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Mistletoe therapy Patient information

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Mistletoe therapy Patient information

Patient information on

mistletoe therapy compiled

and produced by:

ABNOBA GmbH

Allmensstrasse 55

75223 Niefern-Oeschelbronn

www.abnoba.de

4 | 5

Dear reader

With many forms of cancer it is nowadays possible to achieve a lasting

cure. Nevertheless, however positive this statement may be, the diagnosis

of "cancer" is justifiably always associated with many questions and anxieties for the patient, his family and circle of friends. This brochure is intended to help encourage discussions between doctor, patient, family and

friends, to answer unresolved questions, and to stimulate an informed approach to the disease. We would be happy if reading this brochure encourages you to adopt an active approach to your cancer, for this is a definite

step towards successful therapy.

The staff at

ABNOBA GmbH

Almond blossom, almond tree, host tree to almond mistletoe (Viscum album, Amygdali)

Contents

What is cancer?

Frequently asked questions

What causes cancer?

When should mistletoe therapy be started?

Psychological responses to the diagnosis

Is there a special diet?

What is the right way to give an injection?

The area of redness at the injection site, the "local reaction", is much too large.

What does this mean and what can I do differently?

Cancer treatments

Surgery and radiotherapy

Mistletoe therapy in support of surgery

and radiotherapy

Storing the ampoules

Can the contents remaining in the ampoule be used later for other

injections?

Medical treatments

I was not able to inject myself on one day. What effects can this have?

Chemotherapy

When should a mistletoe injection not be given?

Hormonal therapy

Is mistletoe therapy also possible with a malignant disease of the lymphatic

system or the blood?

Can the medicine also be drunk?

What sort of plant is mistletoe? How is it collected?

Is mistletoe therapy reimbursed by the medical insurance companies/NHS?

There are other forms of therapy. What does this mean?

Can mistletoe products be injected together with other medicines?

Are there any incompatibilities when taking other medicines at the

same time?

How long does mistletoe therapy last?

Can breaks be introduced into long-term therapy?

Medical and pharmaceutical technical terms

Immunotherapies / Monoclonal antibodies

Mistletoe therapy to support chemotherapy and

hormonal therapy

Mistletoe therapy

Therapeutic effects and ingredients of mistletoe

Where to obtain support and counselling

Practical use and effect

Duration of therapy, treatment-free intervals

Manufacture of the medicine

Mistletoe host trees

Useful addresses

8 | 9

What is cancer?

Historically, cancer has been detectable from the earliest times.

However, the frequency and nature of the disease have changed with the

different civilisations. Today, for example, tumour diseases of the bowel

are increasing because of changes in dietary habits.

The question "What is cancer?" used to be answered on the basis of

externally visible symptoms, but today molecular biological and genetic

explanations have taken precedence.

The terms "tumour", "cancer", "leukaemia" and many other names

cover more than a hundred different diseases which have in common the

uncontrolled and malignant growth of body cells.

Apple tree, host to apple mistletoe (Viscum album, Mali)

All healthy cells follow an ordered life course. The life cycle of malignant

cells and their proliferation by cell division, however, no longer fits in with

the body as a whole and develops an independent "life of its own".

Scientifically, the cause of this lies in the presence, in the diseased cells, of

"disrupted" genes which are responsible for cell growth and function. In

healthy subjects, this genetically ordained programming is also controlled

by the neighbouring cells and by messenger substances in the human blood

so that human organs or tissues assume an appropriate size and form. Each

organ grows or regenerates itself to its natural individual size and shape.

The diseased cell, however, lacks "information" about its function and its

intended location. It therefore invades foreign tissue as well and migrates,

establishing itself (metastasising) in other regions of the body. Generally,

the cellular changes occur years before the disease is ever apparent.

However, not only has the individual cell and the enclosing organ- or

tissue-forming architecture lost its capacity for control to the tumour, but

so has the whole body as well. Cancer is therefore always also a disease of

the human immune system. In the human body, new cells are constantly

being formed and old ones dying. This natural process that occurs daily

in millions of different ways is "monitored" by the immune system. In

cancer, the immune system has, among other things, lost the ability to

intercept messenger substances that stimulate the unbridled growth of

cells and to destroy malformed cells.

There are therefore three disorders regularly associated with cancer

disease:

the degenerated genetic information in the cell,

the lack of communication between cells which determines the shape

and size of tissues or organs

and the disorientation or weakness of the immune system.

Tumours present as solid and sometimes palpable growths or systemically in the whole body, for example as a lymphoma or leukaemia. In

solid tumours, the removal of tumour tissue (biopsy) determines how

malignant the tumour is. The more similar the tumour is to the tissue

out of which it is growing, the more likely it will be "graded" as benign

(harmless) because at that stage it has only to a limited extent developed

its own dynamic processes distinct from the rest of the body. In addition

to grading, tumours are also classified in terms of the TNM system which

describes the size of the tumour, the involvement of the lymphatic system

and the spread of metastases. (For "Grading" and "TNM system" see also

the detailed index in the appendix.)

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hat causes

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cancer?

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disciplines which study the interaction between psychological and physical processes, psychosomatics or psycho-oncology. Also, the simple

explanation often advanced that there is a specific cancer type, in other

words a personal predisposition to cancer, has not proved correct in any

respect. These comments, however, should not conceal the fact that

there is undoubtedly a relationship between psychological constitution

and physical process which current scientific methodology are unable to

describe adequately.

