From the Guidelines
Ivermectin is not currently recommended for treating pancreatic cancer as there is insufficient clinical evidence supporting its efficacy in this context. While some laboratory studies have shown that ivermectin may have anti-cancer properties by inhibiting certain cellular pathways, these findings have not translated to proven benefits in human pancreatic cancer patients 1. Regarding liver effects, ivermectin is generally metabolized by the liver and can potentially cause elevated liver enzymes in some patients, particularly at high doses. Standard ivermectin doses (typically 200 μg/kg for parasitic infections) are usually well-tolerated, but the significantly higher doses that might be needed for any potential anti-cancer effect could increase the risk of hepatotoxicity. Patients with pre-existing liver disease should be particularly cautious. The mechanism behind ivermectin's potential liver effects involves its metabolism through cytochrome P450 enzymes, which can lead to increased stress on liver function when the drug is used at high doses or for extended periods.
Currently, established treatments for pancreatic cancer include:
- Surgery
- Chemotherapy regimens (such as FOLFIRINOX or gemcitabine plus nab-paclitaxel) 1
- Radiation therapy
- Targeted therapies based on genetic testing, all of which have demonstrated clinical benefit in appropriate patients. For example, pembrolizumab is recommended by the NCCN Panel for the advanced disease setting for first-line and subsequent treatment as appropriate, particularly for patients with MSI-H or dMMR tumors 1. Additionally, larotrectinib and entrectinib are recommended as first-line and subsequent treatment options for patients with NTRK gene fusion positive locally advanced or metastatic pancreatic adenocarcinoma 1.
It's essential to note that the clinical course of pancreatic cancer is usually aggressive, with high symptom burden and potential for a substantial deterioration in quality of life 1. Therefore, palliative care to focus on distressing symptoms and quality of life is an important adjunct in the management of this condition. The choice of treatment depends on patient performance status, comorbidities, organ function, and residual toxicities from the first-line regimen 1.
In summary, ivermectin is not a recommended treatment for pancreatic cancer, and patients should be offered established treatments based on their individual needs and disease characteristics, with a focus on improving quality of life and reducing symptom burden.
From the Research
Ivermectin in Pancreatic Cancer
- Ivermectin has been found to exert antitumor effects in various cancer types, including pancreatic cancer 2.
- The combination of ivermectin and gemcitabine has been shown to suppress pancreatic cancer more effectively than gemcitabine alone treatment 2.
- Ivermectin-gemcitabine combination treatment inhibited cell proliferation via G1 arrest of the cell cycle and increased cell apoptosis by inducing mitochondrial dysfunction 2.
Effects on Liver
- There is no direct evidence in the provided studies on the effects of ivermectin on the liver in the context of pancreatic cancer.
- However, ivermectin has been found to be effective at clinically feasible concentrations, which may support its clinical development as a repositioned cancer drug 3.
Pancreatic Cancer Treatment
- Pancreatic cancer is an aggressive cancer with a poor prognosis, and current treatment options include chemotherapy, radiation therapy, and surgery 4, 5, 6.
- Adjuvant chemotherapy has been shown to offer a survival advantage over surgery alone in resected pancreatic ductal adenocarcinoma 6.
- The optimal regimens recommended for adjuvant chemotherapy include mFOLFIRINOX, gemcitabine plus capecitabine, gemcitabine alone, or S-1 6.