Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2019; 25(12): 1524-1530
Published online Mar 28, 2019. doi: 10.3748/wjg.v25.i12.1524
Long-term survival of a patient with advanced pancreatic cancer under adjunct treatment with Viscum album extracts: A case report
Paul G Werthmann, Robert Kempenich, Gerlinde Lang-Avérous, Gunver S Kienle
Paul G Werthmann, Gunver S Kienle, Department of Methodology, Institute for Applied Epistemology and Medical Methodology (IFAEMM), Freiburg 79111, Germany
Paul G Werthmann, Gunver S Kienle, Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Center - University of Freiburg, Freiburg 79106, Germany
Robert Kempenich, Private Praxis, General Practitioner with Specialization in Oncology, Strasbourg F-67000, France
Gerlinde Lang-Avérous, Department of Pathology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg F-67000, France
Author contributions: Werthmann PG, Kempenich R, Lang-Avérous G and Kienle GS contributed to the case report design. Kempenich R was the physician in charge who provided the patient’s information. Lang-Avérous G provided the histologic images and confirmed the diagnosis and contributed the details about the histologic diagnosis. Werthmann PG and Kempenich R collected and provided the data. Werthmann PG was the principle author of the paper, had full access to all data, and is the guarantor. Kienle GS supervised the report and the publication process. All authors read and confirmed the final version of this article.
Supported by Stiftung Integrative Medizin Stuttgart, Germany.
Informed consent statement: Informed consent was received from the patient for the publication of the report and accompanying images. The patient read the submission version of the report and confirmed its content.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
CARE Checklist (2016) statement: This case report was prepared following the CARE Guideline.
Corresponding author: Paul G Werthmann, MD, Academic Research, Department of Methodology, Institute for Applied Epistemology and Medical Methodology (IFAEMM), Zechenweg 6, Freiburg 79111, Germany.
Telephone: +49-15771984421
Received: November 1, 2018
Peer-review started: November 1, 2018
First decision: December 20, 2018
Revised: February 13, 2019
Accepted: March 1, 2019
Article in press: March 2, 2019
Published online: March 28, 2019

Advanced pancreatic cancer (aPC) has a poor prognosis with limited survival benefit from current standard treatment. Viscum album extracts (VAE) are used by many cancer patients, showing immune-stimulating effects, improved quality of life, and a survival benefit in patients with aPC.


A 59-year-old architect developed epigastric pain. A cystic lesion of the pancreas of 45-mm diameter was detected. In a follow-up magnetic resonance imaging, about one year later, multiple lesions were seen in the corpus and the tail of the pancreas; CA-19-9 was elevated to 58.5 U/mL. A distal pancreatectomy with splenectomy was performed, and a tumor of 7 cm × 5 cm × 3.5 cm was excised. Histologic investigation showed an intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma with invasion of the lymph vessels, perineural invasion, and positive nodes (2/27); surgical margins showed tumor cells, and the tumor was classified as pT3 N1 M0 R1. The patient was treated with radiation of the tumor bed and capecitabine/oxaliplatin followed by gemcitabine and FOLFIRINOX. Seven months after surgery, a liver metastasis was detected and treatment with FOLFIRINOX was started. Four months after detection of the metastasis, the patient opted for additional treatment with VAE. Another month later, the metastasis was treated with radiofrequency ablation (RFA). Eight months later, the hepatic lesion recurred and was again treated with RFA. The continuous VAE treatment was increased in dose, and the patient stayed recurrence-free for the next 39 mo in good health and working full-time (as of the time this case report was written).


We present the case of a patient with aPC with R1-resection with development of liver metastasis during the course of treatment who showed an overall survival of 63 mo and a relapse-free survival of 39 mo under increasing VAE therapy. The possible synergistic effect on tumor control of RFA treatment and immune-stimulatory effects of VAE should be further investigated.

Keywords: Pancreatic cancer, Integrative medicine, Viscum album extract, Radiofrequency ablation, Case report

Core tip: We herewith present a case report of a patient with advanced pancreatic cancer with a survival time of 63 mo despite 2 times of relapse und continuous treatment with Viscum album extracts. The patient preserved a good quality of live, regained his weight after weight loss during chemotherapy and is currently working full-time in his job.