The study evaluates the efficacy of the therapy of Mistletoe Extract in patients with superficial bladder cancer. There fore the Mistletoe Extract will be administered directly into the bladder.

Prior treatment

• Patients who were administered within a 4-week period before Visit 1 any other experimental drug under investigation
• Male patients planning to father a child or sperm donation from the first administration of study medication until 3 months after the last administration of the study medication
• Male patients unwilling to use barrier contraception ie, condoms and spermicide, from the day of first administration of the study medication until 12 weeks after administration of the study medication. In case the sexual relation is restricted to women fulfilling one of the criteria listed under inclusion criteria 8. for female patients the barrier contraception is not necessary.
• Patients with previous recurrence of a superficial bladder cancer or radiotherapy of the bladder or other intravesical treatment within the last 6 months, or patients with previous mistletoe therapy
• Patients with other previous or co-existing malignancies or CIS
• Patients having any previous or concurrent therapy with a systemic chemo- / immunotherapeutical treatment regimen, in particular vinca alkaloids, bleomycine and doxorubicine, or patients who are treated with pyroxidine hydrochloride (vitamin B6)

Other illness

• Have locally infiltrative or metastatic bladder tumor (Stage T2 or greater), low-risk Ta tumor (primary, solitary, LG/G1, < 3 cm, no CIS) or high risk tumors according to EAU classification (T1; HG/G3; CIS; multiple and recurrent and large [> 3 cm] Ta G1/G2 tumors [all conditions must be present at this point]), presence of upper urinary tract tumors or lesions which were not completely removed by TURB
• Patients with known hypersensitivity to the excipients of the study medication (monosodium phosphate, disodium phosphate, ascorbic acid)
• Patients with a known hypersensitivity to mistletoe products and MMC
• Patients with a history of alcohol and / or drug abuse
• Have urinary tract infection, benign prostatic obstruction grade II or III, neurogenic bladder, stress incontinence, bladder or urethral diverticula, fistulas or urethral stenosis
• Patients with acute systemic illness, such as inflammatory infections with fever > 38°C
• Untreated coagulation disorders or inadequate anticoagulation therapy

Lab values

• Leukocyte count < 4,000/mm3 or platelet count < 100,000/mm3
• Serum creatinine > 1.7 mg/dL (129.6 μmol/l)

Other

• Patients who are unable to be regularly observed, not permitting adequate follow-up and compliance to the protocol

• Signed and dated written informed consent for data protection and willingness to participate and comply with the study protocol prior to any study-related procedures
• Male or female outpatients
• Aged ≥ 18 to ≤ 85 years
• Completely resected (detrusor muscle in the TUR specimen according to need) superficial bladder carcinoma (Stage Ta) with classification as intermediate-risk according to the EAU (update 2013, see Appendix 4) and one immediately post operative intravesical MMC instillation of 40 mg or Epirubicin 50 mg (only Poland), completed re-resection (without another immediate MMC instillation) if indicated
• Have a Karnofsky Performance Status of 50% to 100% (corresponding to ECOG Performance Status of 0 to 2)
• Have a life expectancy of ≥ 2 years at the time point of study inclusion
• Have normal renal and liver function, normal cardiac and hematology profiles (patients with laboratory values slightly outside the reference range may be included, unless the investigator considers the abnormality as clinically significant)
• Female patients of childbearing potential must have a negative pregnancy test (β-HCG test) at screening. All female patients must fulfill one of the following criteria: • Post-menopausal defined as amenorrhea for at least 12 months following cessation of all exogenous hormonal treatments and with follicle-stimulating hormone (FSH) levels in the laboratory defined post-menopausal range • Documentation of irreversible surgical sterilization by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation • Sexually active women of childbearing potential must use an effective method of contraception (Pearl-Index < 1, e.g. oral contraceptives, other hormonal contraceptives [vaginal products, skin patches, or implanted or injectable products], or mechanical products such as an intrauterine device or barrier methods [diaphragm, spermicides]) from the time point of signing informed consent until 12 weeks after the last instillation