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Multicenter Study
. 2020 Jan-Dec:19:1534735420940384.
doi: 10.1177/1534735420940384.

Overall Survival of Nonmetastasized NSCLC Patients Treated With Add-On Viscum album L: A Multicenter Real-World Study

Anja Thronicke  1 , Burkhard Matthes  1   2 , Philipp von Trott  2 , Friedemann Schad  1   2 , Christian Grah  1   3
Affiliations
Multicenter Study

Overall Survival of Nonmetastasized NSCLC Patients Treated With Add-On Viscum album L: A Multicenter Real-World Study

Anja Thronicke et al. Integr Cancer Ther. 2020 Jan-Dec.

Abstract

Background: Recent data suggest a beneficial effect of add-on treatment with Viscum album L (VA) on the survival in cancer patients. The objective of this study was to compare the impact of standard oncological therapy plus add-on VA treatment (S+VA) versus standard oncological therapy alone (S) on the overall survival (OS) of patients with nonmetastasized non-small cell lung carcinoma (NSCLC).

Methods: The multicenter real-world data study was conducted using data from the Network Oncology Clinical Registry. The primary end point was OS. OS and impact on hazard in both treatment groups were compared.

Results: A total of 275 patients with stages I to IIIA NSCLC were enrolled (mean age = 67.6 years, 57.2% male patients). No significant difference of OS was observed between both groups. Even though not significant, for a subgroup of unresected patients with stage I NSCLC, adenocarcinoma or squamous cell carcinoma, a medium effect size OS improvement was observed for S+VA compared to S.

Conclusions: Our findings support the importance of surgery as the most effective intervention in nonmetastasized NSCLC patients. Add-on VA therapy shows here no additional effect in resected patients. However, a small subgroup analysis suggests a possible role of add-on VA for nonresected subgroups. Our results complement existing knowledge on the clinical impact of add-on VA therapy in NSCLC patients and may serve as hypothesis-generating data for further examinations in this cohort. Further research could be directed towards the role of combined therapy for nonresected early-stage NSCLC.

Keywords: NSCLC; Viscum album L; advanced; lung cancer; nonmetastasized; overall survival.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: BM received fees for lectures or advisory boards from AstraZeneca, Boehringer Ingelheim, Helixor, Kyowa-Kirin, Leo, Lilly, Roche, Teva, outside the submitted work. BM received grants for travelling from AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Helixor, Iscador, Janssen, Kyowa-Kirin, Leo, Lilly, Novartis, MSD, Pfizer, Roche, Teva. FS reports grants from Helixor Heilmittel GmbH (travel costs and honoraria for speaking), grants from AstraZeneca (travel costs and honoraria for speaking), grants from Abnoba GmbH, grants from Iscador AG, outside the submitted work. CG reports grants from Iscador AG, outside the submitted work. The other authors have declared that no competing interests exist. No payment was received for any other aspects of the submitted work. There are no patents, products in development or marketed products to declare. There are no other relationships, conditions, or circumstances that present a potential conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the study population. NSCLC, non-small cell lung carcinoma; VA, Viscum album L, mistletoe.
Figure 2.
Figure 2.
Overall survival by cancer-related surgery. Kaplan-Meier survival curves displaying overall survival in stages I to IIIA NSCLC (non–small cell lung carcinoma) patients in accordance to cancer-related surgery (green line) or no cancer-related surgery (blue line), n = 275.
Figure 3.
Figure 3.
Overall survival by treatment group standard versus standard + Viscum album L (VA). Kaplan-Meier survival curves displaying overall survival in stages I to IIIA non–small cell lung carcinoma patients in accordance to the treatment, n = 110; standard, oncological standard treatment, standard + VA, oncological standard treatment plus add-on VA.
Figure 4.
Figure 4.
Overall survival by treatment and histology group. Kaplan-Meier survival curves displaying overall survival in stages I to IIIA non–small cell lung carcinoma (NSCLC) patients in accordance to the NSCLC histology group (A) adenocarcinoma (n = 37), χ2 = 1.7, P = .2, d = 0.44, or (B) squamous cell carcinoma (n = 68), χ2 = 1.6, P = .2, d = 0.31; Standard, oncological standard treatment; Standard + Viscum album L (VA), oncological standard treatment plus add-on VA; adc, adenocarcinoma; lcc, large cell carcinoma; sqc, squamous cell carcinoma.
Figure 5.
Figure 5.
Overall survival by treatment and Union for International Cancer Control (UICC) tumor stage. Kaplan-Meier survival curves displaying overall survival in stages I to IIIA non–small cell lung carcinoma patients in accordance to the UICC stages: (A) I (n = 35), χ2 =1.7, P = 0.2, d = 0.44; (B) stage II (n = 34), χ2 = 0, P = 0.9, d = 0; or (C) stages IIIA (n = 41), χ2 = 0.1, P = 0.7, d = 0.09; Standard, oncological standard treatment; standard + VA, oncological standard treatment plus add-on VA; UICC, UICC tumor stage.
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