Self-reproach or the gnawing question of "why me?" are therefore

only beneficial if they do not result in excessive fatalism, but instead in

a change of previous habits. Artistic activities or art therapy can here

provide a very meaningful and successful supplement to medical therapy.

Taking up new interests should also be mentioned in this context.

As a rule, it is the interaction of several factors which is used today to

explain the disease. Each therapy is therefore only rarely limited to one

particular aspect, and should instead take account of and include a wide

range of social, individual, environmental, physical and psychological

factors. An exact description of your condition and your situation will

be extremely useful to your doctor in establishing your individual therapeutic plan.

Psychological reactions

to the diagnosis

Just the suspicion of cancer unleashes many fears. This applies to the

patient and also, in terms of the uncertainty, to the doctor who, although

he knows what the disease is when it is first detected, does not know its

severity. In spite of this he is expected to provide definite responses from

the outset.

Many patients describe their experience of waiting for the test results,

of the associated uncertainty, of the hopes and fears relating to a life

t reatening disease, as often being more unbearable than the knowledge

of being ill.

To ensure that wild speculation is not given free rein at a time when so

many different suspicions are circulating, discuss the nature and scope of

the information that is available to you, your family and friends with your

doctor. This can form the basis for intimate and honest discussions for

everyone involved.

The patient often has the feeling "as if the floor had been taken away

from under his feet" if he suspects and then finally knows that he is suf

fering from cancer. This experience is described as diagnosis shock and is

an entirely normal reaction to a so extraordinary event. A "healthy" self

confidence and the active deployment of all one’s usual resources will not

always be possible in this situation and are only rediscovered with time. It is

only natural that patients under huge psychological stress should experience

rapid changes of mood and a greater debility than they previously

have done. This requires a considerable amount of consideration

and objectivity on the part of family and friends. Objectivity, however,

also includes expressing hopes and wishes clearly and basing them on

truth as far as successful therapy is concerned.

The patient can, however, also tell himself that people close to him

would be happy to help and are also faced with an entirely new situation.

A clear discussion of what is and is not good for him constitutes a good

basis for agreeable help and support.

Many patients want to approach the disease intellectually in order to

make a definite assessment and to provide a healthy corrective to fluctuating moods. Obtaining information and, through first hand experience, supporting medical measures on the basis of one's own judgement

can then be a major help for all those involved. It is sometimes necessary

here to seek advice from another doctor or pharmacist. However, you as

a patient can enhance the confidential relationship with your doctor

from the start if you discuss any questions and opinions with him openly,

including "well-meaning" advice from family and friends. If treatment is

to be successful, it is important to back one's own decisions as well as

those made jointly.

Everything that the patient can do to achieve psychological balance

and mental alertness represents the basis for "healthy" control of the

disease.

16 | 17

Cancer treatments

In the treatment of cancer the following types of therapy are distinguished

from one another :

Curative therapies, such as surgery and radiotherapy, are intended to

cure the disease.

Adjuvant therapies, i.e. supporting therapies, are intended to support

the success of curative therapy, for example when chemotherapy is started after surgery to suppress the growth of, or kill, any cells that have

spread.

Palliative therapies result for instance in the relief of tumour pain and

are intended in particular to produce a higher quality of life, such as improved appetite and deeper sleep in patients. These therapies are often

used in severely ill patients.

Supportive therapies serve to relieve or suppress severe side-effects

that regularly occur with chemotherapy and radiotherapy. For instance,

disorders of the blood-forming function of the bone marrow, nausea

and pain are treated, but also psychosocial disorders in the course of the

disease with the aim of achieving a more effective therapy.

A further distinction is made between local therapies, which combat a

tumour directly by surgery, radiotherapy or the targeted administration

of drugs, and systemic therapies. Systemic therapies have a cytostatic

or hormonal effect and suppress the growth of diseased cells and tissue

in the whole body or, as mistletoe therapy does, stimulate the immune

system in its role against the cancer.

Pine, host tree to pine mistletoe (Viscum album, Pini)

Surgery and radiotherapy

If a tumour can be removed surgically, particularly in the early stages

of disease, this is the most effective treatment of all. To ensure that no

affected tissue remains in the body, a small part of the healthy tissue

surrounding the tumour is always removed at the same time. The surgeon thus often removes neighbouring lymph nodes because metastatic

cells use the lymphatic system in particular (see Index page 54) to spread

through the body. With cancer that has already spread, it may be useful

to remove the primary tumour before beginning systemic treatment, i.e.

involving the whole body, in order to then administer effective therapy

with drugs or radiation. Only in the case of rare, slow-growing tumours

are distant metastases also included in surgical therapy.

Surgery is frequently followed by chemotherapy, radiotherapy and/or

hormonal therapy. Radiotherapy is administered either by means of

radiation from the outside (percutaneous therapy) or by implanting

radiation-emitting substances into the body (brachytherapy). Different

types of ionising radiation, e.g. X-rays or gamma rays, are used to destroy

the genetic information (DNA) of cells found in the cell nucleus in such

a way as to cause them to die or to inhibit their growth. Depending on

the nature and size of the tumour, radiation must be given for several

treatments in order to achieve a therapeutically effective total dose. The

techniques used today enable the tumour to be targeted very specifically

and consequently reduce the damage to irradiated, healthy tissue. Sideeffects of this therapy appear after months and even years if healthy cells

are also damaged by the radiation. The symptoms of the side-effects during and shortly after therapy are very similar to those of chemotherapy.

