BACKGROUND

Patient: 59-year-old male
Cancer Type: Pancreatic adenocarcinoma
Stage at Diagnosis: Stage IV
Metastatic Site: Liver
Time Since Diagnosis: ~14 months

Pancreatic cancer is among the most aggressive solid tumors, with poor outcomes once metastatic. This case is notable for early metabolic intervention combined with immunotherapy, resulting in sustained disease control.

TUMOR & DISEASE CHARACTERISTICS

• Primary tumor location: Head of the pancreas
• Obstructive complication: Biliary obstruction requiring metal stent placement
• Molecular profile:Microsatellite instability–positive (MSI-positive)
  • Important predictor of response to immunotherapy

CURRENT CANCER STATUS

• Pancreas: No Evidence of Disease (NED)
• Liver: Residual shadow on imaging (non-progressive)
• Other findings: Small fluid collection near pancreatic tail

Overall assessment indicates excellent disease control, with pancreatic primary resolved and no active progression.

CONVENTIONAL TREATMENT HISTORY

• Immunotherapy: Pembrolizumab
• Initiation: Shortly after diagnosis
• Duration: ~14 months
• Response: Sustained, consistent with MSI-positive status

METABOLIC & REPURPOSED DRUG STRATEGY

Metabolic therapy was initiated early, approximately 2 weeks after diagnosis, and continued concurrently with immunotherapy.

Repurposed Agents

• Ivermectin: 12 mg/day, 5 days/week
• Fenbendazole: 222 mg/day, 5 days/week

This combined strategy was followed independently by the patient prior to formal consultation, with high adherence throughout.

DIET & FASTING STRATEGY

• Diet: Strict ketogenic diet
• Fasting:
  • Typically 1 day/week
  • Occasionally extended to 2 days/week

This approach aimed to maintain low glucose availability and improve systemic metabolic control.

METABOLIC & BLOOD MARKERS

• Fasting glucose: Consistently ~80–84 mg/dL
• Inflammation markers: Low
• Liver function: Normal
• Kidney function: Normal
• Immune markers: Reported as good

These findings indicate a stable metabolic and inflammatory environment, supportive of long-term disease control.

TREATMENT SEQUENCING & COMPLIANCE

A key point confirmed during the consultation:

• Immunotherapy, ketogenic diet, fasting, ivermectin, and fenbendazole were used simultaneously, not sequentially.
• Protocol adherence: High
• Early metabolic intervention: Implemented shortly after diagnosis

This concurrent approach likely contributed to sustained response.

CLINICAL INTERPRETATION

Despite achieving NED, several critical considerations remain:

• Pancreatic cancer is highly aggressive, and NED status can be temporary.
• Long-term control requires continued metabolic pressure and vigilance.
• Given tumor type, a switch from fenbendazole to mebendazole was suggested, as mebendazole appears better suited for pancreatic cancer biology.

OVERALL ASSESSMENT

This case demonstrates that in MSI-positive metastatic pancreatic cancer, early and sustained combination of immunotherapy with metabolic intervention can lead to:

• Resolution of the primary pancreatic tumor
• Stable residual findings in the liver
• Excellent metabolic control
• Preserved organ function
• High treatment tolerability

While continued monitoring is essential, this represents a notable example of durable disease control in a cancer type with otherwise poor prognosis.