Zie ook in de literatuurlijsten samengesteld door arts-bioloog drs. Engelbert Valstar en waarvan wij per vorm van kanker of naast operatie, chemo of bestraling of een beenmergtransplantatie weer aparte literatuurlijsten hebben gemaakt. En in een aantal lijsten komen ook daarin de maretakinjecties voor. 

Zie ook in gerelateerde artikelen. 

16 oktober 2022: Bron: World Journal of Surgical Oncology volume 19, Article number: 178 (2021)

Maretakinjecties (in deze studie is Viscum Album L. gebruikt) naast chemoradiotherapie vooraf aan operatie bij patiënten met rectumkanker graad II en III zorgt voor meer complete remissies en gedeeltelijke remissies na operatie dan chemoradiotherapie zonder maretakinjecties. Dat blijkt uit een gerandomiseerde studie bij totaal 52 patiënten. Een kleine studie dus maar het verschil van de maretakinjectie verdubbelde de complete remissies, (53,3% vs. 21,6%, P = 0,044).

Uit het studieverslag:

Abnoba Viscum Q® (ABNOBA GmbH, Pforzheim, Duitsland) werd gebruikt als het maretakextract. Er was geen criterium voor het selecteren van patiënten voor behandeling met Abnoba Viscum Q®. Het extract werd subcutaan toegediend in een dosis van 0,02 mg/ampul driemaal per week gedurende 3 weken, gevolgd door 0,2 mg/ampul driemaal per week gedurende 3 weken, 2 mg/ampul driemaal per week gedurende 3 weken en ten slotte 20 mg /ampul driemaal per week; daarna werd vlak voor de operatie een laatste dosis van 20 mg toegediend. De patiënten dienden Abnoba Viscum Q® zelf toe nadat ze van de medische staf hadden geleerd hoe ze het moesten injecteren en werden opgevolgd op onze polikliniek. De toediening van het extract werd tijdelijk stopgezet in geval van lokale of systemische bijwerkingen, zoals ernstige urticaria, lokale zwelling > 5 cm of hoge koorts > 38 °C.

In totaal werden 52 patiënten geïncludeerd in de studie: 15 in de Maretakgroep (MG) en 37 in de niet-maretakgroep (NMG). Alle patiënten in de MG kregen de volledige dosis maretakextract volgens het schema.
De mediane leeftijd van de patiënten was 68 jaar (bereik 38-86 jaar) en de onderzoeksgroep bestond uit 35 mannen en 17 vrouwen. Baseline demografie was grotendeels vergelijkbaar tussen de twee groepen (Table 1), hoewel er enkele uitzonderingen waren.
CA 19-9-niveau was hoger in de NMG dan in de MG (P = 0,01) en de tumorafstand van de AV was langer in de NMG dan in de MG (P = 0,008). Mesorectale fascia (MRF) betrokkenheid was aanwezig bij 10 (66,7%) patiënten in de MG en 19 (51,4%) patiënten in de NMG (P = 0,314), gebaseerd op de bevindingen van de abdominoperineale CT en rectale MRI.

Alle patiënten in de MG werden gediagnosticeerd met klinische stadium III-ziekte, terwijl de NMG drie (8,1%) patiënten met klinische stadium II-ziekte en 34 (91,9%) patiënten met klinische stadium III-ziekte had. Er was geen statistisch significant verschil in het klinische stadium tussen de twee groepen (P = 0,548).

Resultaten: Tumorresponsen waren significant beter in de MG dan in de NMG in termen van het pCR-percentage (53,3% vs. 21,6%, P = 0,044), TRG (goede respons 66,7% vs. 32,4%, P = 0,024), T-downstaging ( 86,7% vs. 43,2%, P = 0,004) en algehele TNM-downstaging (86,7% vs. 56,8%, P = 0,040). N downstaging toonde geen statistisch significant verschil tussen de twee groepen (93,3% vs. 78,4%, P = 0,257). Tabel 5 geeft de details van de tumorreacties.

Het volledige studierapprot is gratis in te zien, klik daarvoor op de titel van het abstract:

Effect of mistletoe extract on tumor response in neoadjuvant chemoradiotherapy for rectal cancer: a cohort study

World Journal of Surgical Oncology volume 19, Article number: 178 (2021) Cite this article

Abstract

Background

Mistletoe extract, used as a complementary chemotherapeutic agent for cancer patients, has anticancer effects against various malignancies. The aim of the present study was to evaluate the effect of mistletoe extract (Abnoba Viscum Q®) on tumor responses to neoadjuvant chemoradiotherapy (NCRT) for locally advanced rectal cancer.

Methods

This study included patients with rectal cancer who underwent NCRT between January 2018 and July 2020. In the mistletoe group (MG), the patients were administered Abnoba Viscum Q® subcutaneously during chemoradiotherapy—maintained just before surgery. Patient demographics, clinical outcomes, histopathological outcomes, and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) assay results were compared between the MG and non-mistletoe group (NMG). Two rectal cancer cell lines (SNU-503 and SNU-503R80Gy) were treated with Abnoba Viscum Q® to assess its mechanistic effects in vivo.

Results

Overall, the study included 52 patients (MG: n = 15; NMG: n = 37). Baseline demographics between the two groups were similar, except carbohydrate antigen 19-9 levels and tumor location from the anal verge. There was no difference in the clinical stage between the two groups. A better tumor response in the MG, relative to the NMG, was observed with respect to tumor regression grade (TRG), T stage, and overall tumor–node–metastasis stage. Tumor response was significantly better in the MG than in the NMG in terms of pathologic complete response rate (53.3% vs. 21.6%, P = 0.044), good TRG response (66.7% vs. 32.4%, P = 0.024), T downstaging (86.7% vs. 43.2%, P = 0.004), and overall downstaging (86.7% vs. 56.8%, P = 0.040). The toxicities during NCRT were minimal in both groups. More apoptotic cells were noted in MG samples than in the NMG samples on TUNEL staining. Cleaved caspase-3 level following treatment with Abnoba Viscum Q® was higher in SNU-503R80Gy cells than in SNU-503 cells.

Conclusion

Patients treated with chemoradiation combined with mistletoe extract showed better outcomes than patients not treated with mistletoe extract in terms of tumor responses. This diversity in treatment may improve the efficacy of NCRT, leading to better oncologic outcomes. Prospective and randomized studies with long-term follow-up are warranted to confirm and extend these results.

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for the English language editing.

Funding

Not applicable

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Jeong-Heum Baek, Youngbae Jeon & Kyoung-Won Han

  2. Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea

    Dong Hae Jung

  3. Gachon Medical Research Institute, Gil Medical Center, Gachon University, Incheon, Republic of Korea

    Kyung-Ok Kim

Contributions

JHB designed the study. JHB, YJ, and KWH were involved in data acquisition. JHB, YJ, KWH, DHJ, and KOK undertook data analysis and interpretation. DHJ performed and analyzed the results of the TUNEL assay. KOK performed the western blot analysis. JHB and YJ prepared the manuscript. JHB, YJ, KWH, DHJ, and KOK critically revised the paper. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Jeong-Heum Baek.

Ethics declarations

Ethics approval and consent to participate

The Institutional Review Board of Gil Medical Center approved this retrospective observational study and waived the requirement for patient informed consent (IRB number GFIRB2020-304).

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Competing interests

The authors declare that they have no competing interests.

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maretak extract, rectumkanker, darmkanker, chemoradiotherapie, CR - complete remissies, PR - gedeeltelijke remissies.


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