Mistletoe therapy in support

of surgery and radiotherapy

With radiotherapy and surgery, mistletoe preparations can supplement

and promote treatment both neoadjuvantly, in other words before the

beginning of local therapy, and adjuvantly, i.e. accompanying or suppor

ting it. Surgery, particularly when associated with anaesthesia, and

radiotherapy expose the whole body to considerable stress. A previous

improvement in the general state of health and immune status with

mistletoe therapy therefore regularly results in improved tolerability of

these therapies, which are intended to work locally only, but have an

undermining effect on the body as a whole.

The granulocytes and macrophages stimulated by mistletoe therapy

and thus occurring to an increased extent in the blood help to produce

a more rapid recovery after radiotherapy or surgery. Granulocytes and

macrophages are white blood cells which remove diseased or dead cells.

The aim of adjuvant Viscum therapy (Viscum is the Latin term for mistletoe) is to stimulate the body's own defensive system and thus prevent

a recurrence of the tumour, or relapse. This is because an altered or stimulated immune system can counteract the recurrence of the disease.

In addition, the genetic information (DNA) of healthy cells can be protected by Viscum during radiotherapy.

Viscum therapy can be started up to two weeks before surgery or earlier and is then discontinued two days before surgery. Treatment is then

continued if there are no longer any after-effects of the drugs necessary for

surgery and if inflammation-free wound healing is observed. Depending

on the duration of the treatment-free interval, a lower dose of the mistle

toe preparation may need to be used initially.

It is not recommended to begin mistletoe therapy only one week before

surgery as the whole body experiences too great a stress as a result.

Medical therapies

All cancer therapy is supplemented by drugs or administered solely by

drugs. In Germany, chemotherapy, mistletoe therapy and hormonal therapy are the options most commonly used.

Chemotherapy

Acute leukaemia in children, certain types of testicular cancer, Hodgkin's

disease and many other tumour diseases can today be treated successfully

with the use of chemotherapeutic agents (also known as cytostatics).

Although not as successful as in the examples mentioned above, chemotherapeutic agents have been developed for almost all cancer diseases.

Most of them exploit the reproductive and metabolic mechanisms known

for cancer cells and healthy cells and their chronological sequence to produce a growth-inhibiting effect on the formation of new cells. Tumour cells

frequently proliferate by a more rapid cell division than most healthy cells.

The genetic information which is the cause of the rapid and uninhibited cell

division is attacked by chemotherapeutic agents and thus further tumour

growth or the survival of already existing malignant cells is prevented. A

reduction in the size of the tumour or its complete disappearance can also

occur. This is referred to as a partial or complete remission.

During chemotherapy, in most cases several substances are used to

proceed effectively against the cancer. This "polychemo" combats cell

division with a variety of substances in order to interfere with a wide

variety of mechanisms of cell division, but also to avoid , for example, a

one-sided resistance on the part of the tumour. One typical side-effect

of chemotherapy also derives from the mechanism described above.

Mucous membranes and hair-forming cells are regularly severely affected

because their growth or reproduction is also based on rapid cell division.

Slow-growing tumours (e.g. epithelial tumours) therefore, in some cases,

offer chemotherapy fewer points of attack.

The vomiting (Latin: emesis) that is frequently associated with some

drugs used in chemotherapy is treated by anti-emetic medications. The

exact cause of this vomiting is still not sufficiently explained.

The success of a chemotherapy is based not only on the reduction in

size of the tumour but also on the relapse-free period after the end of

therapy. This requires the chemotherapy where possible to reach all the

diseased cells in the body.

The optimal dose is established individually in chemotherapy - as also

in therapy with mistletoe - and is dependent in particular on blood v alues

which show the functional capacity of the bone marrow. This relates in

particular to leucocytes. The number of leucocytes in the blood is a mea

sure of the functional capacity of the human immune system.

Chemotherapy is generally administered over several sessions lasting

about a week, known as "cycles" or "courses". All cycles and the treatment-free intervals introduced after each cycle generally cover a period of

about six months. Detailed information on chemotherapy and hormonal

therapy in cancer which correctly describes the effects and side-effects

can be obtained from the addresses given on page 40.

Hormonal therapy

Immunotherapies / Monoclonal antibodies

The growth of sex-specific organs is controlled in healthy human

beings by hormones. In the 1940s, it was recognised that specifically

thosetumours which form on or in such organs can be regulated in

their growth by withdrawing hormones. The withdrawal of hormones

prevents thediseased cells from dividing because of the elimination of

growth-promoting signals. It does not act like chemotherapy or radiotherapy by damaging the genetic material.

The withdrawal of hormones can be done surgically, e.g. by removing

adrenal glands, ovaries or testes, or by medically suppressing female

or male hormone formation. Thus, by administering female hormones,

ostrogens, a successful outcome can be achieved in prostate carcinoma,

and vice versa with gestagens, the artificially manufactured male hormone, in breast cancer in women. Other methods again suppress the

signals for hormone formation in the pituitary gland and thus the subsequent formation of hormones in the reproductive glands. Finally, the

"communication pathway" between hormones and cells can be inter

rupted by administration of drugs which block or change the cell receptors necessary for growth signals. Receptors are cell organs for receiving

food and information, e.g. on cell division or cell growth.

