Mistletoe Extracts (PDQ®)–Patient Version
- Mistletoe is a semiparasitic plant that grows on several types of trees such as apple, oak, pine, and elm (see Question 1).
- Mistletoe is one of the most widely studied complementary and alternative medicine therapies in people with cancer. In Europe, mistletoe extracts are among the most prescribed drugs for patients with cancer (see Question 1).
- Mistletoe extracts are usually given by injection under the skin or, less often, into a vein, into the pleural cavity, or into a tumor (see Question 2).
- Few side effects have been reported from the use of mistletoe extracts (see Question 5).
- The U.S. Food and Drug Administration (FDA) has not approved mistletoe as a treatment for cancer or any other medical condition (see Question 6).
Questions and Answers About Mistletoe
- What is mistletoe?
Mistletoe is a semiparasitic plant that grows on trees, such as apple, oak, maple, elm, pine, and birch. It has been used for hundreds of years to treat medical conditions such as epilepsy, hypertension, headaches, menopausal symptoms, infertility, arthritis, and rheumatism.
Mistletoe products vary, depending on the following factors:
- The type of host tree on which the mistletoe grows.
- The species of mistletoe.
- The type of extract used and if it is made with homeopathic methods.
- The time of year the plant is picked.
- The company that makes the product.
Mistletoe extracts are made in water-based solutions or solutions of water and alcohol. Mistletoe products may be named according to the type of tree on which the plant grows. For example, IscadorM is from apple trees, IscadorP comes from pine trees, IscadorQu is from oak trees, and IscadorU comes from elm trees.
- How are mistletoe extracts given?
Mistletoe extracts are usually given by an injection under the skin (subcutaneous). Less common ways to give mistletoe include by mouth, into a vein (intravenous or IV), into the pleural cavity, or into a tumor.
- What laboratory or animal studies have been done using mistletoe extracts?
In laboratory studies, tumor cells are used to test a substance to find out if it is likely to have any anticancer effects. In animal studies, tests are done to see if a drug, procedure, or treatment is safe and effective in animals. Laboratory and animal studies are done before a substance is tested in people.
Laboratory and animal studies have tested the effects of mistletoe extracts in laboratory experiments. See the Laboratory/Animal/Preclinical Studies section of the health professional version on Mistletoe Extracts for information on laboratory and animal studies done using mistletoe extracts.
- Have any studies of mistletoe extracts been done in people?
Most clinical trials using mistletoe extracts to treat cancer have been done in Europe. Many studies use mistletoe as adjuvant therapy in patients with cancer. Although these trials have reported mistletoe extracts to be effective, weaknesses have been reported.
- Size of trial.
- Lack of patient information.
- Lack of dose information.
- Study design.
Findings from studies with large numbers of patients reported the following:
- A retrospective cohort study done between 1993 and 2000 looked at the use of a mistletoe extract as long-term adjuvant therapy in 804 patients treated with chemotherapy and/or radiation therapy for colorectal cancer that had not spread. The study found that patients treated with mistletoe had fewer adverse events, better symptom relief, and improved disease-free survival compared to patients who did not receive mistletoe as adjuvant therapy.
- A study published in 2013 looked at the use of mistletoe in advanced or metastatic pancreatic cancer. Patients received best supportive care and were randomly assigned to receive either mistletoe or no anticancer therapy. Results in 220 patients showed that those treated with mistletoe had improved survival and less disease-related symptoms (including pain, weight loss, fatigue, nausea, diarrhea, and anxiety) compared with those who did not receive mistletoe.
- A study done between 1978 and 1987 looked at the use of mistletoe in non-small cell lung cancer that could not be treated with surgery. Patients were randomly assigned to receive one of 3 treatments: (1) a mistletoe injection; (2) an injection made from a sheep spleen said to stimulate the immune system and have antitumor effects; (3) a placebo injection of vitamin B. Results in 312 patients showed no differences among the 3 groups in survival or tumor response. It was noted that more patients in the mistletoe group reported an improved sense of well-being compared with patients in the other groups.
- A randomized clinical trial in 830 high-risk melanoma patients receiving treatment of interferon or mistletoe for one year, found that at 8 years follow-up there was no increase in survival time in either the interferon or the mistletoe group.
In 2002, the National Center for Complementary and Integrative Health (NCCIH) and the National Cancer Institute (NCI) enrolled patients in a phase I clinical trial of a mistletoe extract and gemcitabine in patients with advanced solid tumors. This combination showed low toxicity and no botanical-drug interactions were reported.
Reviews of combined clinical trials
Reviews have looked at the effects of mistletoe on quality of life, survival, and symptom relief in different types of cancer:
- Quality of life was measured in a review that included 26 randomized clinical trials. Of these, 22 trials showed patients had improved quality of life. Chemotherapy-related fatigue, nausea and vomiting, depression, emotional well-being, and concentration improved. All 10 nonrandomized, controlled clinical trials reviewed also reported the same benefits. Some of the studies were well designed, while others had weaknesses.
- Tumor response, quality of life, and psychological distress were measured in a review of 21 randomized clinical trials in patients with different types of cancer. Mistletoe extracts were used either alone, with chemotherapy, or with radiation therapy. Most of the studies reported benefits for patients, although this review had weaknesses in design and size.
