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Advanced pancreatic cancer is associated with poor quality of life and better therapies for symptomatic relief are highly needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>MISTRAL aimed to assess the impact of mistletoe extract on quality of life, body weight, observed costs and blood biomarkers in patients with advanced pancreatic cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>MISTRAL was an investigator-initiated, phase III, randomized, double-blind, placebo-controlled, parallel-group, superiority, multicenter, clinical trial with a nested biomarker study. Registration EudraCT 2014\u2013004552\u201364, NCT02948309.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants:<\/jats:title>\n                    <jats:p>At 9\u2009oncology centers, 290 participants were randomized to standard treatment (palliative chemotherapy or best supportive care) plus subcutaneous mistletoe extract or placebo. Main inclusion criteria were advanced pancreatic cancer, performance status 0\u20132, main exclusion criteria neuroendocrine pancreatic tumor. EORTC-QLQ-C30, EORTC-QLQ-PAN26, body weight, cost parameters and biomarkers were assessed from baseline up until 9\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>No statistically significant differences for quality of life and weight were evident between treatment arms. Parameters for observed costs for supportive and inpatient care (days at hospital, parenteral nutrition infusions, nutritional supplement drinks, number of visits of palliative home care teams, symptom-relieving medication) were similar in both arms. Thus, calculation of costs was not performed. No effect on explored biomarkers (differential blood count, lymphocyte subpopulations, C-reactive protein, albumin and Ca19-9) was found except for a statistically significant increase of eosinophils in the mistletoe arm without association to clinical effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Since no benefit was observed, there is no clinical reason to recommend mistletoe extract in patients with advanced pancreatic cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163261437609","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:12:36Z","timestamp":1777551156000},"page":"1059-1076","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mistletoe extract in patients with advanced pancreatic cancer: Health-related quality of life in a double-blind, randomized, placebo-controlled trial (MISTRAL)"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6449-6349","authenticated-orcid":false,"given":"Kathrin","family":"Wode","sequence":"first","affiliation":[{"name":"Department of Diagnostics and Interventions\/Oncology, Ume\u00e5 University, Sweden"},{"name":"Regional Cancer Centre Stockholm Gotland, Sweden"},{"name":"Karolinska Institutet Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8409-0354","authenticated-orcid":false,"given":"Ove","family":"Bj\u00f6r","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Interventions\/Oncology, Ume\u00e5 University, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6111-3901","authenticated-orcid":false,"given":"Reinhild","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Immunopathological Laboratory, University T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9345-0278","authenticated-orcid":false,"given":"Nils Oskar","family":"Elander","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences and Department of Clinical Oncology, Link\u00f6ping University, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1248-5581","authenticated-orcid":false,"given":"Per","family":"Fransson","sequence":"additional","affiliation":[{"name":"Department of Nursing, Ume\u00e5 University, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1467-9339","authenticated-orcid":false,"given":"Roger","family":"Henriksson","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Interventions\/Oncology, Ume\u00e5 University, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Sharp","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre Stockholm Gotland, Sweden"},{"name":"Department of Nursing, Ume\u00e5 University, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0088-7465","authenticated-orcid":false,"given":"Ursula","family":"Scheibling","sequence":"additional","affiliation":[{"name":"The Institute for Palliative Care, Lund University and Region Sk\u00e5ne, Sweden"},{"name":"Department of Oncology, Ryhov County Hospital, J\u00f6nk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Johansson","sequence":"additional","affiliation":[{"name":"Department of Oncology, V\u00e4stmanlands Hospital, V\u00e4ster\u00e5s, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8029-6734","authenticated-orcid":false,"given":"Johanna","family":"H\u00f6k Nordberg","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre Stockholm Gotland, Sweden"},{"name":"Karolinska Institutet Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunver Sophia","family":"Kienle","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Center for Complementary Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Germany"},{"name":"Institute for Applied Epistemology and Medical Methodology at Witten\/Herdecke University (IFAEMM), Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Picozzi V Narayanan S Henry Hu X et al. 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