Fenbendazole appears to be a potentially safe and effective anti-cancer agent that can be repurposed for human use in treating genitourinary cancers. Further research is necessary no doubt to

clarify the role of Fenbendazole (antiparasitic drug) as a chemotherapeutic option...very interesting, exciting paper by Chiang et al.; "Fenbendazole Enhancing Anti-Tumor Effect: A Case Series"

‘The cases of three patients with various genitourinary malignancies who demonstrated complete response after receiving FBZ therapy as a single or supplementary chemotherapeutic agent. In two patient scenarios, they had experienced progression of metastatic disease despite multiple lines of therapy prior to initiation of FBZ (fenbendazole). No side effects from FBZ were reported.’

This work dove tails well with work by 2nd Smartest Guy in The World…

‘Case Presentation

Case 1

A 63-year-old Caucasian male presented with flank pain, rapid weight loss, and transient fever. Abdominal Computed Topography (CT) revealed a 3 cm left lower-pole solid renal mass. He underwent open partial nephrectomy with pathology showing pT1a high grade clear cell Renal Cell Carcinoma (RCC). Several months later, he developed persistent left flank pain with finding of a 5.2 cm left kidney mass. Fine Needle Aspiration (FNA) biopsy redemonstrated clear cell RCC, and pazopanib 800 mg was initiated. Follow-up CT revealed a new 1.4 cm pancreatic head/body lesion, persistent left renal mass, and signs of sigmoid colitis. Given the concerns for disease progression and intolerable side effects, pazopanib was discontinued and cabozantinib was initiated. Interval Magnetic Resonance Imaging (MRI) showed stable size of recurrent left renal mass, mild decrease in 2.9 cm pancreatic head lesion, stable 1.2 cm distal pancreatic body lesion, and new 1.1 cm right posterior iliac bone lesion. Cabozantinib was ultimately discontinued due to persistent intolerable side effects. One month after discontinuation, repeat MRI showed increase in size of recurrent left renal mass, mild decrease in 2.3 cm pancreatic head lesion, stable 1.4 cm distal pancreatic body lesion, and unchanged 1.1 cm right posterior iliac bone lesion. Third-line treatment with nivolumab was initiated, and he only received three total treatments (240 mg × 3) over the course of a month due to developing severe rash and colitis. He was treated with steroids with resolution of colitis. During this time, he also started alternative therapy with FBZ 1 gm three times per week at the suggestion of one of his friends with head/neck cancer. Interval MRI imaging found near complete resolution of the previously noted left renal mass as well as decrease in pancreatic head/body and right posterior iliac spine lesions (Figure 1). Serial imaging for the past 10 months have not shown any evidence of recurrence or metastatic disease. He has continued taking FBZ without any reported side effects.

Figure 1: Near complete resolution of persistent left renal mass (left image) after initiation of three total doses of nivolumab and FBZ therapy 1 gm three times weekly for several months (right image).

Case 2

A 72-year-old caucasian male presented with increasing lower urinary tract symptoms and a urethral lesion. He underwent distal penectomy with pathology showing pT2 high-grade urothelial carcinoma of the urethra with focal squamous differentiation. Four years later, the patient developed a cough with finding of a 5.5 cm × 4.0 cm left hilar mass and a 1.5 cm × 1.4 cm left upper lobe nodule, with multiple abnormal AP window lymph nodes, the largest measuring 1.8 cm × 0.9 cm all avid on PET CT. Brain MRI revealed a right occipital lobe metastasis. Bronchoscopy with biopsy revealed squamous carcinoma. His presentation was felt most consistent with a lung primary and the patient was treated with gamma knife radiotherapy and carboplatin, paclitaxel, and pembrolizumab. Subsequent sequencing of the lesion from the penectomy and bronchoscopy demonstrated shared PIK3CA, RB1, CCND1 and CDKN2A alterations demonstrating that the pulmonary disease represented metastasis from urethral primary. The patient developed progressive retroperitoneal disease while on pembrolizumab maintenance and was treated with gemcitabine and cisplatin for 6 cycles over the course of 4 months with near complete response. However, interval CT imaging demonstrated increase of an aortocaval node from 1.2 cm × 1.0 cm on to 1.5 cm × 1.5 cm. No therapy was initiated and a subsequent scan demonstrated further increase to 2.0 cm × 1.5 cm with no evidence of progression elsewhere (Figure 2). The patient opted for complementary therapy with FBZ 1 gram orally three days per week, vitamin E 800 mg daily, curcumin 600 mg daily and CBD oil while awaiting more substantial disease progression before initiating additional systemic therapy. Serial CTs from the past 9 months showed progressive decrease in size to 0.5 cm × 0.5 cm, complete radiographic response.

Figure 2: Near complete radiographic response of a 2.0 cm × 1.5 cm aortocaval node (left image) after initiation of alternative therapy including FBZ therapy 1 gm three times weekly (right image).

Case 3

A 63-year-old Caucasian female presented with increasing lower urinary tract symptoms and hematuria. CT imaging revealed a 7.5 cm right lateral bladder mass with extension to the right pelvic sidewall and right-sided hydronephrosis requiring percutaneous nephrostomy. There was no evidence of metastatic disease, consistent with clinical T4 tumor. Transurethral Resection of Bladder Tumor (TURBT) demonstrated a large necrotic mass with pathology confirming urothelial carcinoma with 85% squamous and 2% sarcomatoid histology. She was treated with Accelerated Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (AMVAC) for 6 cycles over the course of 4 months along with concurrent FBZ 1 gram three times weekly. Follow-up CT revealed no evidence of disease with minimal residual thickening in the right inferior bladder wall (Figure 3). She declined to proceed with cystectomy and remains on surveillance with no evidence of progression.

Figure 3: Resolution of 7.5 cm right lateral bladder mass (left image) after treatment with TURBT, Accelerated Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (AMVAC), and concurrent FBZ 1 gm three times weekly (right image).

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