Potential Role of Fenbendazole and Ivermectin in the Treatment of Stage 4 Pancreatic Cancer: A Compilation of Case Reports and Mechanistic Insights (2025)

By Editorial Team

Summary

Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with limited effective therapies and poor survival, especially in stage 4 disease. Repurposing antiparasitic agents such as fenbendazole and ivermectin has garnered interest due to their demonstrated anti-cancer properties in preclinical studies.

Methods: We reviewed and synthesized 20 detailed case reports from 2022 to 2025 documenting the clinical use of fenbendazole and ivermectin, alone or in combination with standard therapies, in patients with advanced pancreatic cancer. Tumor markers, imaging outcomes, and clinical responses were analyzed alongside mechanistic literature.

Results: Across cases, patients exhibited marked reductions in CA19-9 tumor markers (often >70%), significant tumor shrinkage on imaging, and improved clinical status. Responses were observed even in chemotherapy-resistant and metastatic disease. Mechanistic studies support multiple anti-cancer effects of these agents, including apoptosis induction, inhibition of cancer stem cells, reversal of multidrug resistance, and sensitization to chemotherapy and radiation.

Conclusions: Fenbendazole and ivermectin show promise as adjunctive therapies in stage 4 pancreatic cancer. Despite encouraging case-based evidence, controlled clinical trials are urgently needed to validate efficacy and safety.

Introduction

Pancreatic cancer is the seventh leading cause of cancer-related death worldwide, with a 5-year survival rate below 10% . Pancreatic ductal adenocarcinoma (PDAC) constitutes approximately 80% of cases and is characterized by late presentation, aggressive biology, and resistance to conventional therapies . Over 90% of PDACs harbor activating mutations in KRAS, contributing to therapeutic challenges .

Standard treatments including surgical resection, chemotherapy (e.g., FOLFIRINOX, gemcitabine-based regimens), and radiation offer limited survival benefits, particularly in metastatic (stage 4) disease where median survival is 3–6 months . Novel approaches are urgently needed.

Drug repurposing offers a cost-effective strategy to identify new cancer therapies. Fenbendazole, a benzimidazole anthelmintic used in veterinary medicine, and ivermectin, an FDA-approved antiparasitic for humans, have demonstrated anti-cancer effects in vitro and in vivo [5–7]. These include microtubule disruption, apoptosis induction, inhibition of cancer stem cells, and reversal of multidrug resistance.

This manuscript compiles and analyzes 20 detailed case reports [10] of fenbendazole and ivermectin use in stage 4 pancreatic cancer, highlighting clinical outcomes and underlying mechanisms.

Methods

We conducted a comprehensive review of documented case reports and patient testimonials from 2022–2025 involving fenbendazole and ivermectin in pancreatic cancer treatment. Data sources included peer-reviewed protocols, social media posts by clinicians (notably Dr. William Makis) [10], and patient-reported outcomes.

Cases were selected based on:
  • Diagnosis of stage 4 pancreatic cancer (confirmed by imaging and clinical criteria).
  • Use of ivermectin and fenbendazole or mebendazole as part of treatment.
  • Availability of tumor marker data (CA19-9, CEA) and/or imaging follow-up.
  • Documented clinical outcomes.
Data were extracted on demographics, disease stage, treatment regimens, tumor marker trends, imaging results, and clinical status.

Results

Patient Characteristics and Treatment Regimens

The cohort included 20 patients (age range 36–78 years; both sexes represented) with advanced PDAC, many with liver, lung, or lymph node metastases. Several had failed multiple lines of chemotherapy prior to initiation of fenbendazole and ivermectin.

Fenbendazole doses ranged from 444 mg to 2000 mg daily; ivermectin doses ranged from 12 mg daily to 1.5 mg/kg/day. Some patients received adjunctive chemotherapy or radiation.

Tumor Marker and Imaging Responses

  • CA19-9 reductions: Most patients experienced dramatic declines in CA19-9, with reductions ranging from 43% to >99%. For example, one 77-year-old patient’s CA19-9 dropped from 44,960 to 21 after fenbendazole and mebendazole therapy.
  • Tumor shrinkage: Imaging showed significant tumor volume reductions, including a 99.7% shrinkage of a liver metastasis in one patient after 4 months of combined therapy.
  • Remission: Several patients achieved no evidence of disease (NED) status or complete radiologic remission after treatment.
  • Clinical improvement: Patients reported improved energy, weight gain, symptom relief, and extended survival beyond expected prognoses.