Typical side-effects of hormonal therapy are menopausal symptoms in

women and a loss of desire in men and also of potency with some medicines.

Hormonal therapy can last from a few weeks to several years. In unfavourable cases, however, resistance to hormones can develop in tumour

cells after long-term therapy, so that hormonal therapy is often supplemented by chemotherapy.

To understand the mode of action of immunotherapies, a distinction

must first be drawn between two spheres of the immune system: the

innate or non-specific immune system and the specific immune system.

The cells of the innate immune system rapidly recognise and combat

pathogens, because the characteristics of these diseases are known

to the immune system. Thus, the body reacts rapidly to a flu virus, a

cold or inflammations, for example. The reaction of specific immune

system cells is delayed, because they first have to "learn" to react to a

previously unknown disease. This learning is usually triggered by mediating cells (e.g. T or B cells and dendritic cells). In the case of a tumour,

the interaction of the two spheres of the immune system – specific and

non-specific – and the learning process itself are impaired in a variety

of different ways.

The essential function of therapeutically administered monoclonal antibodies is to act on these disorders. The antibodies alter the information

that is exchanged between the cells of the immune system or between

the immune system and diseased cells or during the learning process of

the specific immune system.

Information is also found on the surface of cancer cells that allows the

immune system to recognise these cells as foreign or malignant. However,

it is a particular property of tumours that over the course of time they

are no longer recognised as 'foreign' by the innate immune system and,

as a result, also evade an immune reaction by giving the specific immune

system false information with regard to recognising the tumour cell and

learning the immune response.

Tumour cells therefore prevent both the recognition of the tumour

and the learning process necessary to combat it.

One example of the deception perpetrated by the tumour cells is the

provision of particular information on their surface at what are known

as immune checkpoints. The information conveys to the immune system‘s

cytotoxic T cells that the cancer cell is a harmless, endogenous cell and

therefore does not need to be combatted. Monoclonal antibodies can

intervene therapeutically at this level to suppress the false information

provided by the immune checkpoint and thus allow the cytotoxic T cells

to once again proceed actively against the tumour.

A further therapeutic mechanism of action exploits a particular property of cytotoxic T cells. In order to prevent healthy tissue from also

being attacked by such T cells, these cells must not proliferate excessively.

They therefore possess a healthy self-reduction mechanism, which is activated by surface information on the cell, known as a PD-1 receptor, if too

many T cells are present. Monoclonal antibodies can interfere with the

actually healthy 'selfrestriction' information of this receptor. Cytotoxic T

cells are then present in very large numbers. The increased number of

these T cells thereupon generates a more effective control of cancer cells.

Both mechanisms of action, the prevention of deception (the cancer

cell pretends to be a healthy cell) and the proliferation of cytotoxic T

cells, are also often used simultaneously for treatment with monoclonal

antibodies.

The simultaneous use of mistletoe therapy and antibody therapies

has been studied and can be undertaken without any restriction on the

antibody therapy. There was also evidence to show benefits in terms of

adverse reactions for patients receiving both treatments.

Mistletoe therapy to support

chemotherapy and hormonal therapy

Chemotherapeutic agents damage the body's own formation of leucocytes, as a result of which the patient is highly susceptible to infection.

Infections, including a harmless cold, can further weaken the body to a

considerably greater extent during chemotherapy and may even result in

the cycle being stopped or in a non-optimal dosage of chemotherapy.

Treatment with mistletoe activates natural killer cells (NK cells), among

others, which belong to the leucocytes, and stimulates their prolifer

ation. Granulocytes and macrophages, which are also leucocytes and

which remove dead or diseased cells and thus reduce the susceptibility to

infections, are likewise increased. Furthermore the adjuvant (supportive)

administration of mistletoe enables the dose of those drugs intended to

prevent vomiting during chemotherapy to be reduced.

All these effects contribute to a better general state of health. This

is also supported by the release of interleukins. Interleukins increase,

among other things, the production of the body's natural morphines

(socalled endorphins) and lighten the depressed mood often produced

by chemotherapy, therefore increasing acceptance of the therapy. The

appetite-enhancing and mood-lightening effect of mistletoe therapy

can in this way be used to support chemotherapy.

Hormonal therapy effectively suppresses, albeit ‘only’ one-sided, the

hormonally controlled growth of tumour cells. Therapy with mistletoe

can be viewed here as a holistic, supplementary treatment of the ill patient. The serious attack on the patient’s hormone balance requires the

accompanying immunomodulation described in the beginning of the

next section.

26 | 27

Mistletoe therapy

Therapy with mistletoe products is used in a number of different ways

and for a broad spectrum of tumour diseases. Within a treatment plan,

it can have a supportive (adjuvant), alleviating (palliative) or, most commonly, a general strengthening and preventive character.

In oncology, attention is devoted principally to the aspects of quality of

life, prolonging survival and relapse prophylaxis. Mistletoe therapy can

be used in a variety of ways for these purposes:

The body's own defences are strengthened by mistletoe therapy in

such a way that granulocytes, lymphocytes and natural killer cells appear in the blood to an increased extent. Any degenerated cells still

found in the body can therefore be combated and the risk of metastatic spread reduced.

Mistletoe therapy can therefore improve the immune system weakened by surgery, anaesthesia, radiotherapy and chemotherapy in its role

against cancer.

Mistletoe plant in winter, birch, host tree to birch mistletoe (Viscum album, Betulae)

A healthy immune system, i.e. one which reacts in a variety of ways,

makes relapses less likely. To this extent, mistletoe therapy is also a

preventive measure in terms of relapse prophylaxis.

