Mistletoe extract is one of the most widely used complementary therapies among people with cancer in parts of Europe, and interest in it has grown in the United States. Here’s what the research shows, including a major recent trial.
What mistletoe extract is
European mistletoe (Viscum album) extracts are typically given as injections under the skin. They contain compounds, including lectins, that affect the immune system in laboratory studies. Mistletoe extract is not FDA-approved for any medical use in the United States.
What the research shows
Earlier studies
A number of European studies, many without placebo control, reported improvements in quality of life. An open-label trial in Serbia (Tröger et al., 2013) reported longer survival and better quality of life in patients with advanced pancreatic cancer who were not receiving chemotherapy. Because patients and doctors knew who received mistletoe, those results were considered promising but not definitive.
The MISTRAL trial
To test those findings rigorously, Swedish researchers ran MISTRAL, a double-blind, randomized, placebo-controlled trial in 290 patients with advanced pancreatic cancer (Wode et al., Deutsches Ärzteblatt International, 2024).
- Adding mistletoe extract to standard care did not improve overall survival compared with placebo.
- Follow-up analyses reported no improvement in quality of life either.
- The researchers noted no major safety concerns, and that their results don’t answer the question for other cancer types.
Other cancers
Evidence in other cancers is mixed and generally lower quality. The National Cancer Institute’s summary describes the need for more rigorous trials.
Safety considerations
- Common: redness, swelling, and itching at the injection site, flu-like symptoms, and low-grade fever.
- Less common: allergic reactions, which can be serious.
- Interactions: effects alongside immunotherapy and other cancer treatments aren’t well studied.
- Product quality: extracts vary by host tree, preparation, and manufacturer.
Talking to your oncology team
If you’re considering mistletoe extract, discuss it with your oncologist, especially if you’re receiving immunotherapy. For guidance on raising complementary therapies with your care team, see our page on supportive care during and after cancer treatment.
Frequently asked questions
Does mistletoe cure cancer?
No. There is no evidence that mistletoe extract cures cancer.
Does mistletoe help people with pancreatic cancer live longer?
The largest placebo-controlled trial, MISTRAL, found no survival benefit.
Is mistletoe therapy FDA-approved?
No. It is not approved for any medical use in the United States.
Is it safe?
Side effects are usually mild, but allergic reactions and interactions with cancer treatments are possible.
This article is an educational review of published research. It is not a recommendation for any treatment and is not a substitute for care from your oncology team. From Venturis Clinic in Oklahoma City.
By Alvin Philipose, DC, ICCP
Sources
- Wode K, et al. Mistletoe extract in patients with advanced pancreatic cancer: a double-blind, randomized, placebo-controlled trial (MISTRAL). Deutsches Ärzteblatt International. 2024;121:347–354.
- Tröger W, et al. Viscum album extract for patients with locally advanced or metastatic pancreatic cancer: a randomised clinical trial on overall survival. European Journal of Cancer. 2013;49(18):3788–3797.
- National Cancer Institute. Mistletoe Extracts (PDQ®) – Health Professional Version. cancer.gov
