Mistletoe extract use in cancer patients is widely increasing with the upsurge of cancer incidence rates and reduction in survival time of patients. This study was designed to assess the tumor regression in breast cancer patients with the mistletoe extract. Subjects were designated from outpatient clinic at Rishikesh Hospital, Nashik, INDIA. After giving written informed consent, participants completed a self-administered questionnaire. Twelve patients with histologically confirmed breast cancer tumors of at least 2 cm in diameter received mistletoe extract in an ascending dosage. The tumour was again measured after six months to assess the therapeutic potential of mistletoe extract. The median size of the tumour decreased significantly, from 3.8 cm (range, 1 to 8 cm) to 2 cm (range, 0.1 to 4.8 cm; P < 0.001) on physical examination. Sonographic measurement revealed that, the tumour median size was significantly decreased from 3 cm (range, 0 to 8 cm) to 1.5 cm (range, 0 to 4 cm; P < 0.001). The area of tumour was significantly decreased on physical measurement and sonographic measurement (P < 0.001). The positive nodal status decreased from 66.6 to 41.6 percentages of patients. Mistletoe extract is highly effective and provides a feasible therapeutic option to the clinical oncologist in tumour regression of breast cancer.
Breast cancer is one of the most extensively prevalent cancer in women, which accounts almost 30 % of all cancers (Ries et al., 2001). Breast cancer is the most common type of non-cutaneous malignancy in women in the United States (Greene et al., 2002). Globally, US, India and China accounts almost one third of the breast cancer burden. In India, the incidence rate of breast cancer increasing rampantly. A statistical trend of breast cancer was compared in India with western nations like the US and with neighbour, China. In year 2012, the incidence to mortality ratio was high in India, almost three times higher than US and two times higher than China. The breast cancer burden in India has almost
reached about two third of that of the US and is steadily rising (IARC, 2012). Breast cancer survival is robustly associated with tumour size detection at initial stages of the disease (Okugawa et al., 2005; Michaelson et al., 2002; Jayasinghe et al., 205). Taking into an account of various factors like physical, emotional, and financial impacts allied with disease, it is prudent to diagnose with greatest accuracy. Tumour size pivots a major role in determining disease-free and cause-specific survival in invasive breast cancer particularly, in cases of node-negative breast cancers.
Breast tumours are pathologically classified into groups for staging purpose, because accurate measurement of the tumour is decisive for management of best outcomes. Measuring tumour size is one of the most conventional technique for monitoring cancer development with response to treatment in oncology. Tumour size is measured by various methods including palpation on physical examination and breast-imaging studies such as mammography, sonography and MRI. In this present study, tumour size of patients before and after treatment was measured by physical examination and sonography.
Mistletoe extract is also known as European mistletoe (Viscum album) and used as cancer therapy based on anthroposophy (Steiner et al., 1985). However, mistletoe extract is considered as complementary medicine, it is most commonly used in oncological medicine (Schwabe et al., 1998). Mistletoe extract management in cancer is evidenced from a plethora of clinical studies. Quality of life and survival of cancer patients significantly increased with mistletoe in cancer patients was reported in various studies (Sandeep roy, 2014; Semiglazov et al., 2006; Piao et al., 2004; Kim et al., 2012; Semiglazov et al., 2004). The present investigation was carried out to determine the effects of mistletoe extract in breast cancer patients.
Mistletoe extract (Viscum Album Extract or European mistletoe) is the most frequently used plant extract to treat across an array of solid tumours especially in gynecological and breast-cancer treatment (Fasching, 2007; Molassiotis et al., 2006; Molassiotis et al., 2005). Mistletoe extract possesses potent cytotoxic and apoptosis-inducing effects, which are the key pathways in the treatment of cancer. (Eggenschwiler, 2007; Bussing, 1999; Elsässer-Beile, 1998). A significant morbidity and mortality was observed in women with breast cancer across world. A systematic literature review conducted by Osterman et al., (2009) concluded that adjuvant treatment of cancer patients with the mistletoe extract allied with a better survival. Quality of life improvement in cancer patients with mistletoe extract was reported by glut of studies (Semiglazov et al., 2006; Semiglazov et al., 2004; Piao et al., 2004; Steuer-Vogt et al., 2001; Kim et al., 2012). A comparative evaluation between quality of life, adverse events and survival analysis depicted clear pictorial manifestations of mistletoe extract (Sandeep roy, 2014). In the future, the manifestations of mistletoe extract must be evaluated in broad number of subjects with effective study designs.
Mistletoe extract contains most active group of constituents for the management of cancer. In this investigation, mistletoe extract treatment in the breast cancer patients causes an overall clinical response rate of 83.3 %, as determined by physical examination and 50 % by sonographic measurement. A similar study which was conducted by Moliterni et al., (1997) found overall clinical response rate was 88 % in breast cancer patients treated with doxorubicin and paclitaxel. Clinically, doxorubicin combination with docetaxel in breast cancer patients significantly decreased the tumour size and overall response rate was observed as 93 % and 67 % by physical and sonographical assessment respectively (Mincwitz et al., 1999). The overall response rate for the combination of doxorubicin and cyclophosphamide was 85 %, with a complete remission of 14 % (Dieras et al., 1998).
Side effects were observed by mistletoe treatment which included reddening of skin, and allergic skin reaction, fever, pruritus at the injection and local inflammatory skin reaction at the injection site. Physical measurement of tumour seems to be a vague method for determining tumour regression rate in cancer patients. The estimated overall response rate was higher in physical measurement than sonography. The complete remission was observed in 25 % of patients with physical measurement while it was found 8.33 % with sonography.The correlation between sonography and physical measurement was poor, however the use of techniques like mammography, magnetic resonance imaging must be evaluated in cancer patients treated with mistletoe extract for comparative efficacy of same. Emerging technologies, flawless study designs and effective outcomes will be needed in imminent studies.
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