gaps in between as per physician’s advice so are quite expensive for use in India. If homoeopathic preparations of viscum album are showing evidence of producing significant cytotoxic effect on different cancer cells in several in-vitro studies so we may employ the similar preparations in clinical set up in India. As homoeopathic preparations are highly cost-effective. In iscador therapy there may be common side effect such as erythema at local site of injection, fever or sometime severe allergic reactions, it can be avoided by using homoeopathic preparations. Though it cannot be used exclusively in clinical set up in form of homoeopathic preparations but may be used as complementary or adjuvant therapy in treatment of cancer along with other suitable homoeopathic remedies in lower potencies. Now a days several homoeopaths are using iscador therapy along with homoeopathic treatment are getting better results in management of cancer cases. Though more clinical research work is needed to be carried in this sphere. For the management of cancer cases, one may use iscador therapy as adjuvant along with homoeopathic medicine just like it is being used with conventional treatment in European countries.
- Parkin DM. Cancer in developing countries. Cancer Surv. 1994;19-20:519-61.
- Iscador AG. Iscador in cancer therapy. Solutions for integrative oncology. 2018.
- Marvibaigi M, Supriyanto E, Amini N et al. Preclinical and clinical effects of mistletoe against breast cancer. Biomed Res Int. 2014. Doi: 10.1155/2014/785479.
- Bar-sela G, Wollner M, Hammer Liat et al. Mistletoe as complementary treatment in patients with advanced non-small-cell lung cancer treated with carboplstin based combinations: A randomized phase II study. European Journal of Cancer. 2013:49:5. Pg. 1058-1064.
- Schaefermeyer G, Schaefermeyer H. Treatment of pancreatic cancer with viscum album (iscador): A retrospective study of 292 patients 1986-1996. 1998:6:4. Pg. 172-177.
- Pelzer F, Loef M, D. Martin D, Baumgartner S. Cancer related fatigue in patients treated with mistletoe extracts: a systematic review and meta-analysis. Supportive care in cancer. 2022. 30:6405-6418.
- Ostermann T, Raak C, Bussing A. Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review. BMC cancer. 2009. 9:451. Doi: 10.1186/1471-2407-9-451.
- . Homoeopathic viscum album extract inhibit the growth of osteosarcoma cells. J Intgr Stand Homoeopathy 2020;3(2):1-5.
- Valle AC, Aguiar LR, Brunel HSS, Malard PF, Andrade RV et al. Homoeopathic viscum album (10-3) is more cytotoxic to in vitro culture of human breast cancer cell line than to human mesenchymal stem cells. Int J High Dilution Res. 2020;19(4):25-34.
ABOUT THE AUTHORS
- Dr Kirti Mishra
PGT, Dept. of Organon of Medicine & Homoeopathic Philosophy
- Dr Divya Rani
PGT, Dept. of Organon of Medicine & Homoeopathic Philosophy
- Dr Sachchida Nand Yadav
PGT, Dept. of Materia Medica