In SIlico Evaluation of Ivermectin and Fenbendazole Protocol Improved Overall Survival in Non-BRCA-Mutated Stage 4 Pancreatic Cancer (2025)
Abstract Background: Stage IV pancreatic ductal adenocarcinoma (PDAC) lacking actionable mutations has limited treatment options, with median overall survival (mOS) of 9–11 months using standard chemotherapy. Repurposed drugs (ivermectin, mebendazole) and hyperthermia show preclinical promise. This in silico randomized controlled trial (RCT) evaluates an integrative protocol combining ivermectin, mebendazole, hyperthermia, supplements, and lifestyle interventions versus standard-of-care (SOC) NALIRIFOX chemotherapy in non-BRCA-mutated stage IV PDAC. Methods: A simulated two-arm RCT enrolled 200 patients with non-BRCA-mutated stage IV PDAC, randomized 1:1 to an experimental arm (ivermectin 1 mg/kg/day 3 days/week, mebendazole 500 mg twice daily, localized hyperthermia 42–43°C 3 sessions/week, supplements [vitamin C, vitamin D, curcumin, berberine], ketogenic diet, intermittent fasting, pancreatic enzymes) or control arm (NALIRIFOX). Primary endpoint was 12-month overall surv...