- Quality of life and survival were measured in a review of 10 randomized clinical trials which used mistletoe extracts in patients with different types of cancer. There was no difference in survival or quality of life measures in patients who received mistletoe compared to those who did not.
- Have any side effects or risks been reported from mistletoe?
One review reported that treatment was not found to lessen immune system response. High doses of mistletoe damaged the liver in some cases, but damage was correctable. Another review of clinical trials reported adverse effects that included circulatory problems, thrombophlebitis, swelling of lymph nodes, and allergic reactions.
A few cases of severe allergic reactions, including anaphylactic shock, have been reported.
- Is mistletoe approved by the U. S. Food and Drug Administration (FDA) for use as a cancer treatment in the United States?
Current Clinical Trials
Changes To This Summary (04/25/2019)
About This PDQ Summary
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
Purpose of This Summary
This PDQ cancer information summary has current information about the use of mistletoe extracts in the treatment of people with cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board.
Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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The best way to cite this PDQ summary is:
PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Mistletoe Extracts. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/cam/patient/mistletoe-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389415]
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General CAM Information
Complementary and alternative medicine (CAM)—also called integrative medicine—includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. (Conventional treatments are those that are widely accepted and practiced by the mainstream medical community.) Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease.
Unlike conventional treatments for cancer, complementary and alternative therapies are often not covered by insurance companies. Patients should check with their insurance provider to find out about coverage for complementary and alternative therapies.
Cancer patients considering complementary and alternative therapies should discuss this decision with their doctor, nurse, or pharmacist as they would any type of treatment. Some complementary and alternative therapies may affect their standard treatment or may be harmful when used with conventional treatment.
Evaluation of CAM Therapies
It is important that the same scientific methods used to test conventional therapies are used to test CAM therapies. The National Cancer Institute and the National Center for Complementary and Integrative Health (NCCIH) are sponsoring a number of clinical trials (research studies) at medical centers to test CAM therapies for use in cancer.
Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Few CAM therapies have been tested using demanding scientific methods. A small number of CAM therapies that were thought to be purely alternative approaches are now being used in cancer treatment—not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) meeting in November 1997, acupuncture has been found to help control nausea and vomiting caused by chemotherapy and pain related to surgery. However, some approaches, such as the use of laetrile, have been studied and found not to work and to possibly cause harm.
The NCI Best Case Series Program which was started in 1991, is one way CAM approaches that are being used in practice are being studied. The program is overseen by the NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM carefully reviews these materials to see if any seem worth further research.
Questions to Ask Your Health Care Provider About CAM
When considering complementary and alternative therapies, patients should ask their health care provider the following questions:
- What side effects can be expected?
- What are the risks related to this therapy?
- What benefits can be expected from this therapy?
- Do the known benefits outweigh the risks?
- Will the therapy affect conventional treatment?
- Is this therapy part of a clinical trial?
- If so, who is the sponsor of the trial?
- Will the therapy be covered by health insurance?
To Learn More About CAM
National Center for Complementary and Integrative Health (NCCIH)
The National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH) facilitates research and evaluation of complementary and alternative practices, and provides information about a variety of approaches to health professionals and the public.
- NCCIH Clearinghouse
- Post Office Box 7923 Gaithersburg, MD 20898–7923
- Telephone: 1-888-644-6226 (toll free)
- TTY (for deaf and hard of hearing callers): 1-866-464-3615
- E-mail: email@example.com
- Website: https://nccih.nih.gov
CAM on PubMed
NCCIH and the NIH National Library of Medicine (NLM) jointly developed CAM on PubMed, a free and easy-to-use search tool for finding CAM-related journal citations. As a subset of the NLM's PubMed bibliographic database, CAM on PubMed features more than 230,000 references and abstracts for CAM-related articles from scientific journals. This database also provides links to the websites of over 1,800 journals, allowing users to view full-text articles. (A subscription or other fee may be required to access full-text articles.)
Office of Cancer Complementary and Alternative Medicine
The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine (CAM). OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via the NCI website.
National Cancer Institute (NCI) Cancer Information Service
U.S. residents may call the Cancer Information Service (CIS), NCI's contact center, toll free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 am to 9:00 pm. A trained Cancer Information Specialist is available to answer your questions.
Food and Drug Administration
The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective.
- Food and Drug Administration
- 10903 New Hampshire Avenue
- Silver Spring, MD 20993
- Telephone: 1-888-463-6332 (toll free)
- Website: http://www.fda.gov
Federal Trade Commission
The Federal Trade Commission (FTC) enforces consumer protection laws. Publications available from the FTC include:
- Who Cares: Sources of Information About Health Care Products and Services
- Fraudulent Health Claims: Don’t Be Fooled
- Consumer Response Center
- Federal Trade Commission
- 600 Pennsylvania Avenue, NW
- Washington, DC 20580
- Telephone: 1-877-FTC-HELP (1-877-382-4357) (toll free)
- TTY (for deaf and hard of hearing callers): 202-326-2502
- Website: http://www.ftc.gov