Mistletoe therapy can reduce or make more bearable the pain which

can occur in advanced stages of tumours by stimulating the release of

endorphins. Endorphins are natural morphines produced by the body

which have a pain-relieving action.

The loss of appetite and the disturbed sleep pattern that frequently occur in association with a cancer disease can be eliminated or alleviated.

Healthy eating and sleeping behaviour should not be underestimated

as a precondition for long-term recovery. This also applies to the reduced susceptibility to infectious diseases that can be observed during

mistletoe therapy.

It has been shown in several studies that mistletoe injections have a

protective effect on the genetic material (DNA) of human cells. This

also explains the improved tolerance of chemotherapy or radiotherapy

during mistletoe therapy.

As well as these effects which are based primarily on immunomodulation,

a cytotoxic effect of Viscum album on tumour cells has also been demonstrated. Cytotoxic effects, i.e. which destroy cells, are exerted in particular by the lectins and viscotoxins contained in mistletoe.

Therapeutic effects of the

ingredients of mistletoe

Mistletoe preparations are plant-based medicines, and use the whole

plant or the composition of active substances in the plant as the basis for

their therapeutic effect. However, some manufacturers concentrate their

efforts solely on one ingredient, the lectin content of mistletoe.

In this respect, the widespread belief that plant medicines are harmless

is incorrect, for although the side-effects of therapy with mistletoe preparations are comparatively minor, some of the individual ingredients are

among the most poisonous substances known. Mistletoe preparations for

this reason can only be obtained on prescription and are not to be used

without medical supervision. The fact that, despite this, the side-effects

that occur are only minor is due to the interaction of the various ingre-

dients in mistletoe. This effect, known as synergy, is however also shown

in a totally different way when laboratory tests on different tumour cells

have shown that individual ingredients of mistletoe, such as lectins, have

a markedly lower therapeutic effect than the extract of the mistletoe

plant as a whole.

Two important groups of substances in mistletoe are viscotoxins and

lectins.

Viscotoxins produce necrosis, in other words they cause cell death by

poisoning the cell, accompanied by inflammation. Lectins, however, act

on the cell nucleus where they cause an apoptotic reaction of the cell.

Apoptosis means the stimulation of an ordered degradation of all the cell

components, comparable to natural cell death. At present, four groups of

mistletoe lectins are known.

In addition to the function described, directed specifically against the

diseased cell, mistletoe possesses the property, as already mentioned,

ofhaving a modulating effect on the immune system. In this way, the

immune system can be stimulated as a whole, non-specifically or specifically, in its capacity to deal with diseased cells or foreign substances. The

nonspecific reactions, which are inherent in the immune system, include

a marked increase in leucocytes in the blood. Specific reactions, i.e. the

immune system learns this reaction as a result of administration of the

drug, are for example the increased formation of T-cells and B-cells (see

Index pages 53). Mistletoe therapy therefore stimulates the immune system to "remember" its tidying and cleaning function. This is confirmed

by clinical studies.

Mistletoe therapy may therefore be seen as a meaningful supplement to

conventional therapies.

The normal method of giving the subcutaneous injection is described

below and reference is made to the typical side-effects and the readily

observed therapeutic effects.

Practical use

and effect

Mistletoe preparations are administered by subcutaneous injection,

i.e. the contents of the ampoules are injected under the skin. As a rule,

this is done two or three times weekly. Only freshly opened ampoules

should be used. The administered dose is increased during the first few

weeks, depending on the state of health and the therapeutic aims. The

increase in dose is intended to achieve the most effective individual dose.

It can however happen that an optimum level is achieved with the very

first dose used. An effective and tolerated dose is readily recognised by

the patient on the basis of the reactions described below. It should be

mentioned first of all however that these reactions or side-effects are

normally a sign that the body is responding to treatment. Side-effects are

therefore to a certain extent therapeutically desirable.

With an adequate dose, redness and/or swelling of up to five centi

metres in diameter will form at the injection site after about six to eight

hours. This local reaction is associated with itching and will persist for

not more than three days. If the local reaction occurs to a lesser extent

after about 2.5 weeks of treatment, a further increase in dose can be

undertaken. This can often result in the local reaction once again having

a diameter of up to five centimetres. The dose is increased once or twice

at the beginning of therapy. After about nine weeks of uninterrupted

use of the same dose, the local reaction will decline and finally disappear

altogether.

The following side-effects may also occur at the beginning of treatment and be experienced as unpleasant: fatigue, flu-like sensation or

dizziness. These reactions appear a few hours after the injection for a

maximum of 24 hours and can be accompanied by a slight fever. Fever

is unpleasant, but is also always a sign of increased positive activity of

the immune system. The daily timetable should always allow for the

occurrence of a slight fever at the beginning of therapy. However, even

these sideeffects have disappeared after the first nine weeks or are only

very slightly apparent.

The doctor will adjust the number of weekly injections and the dose

used according to the severity of these effects. If there are no symptoms

at all, a change in the type of mistletoe, i.e. the host tree on which the

mistletoe has grown, may be considered (e.g. changing from Viscum album Mali (apple tree mistletoe) to Viscum album Abietis (fir mistletoe).