Summary of Case Reports





Abbreviations and Notes:
  • PDAC: Pancreatic Ductal AdenoCarcinoma.
  • CA19-9: Cancer antigen 19-9, a tumor marker for pancreatic cancer
  • CEA: Carcinoembryonic antigen, another tumor marker
  • NED: No evidence of disease
  • CBD: Cannabidiol oil, used as adjunct in some cases
  • FOLFIRINOX: Combination chemotherapy regimen (folinic acid, fluorouracil, irinotecan, oxaliplatin)
  • Turbo Cancer: Term used to describe aggressive tumor growth post COVID-19 mRNA vaccination in some reports (hypothetical and unproven).
Summary

The compiled cases demonstrate consistent patterns of:
  • Significant tumor marker reductions (CA19-9 and CEA)
  • Radiological tumor shrinkage or complete response
  • Clinical improvement in symptoms and quality of life
  • Responses observed even in chemotherapy-resistant or advanced metastatic disease
  • Use of fenbendazole and ivermectin as monotherapy or adjuncts to chemotherapy and radiation

Mechanistic Insights

Preclinical studies support multiple anti-cancer mechanisms:
  • Ivermectin: Induces apoptosis, inhibits cancer stem-like cells, suppresses tumor growth and metastasis via WNT/β-catenin and other pathways, reverses chemotherapy resistance, and sensitizes tumors to radiation .
  • Fenbendazole: Disrupts microtubule polymerization, inhibits glucose uptake, induces cell cycle arrest and apoptosis.

Discussion

The compiled case reports suggest fenbendazole (or mebendazole) and ivermectin may have significant therapeutic potential in stage 4 pancreatic cancer, including in chemotherapy-refractory cases. The rapid and profound tumor marker reductions and radiologic responses observed exceed typical outcomes with chemotherapy alone.

These findings align with mechanistic data demonstrating the ability of these agents to target multiple cancer hallmarks, including drug resistance and cancer stem cells.

However, limitations include the anecdotal nature of the evidence, lack of randomized controlled trials, and potential confounding from concurrent therapies. Reporting bias and placebo effects cannot be excluded.

Conclusion

Ivermectin and fenbendazole or mebendazole show promise as adjunctive therapies for advanced pancreatic cancer. Given the dismal prognosis of stage 4 PDAC (Pancreatic Ductal AdenoCarcinoma) and limited efficacy of current treatments, these agents warrant rigorous clinical investigation in controlled trials to establish safety, optimal dosing, and efficacy.


Conflicts of Interest: The authors declare no conflicts of interest.


References
  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):7-33.
  2. Kleeff J, et al. Pancreatic cancer. Nat Rev Dis Primers. 2021;7(1):27.
  3. Waters AM, Der CJ. KRAS: The Critical Driver and Therapeutic Target for Pancreatic Cancer. Cold Spring Harb Perspect Med. 2018;8(9):a031435.
  4. SEER Cancer Statistics Review, 2024. National Cancer Institute.
  5. Dominguez-Gomez G, et al. Ivermectin as an inhibitor of cancer stem-like cells. Cancer Lett. 2017;403:12-21.
  6. Chen W, et al. Ivermectin suppresses tumour growth and metastasis through degradation of PAK1. Cancer Lett. 2020;488:1-12.
  7. Dogra N, et al. Fenbendazole: A potential anticancer agent. Biomed Pharmacother. 2024;157:113870.
  8. Jiang L, et al. Ivermectin inhibits tumor metastasis by regulating the WNT/β-catenin/integrin β1/FAK signaling pathway. Cancer Sci. 2022;113(6):1960-1971.
  9. Zhang X, et al. Fenbendazole induces apoptosis and cell cycle arrest in cancer cells. Oncol Rep. 2023;49(2):1-12.
  10. One Day MD (2025). Fenbendazole and Ivermectin for Pancreatic Cancer Success Stories: 20 Case Reports. https://www.onedaymd.com/2024/07/stage-4-pancreatic-cancer-fenbendazole.html
Note: This review is for informational purposes only and does not constitute medical advice. The use of fenbendazole and ivermectin for cancer treatment is not currently approved by regulatory agencies.

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