HER2+

Some more information on mistletoe as a cancer treatment - from the British Medical Journal.

I thought it was interesting.

Mistletoe as a treatment for cancer

BMJ 2006; 333 doi: 10.1136/bmj.39055.493958.80 (Published 21 December 2006) Cite this as: BMJ 2006;333:1282

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1. Edzard Ernst, professor of complementary medicine (Edzard.Ernst@pms.ac.uk)

Author Affiliations

1. ¹Department of Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter EX2 4NT

Has no proved benefit, and can cause harm

Most doctors in the United Kingdom will be surprised to learn from a case reported in this week's BMJ of a use for mistletoe (Viscum album) that has nothing to do with Christmas.1 Some patients with cancer inject themselves with extract of mistletoe in the hope of improving their condition. In continental Europe, at least 30 different mistletoe preparations are available. In Europe, most cancer patients use such extracts, at a total expense of about £30m (€45m; $59m) each year,2 and in Germany the insurance system pays for this treatment.

A Google search (20 November 2006) showed that 145 000 websites promote or mention mistletoe as a treatment for cancer. This much publicity may mean that many cancer patients in the UK will try mistletoe in the future or ask their doctor about it. It is therefore timely to discuss the value of mistletoe as an anticancer drug.

A century ago, Rudolf Steiner developed anthroposophy, a school of thought that led to innovations such as the Waldorf schools, biodynamic farming, and anthroposophic medicine. This approach to healthcare is based on intuitive thinking about assumed associations between four postulated dimensions of the human body (physical body, etheric body, astral body, and ego), plants, minerals, and the cosmos.3

Anthroposophic medicine includes drugs, art therapy, rhythmic massages, special exercises, external applications, counselling, and anthroposophic nursing. These treatments are used "partly as adjuncts to and partly as substitutes for conventional medicine."4 Anthroposophic drugs are based on ancient alchemistic and homeopathic notions, far removed from the concepts of pharmacology. Many of these drugs are produced in unusual ways-some mistletoe preparations are fermented while other anthroposophic drugs are highly diluted according to homeopathic principles.

Steiner's intuition that mistletoe might help treat cancer is based on the fact that, like cancer, mistletoe is a parasitic growth that eventually kills its host. Inspired by Hahnemann's "like cures like" principle, he believed that an extract of mistletoe would cure cancer. Despite the implausibility of this idea, about 1000 in vitro studies have shown that mistletoe or its main constituents (alkaloids, lectins, and viscotoxins) do have anticancer activity.2 5 However, many plants have some sort of anticancer activity.6 Occasionally, this is useful therapeutically-vinblastine and vincristine are derived from the common periwinkle and Taxol comes from the yew tree. In most cases though, toxicity or lack of bioavailability prohibit the use of these compounds.

Proponents of anthroposophic medicine make two claims about mistletoe. Firstly, they claim that regular injections of mistletoe extract improve the natural course of cancer by slowing down or stopping tumour growth. Secondly, they say that such extracts improve the quality of life in patients with cancer.4

Many clinical studies of mistletoe exist, but their findings are inconsistent. Most of them are methodologically weak, and the less rigorous they are the greater the likelihood of a positive result. The conclusions of systematic reviews are therefore contradictory. Anthroposophical doctors, who tend to include unreliable primary studies, arrive at positive conclusions.4 In contrast, independent reviewers tend to focus on the most reliable evidence and regularly find that neither of the above two claims is supported by good evidence.7 8 9

Orange, interesting article on mistletoe. I've never heard of it as an alternative cancer treatment.

Tuckertwo, I agree in chemo/herceptin doesn't cure cancer. The reason for me to consider herceptin is that it locks down the her2+ receptors and flags the immune killer cells for distruction. I'm just not sure if I need to do it for a year as more studies need to be done for those who are early stage cancer.

There is so much that we don't understand, and unfortunately there are no guarantees no matter what we do.

susieq,

Herceptin and chemo don't cure cancer. Remission is not a cure.

Unless the underlying problem is addressed the cancer will return. Chemo does not repair the immune system, rather, it destroys it. Herceptin has not got a track record yet. They don't know what it will do in 10, 15 or 20 yrs. Shrinking a tumor does not mean the cancer won't be back.

Cancer cells become immortal because they don't have an off switch. I have known two women in the past few months who's breast cancer was in remission for 28 and 15 yrs, but it came back. If the doctors have anything to say about it, their treatment will consist of poison, cut and burn. The usual.

tucker

I know it's not a cure but when you see complete pathological response, obviously it's doing something.