In the first two weeks of therapy the tendency to slight "chills" that

frequently occurs in cancer patients will decrease and they will experience

a greater feeling of warmth throughout their whole body. In general, a

deeper, more recuperative night's sleep is also obtained and the appetite

will increase. In addition, in many patients a lightening of mood and an

associated feeling of greater well-being and hence increased quality of

life will be observed.

Some doctors place particular emphasis on the fact that the patient’s

body temperature should be measured and recorded in the morning and

evening because the temperature difference can show an immunomo

dulatory effect of mistletoe therapy. In patients there is almost always

only a minor difference in temperature, whereas healthy subjects show

a marked difference between morning and evening temperature. This

"circadian" temperature rhythm will in most cases adjust to the natural

rhythm after a few weeks and is also the sign of a response to therapy.

32 | 33

Duration of therapy,

treatment-free intervals

Maple, host tree to maple mistletoe (Viscum album, Aceris)

Mistletoe products are used for a period of two to seven years depending on the aim of treatment. This period, also known as "maintenance

therapy", is intended for immunomodulation and thus indirectly for the

effective prevention of relapses. Relapses are tumours which recur after a

successful curative treatment (e.g. after surgery). Often there is an interval of several years between the successful treatment and the occurrence

of a relapse. Preventive (prophylactic) therapies against relapses are

therefore long-term and should be directed at the whole body. Mistletoe

preparations are suitable for effective relapse prophylaxis because any

medication directed solely at the diseased cell would fail to achieve a

long-term improvement in the health of the whole body.

Treatment-free intervals can be introduced during this long-term

maintenance therapy. This is frequently done to restimulate the immune

system to a greater extent by means of different stimuli or because, for

example, additional stress must be avoided during flu. However external

circumstances can also justify a break.

In this context, it should be pointed out that after a break of more

than two months a low dose must again be used to begin with because

the immune system has a learning capacity and once it has "learnt the

poisons of mistletoe" it can respond very violently to a large quantity of

these substances.

Maintenance therapy is programmed according to the individual treatment plan. In most cases an unchanged dosage is prescribed during this

period. However, different dosages are also used to act rhythmically on

the immune system. In modulating the immune system, it can also be

helpful for the doctor to change the species (see here also the section

"Mistletoe host trees," page 36).

If the body has become accustomed to the medication in the course of

long-term therapy, a further increase in dose can be undertaken, as at

the beginning of therapy. Towards the end of maintenance therapy injections are carried out normally only once a week, interspersed by longer

treatment-free intervals.

Manufacture of the medicine

Mistletoe products are manufactured as an extract of mistletoe from

the relevant host trees. Many manufacturers use the mistletoe collected

in both summer and winter, while others only use the plants harvested in

winter. Different extraction procedures and solvents are also used. The

spectra of ingredients and active substances therefore differs in each

product that is on the market.

The Abnoba company uses both summer and winter mistletoe for the

manufacture of the medicinal product in order to ensure a wide spectrum of ingredients. The mistletoe is then extracted without exposure

to air according to a patented procedure so that as a result more than

75% of the plant material used is available in the drug. All essential ingredients such as lectins, viscotoxins, polysaccharides and triterpenoids

(including oleanolic acid, betulinic acid) are then contained in the extract

in very high quantities.

This procedure also allows the formation of mistletoe liposomes (vesicles)

which are formed from the cell membranes occurring naturally in the

plant cell. These structures may be imagined as very small spheres, invisi

ble to the naked eye, which bind or incorporate the active substances and

other ingredients of mistletoe. Pure mistletoe liposomes have an effect

in their own right: they are immunologically active. This should also be

taken into account in the direct effect of the product on tumour growth.

The good tolerability of these products is also probably due to this.

Using special procedures, manufacturers who use two collection times

mix the extracts with one another and then dilute them appropriately to

the required dose. All the products obtained are then filled in ampoules

following sterile filtration.

Mistletoe products from the Abnoba company are processed under

careful protection from oxidation from the time of collection until

sealing of the ampoules. As a concentrated extract, they have a light

yellowishgreen colour which shows that the liposome-forming and fatrelated membrane substances have been transferred to the aqueous

extract. The high extract yield and the presence of liposomes distinguish

these mistletoe products from other mistletoe products. Greenish or

clear preparations also show that no degradation products resulting

from oxidation have been formed.

The constant quality of the extract is ensured by the specified collection time, the formula for the plant parts used and the precise organisation of the manufacturing process as far as this is possible for plant

products at present. Numerous "in-process controls" test the contents of

the extract qualitatively and quantitatively and exclude prohibited impurities. Manufacture and quality control is performed in accordance with

international standards and the rules of "Good Manufacturing Practice"

(GMP rules) which relate to the current state of knowledge and technology and are constantly revised in the interests of patient safety.

Mistletoe host trees

Depending on the tree on which a mistletoe plant has grown - the host

tree - the composition of its ingredients can differ. This fact is used therapeutically. Thus, for example, the high concentration of viscotoxins and

lectins in Viscum album Fraxini can be recommended for the treatment

of metastatic tumour diseases. The Latin word "Fraxini" means "ash" and

designates the tree on which the mistletoe has grown. For Mali (apple

tree) there is good experience, acquired over decades and confirmed by

studies, in the treatment of breast cancer. This applies in the same way to

the oak mistletoe (Quercus), which is used in particular in tumours of the

gastro-intestinal tract, i.e. the digestive tract, and the male sex organs.

