The results in the chapter health services research are also to be considered in this context.
Last update: August 19th, 2020/AT
Schad et al. 2018 
The data for this non-randomised multicentre observational study in 158 patients with histologically confirmed stage IV non-small cell lung cancer (NSCLC) were obtained from the clinical register of the Network Oncology (NO database).
To determine the influence of mistletoe therapy on survival time, data from two patient groups were included. One group of 108 patients received only chemotherapy and the other group of 50 patients received a combination of chemotherapy and mistletoe therapy. Only patients who were still alive for at least 28 days after diagnosis were analysed. The average age was about 64 years; there were no statistically significant differences between the two groups.
First-line chemotherapy consisted of platinum compounds (73.4%), often in combination with gemcitabine, pemetrexed, vinorelbine or etoposide. Patients receiving additional mistletoe therapy (with abonbaVISCUM, Helixor, Iscador) mostly received s.c. administration, sometimes in combination with infusions (off-label).
Median overall survival was 17 months in the group with additional mistletoe therapy compared to 8 months in the group receiving chemotherapy alone. The difference was statistically significant (p = 0.007). The one-year survival rate was 35.5 percent in the chemotherapy group compared to 60.2 percent in the group with additional mistletoe therapy and the three-year survival rate was 14.2 percent compared to 25.7 percent.
The adjusted multivariate stratified Cox proportional hazard analysis showed that concomitant mistletoe therapy in stage IV NSCLC patients significantly reduced the risk of death by 56 percent compared to chemotherapy alone (adjusted hazard ratio: 0.44, 95% CI = 0.26-0.74, p = 0.002). In addition, an extension of mistletoe therapy at ≥ 16 weeks significantly reduced the risk of death (p = 0.007).
The results of this real-world data study suggest that patients with stage IV NSCLC who received combined chemotherapy and mistletoe therapy have a significantly longer survival than patients who received chemotherapy alone. These real-world study results should be complemented by prospective randomized studies.
Last update: August 17th, 2020/AT
Bar-Sela et al. 2013 
In this randomised phase II study, patients with unresectable non-small cell lung cancer (NSCLC) under therapy with gemcitabine/carboplatin or premetrexed/carboplatin were included. They were divided into two groups by 1:1 randomisation. One group of 33 patients additionally received the mistletoe extract Iscador Qu, the other group of 39 patients did not receive any concomitant therapy. The aim of this study was to examine whether mistletoe therapy can reduce the side effects of chemotherapy and improve quality of life.
The patients in the mistletoe therapy group showed significantly fewer chemotherapy-related side effects, with the result that significantly more chemotherapy cycles could be given. The progression-free period was 4.8 months in the control group and 6 months in the mistletoe therapy group; overall survival was 13.3 (control group) and 15.9 months (verum group). Due to the small number of cases, however, these differences were not significant.
With the exception of the parameter "pain in shoulder", the quality of life measurements always showed an advantage for the patients in the mistletoe therapy group.
There was only one side effect of grade II in the mistletoe therapy group resulting in an oversized local reaction at the injection site. Thus the therapy could be classified as safe.
The additive mistletoe therapy parallel to chemotherapy can reduce chemotherapy-related side effects.in late stage NSCLC patients These results should be verified in larger phase III studies.
Last update: January 4th, 2021/AT