Susieq, I see in your tagline, 2nd dx ? and you went through chemo, rads and herceptin twice ? herceptin did not prevent 2nd dx ? nor did chemo and rads ?

Mistletoe will cause a small hive or welt and that's good. That means that it's working and your immune system is dealing with it. You may get a low fever and that's good too.  If that welt doesn't appear after an infusion or pill of mistletoe then the doctor might consider stopping it. The hive is like a mosquito bite, no big deal.

sweetbean, good for you, going this route. My naturopath said they have seen complete remissions and longer survival times with mistletoe. I have a friend on another website who has been taking mistletoe for years and is doing well - she is also her2+. She lives in the Netherlands and says her doc won't give her herceptin because 'it makes women sick'.

I agree with you that research needs to focus on breast stem cells.

tucker

Well, I wish I had your confidence in chemo, you mean you still have the tumour in your other breast ?

It's a good thing I don't believe in statistics otherwise I'd be pulling my hair out....

"The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA" 

Glad for you - I find this whole business so scary, I might have another or other tumours, problem is they've not found them yet

This was posted in the Clinical Trials and Research News Forum

http://www.onclive.com/onclive-tv/Dr-Chang-Discusses-Combining-HER2-Targeted-Therapies

Dr. Chang talks about the combination of Herceptin (trastuzumab) and Tykerb (lapatinib) without chemo producing a high rate of pathological complete response and the addition of Femara for ER+ with goserelin for premenopausal women.

Dalila it's difficult to say with a smaller tumor. There are many other things to consider too. Your age, hormone status of your tumor, grade (HER2+ is usually 3 but there are plenty of women here that are grade 2 as well).

I do know that the studies show that Herceptin seems to work better with chemo. It doesn't mean that Herceptin alone won't work at all but seems to be more effective with chemo.

What rationale did your oncs give you for their recommendations?

The NCI has recommendations but they are only recommendations and it is  up to your onc to help you understand your specific disease and risk and recommend a treatment course.  The NCI recommend chemo/herceptin for tumors larger than 1cm. For tumors smaller than .51-1cm herceptin and possible chemo. (See page 74)

Hi Barbiecorn

Have a look at http://www.predict.nhs.uk/

This will show you how much of an advantage chemo offers...You know my thoughts on this. I'm going for it with HER2+ but over to you!

Best wishes

Alice the Cat 

Dalila if you have completed menopause then your oncs will  probably recommend one of the aromatase inhibitors. If not or you have some other medical issues s/he will recommend Tamoxifen. I have read a few articles stating that HER2+ doesn't always respond to Tamoxifen and those who have low/PR- also don't respond. These were only a few studies so I don't know if the information is accurate but also something to discuss with the onc.

Typically those who have high proliferation rates, high grade tumors tend to respond well to chemo.

So why no sentinel?

Dalila I started Anastrozole March 1, 2011. I have a little stiffness and an occasional warm flash when I eat too much Cayenne pepper… that's it. We are watching my bones but so far no issues. I was very afraid to take this drug too. Even more afraid than chemo but I figured I'd give it a try. I figured I could always quit but if I never tried it I would never know.

I am only 30% ER+ and 5% PR+. In your case, being 90% PR+ I would think one of the aromatase inhibitors might be more important than chemo for you. Your onc should be able to help you understand the significance of this treatment for you.

I haven't heard anything about sentinel node dissection destroying the immune system. I seem to be doing fine. Had a SNB on the right and 10 nodes on the left. Do have some minor LE on the left but so far no issues with infections. Granted everyone is different.

Again these are all things you should discuss in detail with your onc. Don't be afraid to ask "why" and if you don't understand see if they can provide you with more information.

Good luck Tuesday. Keep us posted.

I have been watching the news all weekend about T-DMI. Looks promising, what do you guys think?

dmona I don't know what MMS is but I do know that currently there is no known cure for breast cancer. Some people can go into remission with metastatic disease. There are lots of complimentary & alternatives that claim to "cure" you. I would be very cautious when anyone claims they can cure you with metastatic disease. There are lots of scammers out there.

I highly recommend you talk with a medical oncologist if you haven't already. Go in with an open mind and listen to what they have to say. At the very least you will gain more knowledge about this disease. Don't be afraid to talk to them about the vaccine or MMS. If they discredit it… ask them why.

Alternative seems to discredit standard treatment and standard treatment seems to discredit alternative. Maybe consider complimentary… a little bit of both. 

BTW I did the surgery, chemo, Herceptin and hormone treatment. Most women do just fine. I'm doing fine but I didn't have metastatic disease. Remember HER2+ is a fast growing cancer. You really need to research all treatments before making a decision on what to do.