The selection of the host tree by your doctor, however, also depends

very substantially on the treatment plan and above all on the individual

disease. In individual cases it may occur that in the treatment of breast

cancer that mistletoe from the pine tree (Pini) or Viscum album Abietis

(fir tree) is used instead of the frequently employed "Mali" species (apple

tree). This is done in order to make the body react in a different way to

the different compositions of the ingredients.

38 | 39

Where to obtain

support and counselling

You will always find practical social and nursing care and counselling

in your neighbourhood from the welfare institutions. In the telephone

book you will find the addresses of

The Samaritans www.samaritans.org

Department for Work & Pensions www.gov.uk/dwp

British Red Cross www.redcross.org.uk

These institutions can help you with home nursing, housekeeping and

medical care. Your medical insurance or nursing insurance company is

responsible first and foremost for financing of this assistance.

For more specific questions, such as:

Which aftercare or rehabilitation clinic is recommended?

Where can I find a pain clinic in my neighbourhood?

What financial assistance can a cancer patient claim?

Who finances domestic help during a period in hospital?

Who bears the costs for care at home and who for care in a nursing

home and whom should I contact in this respect?

and for practical questions about coping with the disease or about the

situation of relatives, you will find the appropriate contacts mentioned

below.

Oak, host tree to oak mistletoe (Viscum album, Quercus)

Useful addresses

Cancer Research UK

www.cancerhelp.org.uk

Helpline: 0808 800 4040 (free, only UK)

Macmillan Cancer Support

www.macmillan.org.uk

Helpline: 0808 808 0000 (free, only UK)

Camphill Wellbeing Trust

http://www.mistletoetherapy.org.uk/

National Health Service

www.nhs.uk

www.nhsinform.scot

For specific questions about

Mistletoe therapy please contact

ABNOBA GmbH

eMail: info@abnoba.de

Notes

42 | 43

Frequently asked questions

When should mistletoe therapy be started?

Therapy can be started before the beginning of what are known as

standard therapies (surgery, chemotherapy and radiotherapy) and is

then intended particularly to improve the tolerability of the standard

therapies. Mistletoe therapy may also possibly be started in the intervals

between cycles of chemotherapy.

In most cases, mistletoe is prescribed after the end of the standard

therapies to prevent recurrences (relapses) and to improve the immune

status and the quality of life.

Mistletoe therapy should always be taken on medical advice and under

medical supervision.

Is there a special diet?

Certain dietary habits make a substantial contribution to health. You

should therefore ensure that wholemeal products, fruit and vegetables

are on the daily menu. The excessive consumption of meat, sugar and

fat should be avoided. Changing your eating habits overnight however

should not cause you to lose your pleasure in eating! Brochures from

medical insurance companies and bookshops offer a rich selection of

recommended diets.

Ash, host tree to ash mistletoe (Viscum album, Fraxini)

What is the right way to give an injection?

To begin with, your doctor or her/his assistant will show you how to

use the ampoule and the syringe. During the therapy, you yourself or a

member of your family can give the injection. Please note the following:

At the beginning of treatment (for about 8 weeks) when stronger reactions are possible, the injections should be followed by half an hour's

rest. Change the injection sites. As a rule, injections are given under the

abdominal skin and possibly also under the skin on the upper leg. See

also page 60/61.

The area of redness at the injection site, the "local reaction", is much too

large. What does this mean and what can I do differently?

Initially, the local reaction also depends on the angle and the depth beneath the skin at which you have given the injection. If the injection has

been given at a very shallow angle, a correspondingly large local reaction

may be expected; on the other hand, if the angle of the injection is very

steep, a weaker reaction will be apparent. The diameter of this redness

should be about five centimetres. The local reaction is basically a sign

of a healthy reaction to the medicine. For this reason, an excessive local

reaction is not harmful in terms of an overdose. Obviously, the burning

and itching at the injection site is unpleasant. For this reason, if you have

an excessive reaction, discuss with your doctor whether only half the contents of the ampoule should be used for the next injection or whether

the dose should be reduced still further.

Storing the ampoules

Active plant substances react sensitively to frequent and excessive temperature fluctuations. It is therefore recommended that the ampoules

should be stored in a cool, dark place, for instance in the refrigerator.

Before use, however, the ampoules should be brought to room temperature by warming them briefly in your hands.

Can the contents remaining in the ampoule be used later for other in

jections?

No, the contents of an opened ampoule can be contaminated with

bacteria and become unsterile, even when handled carefully. In addition,

the drug can oxidise on contact with the oxygen in the air.

I was not able to inject myself on one day. What effects can this have?

As this is a long-term therapy, it is not of major importance. You should

however realise that the stimulus for the immune system to be modulated is less pronounced as a result.

When should a mistletoe injection not be given?

In general, if the patient has a high fever or if they react allergically

to the injections. The "local reaction" sometimes associated with slight

swelling and itching is not an allergy! If however the itching at the injection site develops into a generalised itching over the whole body, there

may be an allergy. This very rare reaction should only be described as

allergic if the itching or burning does not disappear with a reduced dose.

Is mistletoe therapy also possible with a malignant disease of the lym

phatic system or the blood?

There have been laboratory tests which suggested that growth of

diseased lymphoma cells would be stimulated by therapy with mistletoe

extracts. This suspicion has not been confirmed either in further cell studies or in retrospective (i.e. looking back) studies of disease processes.

A repeated laboratory test also contradicts this suspicion. Nevertheless,

this rumour has persisted and has led to uncertainty among patients and

doctors, which is the reason why we are discussing this question here.

No treatment processes are known in which mistletoe has stimulated

the growth of malignant cells. In fact, there are a large number of welldocumented cases that prove the opposite. The question has also been

studied by a wide range of scientists who also came to the conclusion that

this suspicion is not tenable.

Research by the University of Tübingen commissioned by the Abnoba

company confirms this result.

Can the medicine also be drunk?

No, because mistletoe products lose the effect necessary for cancer

therapy when they come into contact with the mucous membranes of the

mouth and with gastric acid.

What sort of a plant is mistletoe? How is it collected?

There are a variety of species of mistletoe. The mistletoe used for

cancer therapy is the white-berried mistletoe (Viscum album L.), whose

main habitat extends from Europe via Central Asia to Korea and Japan. In

Europe, three subspecies are distinguished within the species of Viscum

album: pine, fir and deciduous mistletoe.

Birds like to eat white mistletoe berries in winter and thus ensure the

dispersal of the seeds and thus the plant. The mistletoe seedling attaches

itself to the bark of the host tree and germinates in the spring. It first of

all seeks access to the water-conducting vessels in the tree and instead of

a root drives a so-called sinker through the bark. Over a period of about

4 years, the mistletoe grows - like any normal plant - against gravity, upwards towards the light. At this stage, the mistletoe is not yet collected.

Only from the 5th year onwards does the typical spherical bush shape

appear. The plant achieves this through oscillating growth movements

which it performs annually in the early summer. Some manufacturers

see this as being the appropriate time for the summer collection. The

mistletoe thus does not just direct its shoots in one direction, but grows

actively in all directions. In winter, the evergreen mistletoe is particularly

apparent as a spherical bush in the middle of the bare trees. When other

plants are resting, mistletoe does not. There is no seed dormancy. The

nutrient tissue of the mistletoe berry which first ripens in winter contains a green, already germinating embryo with cotyledons (seed leaves)

and a root pole which is attracted to the light shining through the mistletoe berry. The ripening of the flowering organs is already complete

in October. Flowering in most plants follows rapidly on from this cell

division. The mistletoe takes its time and does not flower until January/

February. Some manufacturers carry out the winter collection at the beginning of January - at this point the mistletoe berries are ripe and the

male and female flowers not yet open.

Thus, compared to other plants, mistletoe is distinguished by a series

of characteristics which can be described by biological development processes that are both time-lagged and also spatially independent. These

specific features of mistletoe can also be observed in its spectrum of substances, which is subject to seasonal variations. For this reason, it is suggested that a single collection time is not appropriate for the medicinal

product, which involves the whole plant, but that two collection times

are necessary for the production of medicines. For this reason, collection

is performed in summer and winter at predefined collection times identi

fiable by specific characteristics of biological development.

The mistletoe used for manufacture by the Abnoba company does not

come from crops, but from naturally growing stocks. At each collection

time both the plant and the site are examined, assessed and documented

by experienced biologists. The collected material is processed on the spot

within the first 4 hours of collection. Even in these very early stages of

production, care is taken to ensure that environmental oxygen is excluded in the processing of the mistletoe. At this stage also measures are

taken to prevent the product later on from containing plant or bacterial

degradation products. Mistletoe leaves, shoots and berries are weighed

in accordance with the predefined formula, divided into portions and

stored in transport containers which prevent any oxidative change in the

collected material until the beginning of drug production. Before use in

production, the collected material is tested for impurities from pesticides

and heavy metals or infestation with micro-organisms.

Is mistletoe therapy reimbursed by the medical insurance companies?

The use of mistletoe therapy in cancer diseases is permitted by the

National Health Service (NHS) as well as by private insurance companies

(available on prescription on a named patient only).

There are other forms of therapy. What does this mean?

Forms of treatment other than the subcutaneous injection of Viscum

album are mentioned and discussed on the internet and in self-help

groups. These include the following forms of therapy in particular: intravenous (into the blood circulation), intratumoural (into the tumour or a

metastasis), intrapleural (into the gap in the chest lining) and intravesical

(into the urinary bladder) therapy.

The forms of therapy mentioned are predominantly still in the process of

scientific development and therefore should always only be given by a

doctor and under clinical supervision.

Can mistletoe products be injected together with other medicines?

Mistletoe products should only be injected on their own.

Are there any incompatibilities when taking other medicines at the same

time?

A slight increase in temperature after the injection is desirable at the

beginning of therapy with mistletoe products used in holistic therapy.

These mistletoe preparations should therefore not be taken together

with medicines that lower temperature.

It is essential to seek medical advice if you are taking thymus preparations during mistletoe therapy.

No incompatibility or interactions with medicines other than those

mentioned is known.

How long does mistletoe therapy last? Can breaks be introduced into long

term therapy?

Depending on the risk of relapse of the tumour concerned and/or the

required stimulus for immunomodulation, mistletoe therapy will continue for a period of a few months to several years. Injections are given

more often at the beginning of therapy and subsequently often only

once or twice a week and breaks can be introduced into the treatment.

Following a break of more than two months, the treatment should be

started again at a low dose (as at the beginning of therapy), and at all

events under medical supervision.

50 | 51

Medical and

pharmaceutical terms

Mistletoe branch in winter

Adenokarzinom = a cancer arising from the glandular parts of the mucous membrane.

Adjuvant = accompanying, in the sense

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