| Rank |
Pathway / Axis |
Cancer Cells |
Normal Cells |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
β-Tubulin and microtubule dynamics |
↓ |
↓ (proliferating cells) |
P |
Microtubule destabilization |
Direct class-associated mechanism. Fenbendazole appears to be a moderate rather than highly potent mammalian microtubule destabilizer. |
| 2 |
Mitotic progression and proliferation |
↓ |
↓ (proliferation-dependent) |
R/G |
Mitotic dysfunction and growth arrest |
Loss of spindle integrity and impaired chromosome segregation can reduce clonogenic survival. Selectivity is incomplete. |
| 3 |
Ubiquitin-proteasome pathway |
↓ |
↔ / ↓ (dose-dependent) |
R |
Proteotoxic stress |
Proteasomal impairment and accumulation of ubiquitinated proteins were demonstrated in lung-cancer models and may be mechanistically important beyond tubulin disruption. |
| 4 |
Endoplasmic-reticulum stress response |
↑ |
↔ / ↑ (high concentration only) |
R/G |
IRE1, GRP78, ATF3 and CHOP activation |
Persistent unfolded-protein stress promotes NOXA induction and apoptosis. Evidence is model-dependent. |
| 5 |
Glucose uptake and glycolysis |
↓ |
↔ / ↓ (dose-dependent) |
R |
Reduced glycolytic energy production |
Reduced glucose uptake and glycolytic output are reported in several models. HK2 downregulation has been implicated in breast-cancer cells. |
| 6 |
Mitochondrial membrane potential |
↓ |
↔ / ↓ (high concentration only) |
R |
Mitochondrial dysfunction |
Membrane-potential loss and cytochrome-c release link metabolic and proteotoxic stress to intrinsic apoptosis. |
| 7 |
Intrinsic apoptosis |
↑ |
↔ / ↑ (proliferation-dependent) |
G |
Caspase-associated cell death |
Associated with cytochrome-c release, NOXA induction, and mitochondrial p53 activity. The contribution of individual pathways varies by cell type. |
| 8 |
MDM2 and MDMX p53 axis |
p53 ↑ |
↔ |
R/G |
Tumor-suppressor activation |
MDM2 and MDMX suppression can stabilize p53. Responses depend on intact p53 signaling and may be weak or absent in TP53-mutant tumors. |
| 9 |
Mitochondrial p53 translocation |
↑ (model-dependent) |
↔ |
R |
Transcription-independent apoptosis |
Reported in human cancer-cell models and may connect microtubule disruption with mitochondrial permeabilization. |
| 10 |
ROS and oxidative stress |
↑ |
↔ / ↑ (high concentration only) |
P/R |
Oxidative-stress amplification |
ROS elevation is reproducible in selected models but is generally secondary to proteasome, mitochondrial, or metabolic disruption rather than the initiating target. |
| 11 |
NRF2 antioxidant response |
↔ (context-dependent) |
↔ |
R/G |
Uncertain adaptive response |
No consistent evidence supports NRF2 as a direct fenbendazole target. NRF2 modulation should not be assigned a fixed direction without product-specific experimental evidence. |
| 12 |
MEK3 and MEK6 p38 MAPK stress signaling |
↑ |
↔ / ↑ (high concentration only) |
R |
Stress-mediated growth inhibition |
Observed in HeLa-cell experiments involving oxidative stress and altered energy metabolism. |
| 13 |
HK2 glycolysis and pyroptosis |
HK2 ↓ and pyroptosis ↑ |
↔ |
R/G |
Inflammatory lytic cell death |
Recent breast-cancer evidence identifies an HK2-linked pyroptosis mechanism. It is not yet established as a general mechanism across tumor types. |
| 14 |
HIF-1α hypoxia adaptation |
↓ (model-dependent) |
↔ |
G |
Reduced hypoxic adaptation |
Limited evidence suggests HIF-1α reduction in specific experimental contexts. This is a secondary and insufficiently generalized mechanism. |
| 15 |
Chemosensitization |
↑ / ↔ (combination-dependent) |
Unknown |
G |
Potential additive or synergistic cytotoxicity |
Preclinical combinations have been investigated, but interaction direction varies by drug and model. Clinical safety and efficacy are unestablished. |
| 16 |
Clinical Translation Constraint |
↓ |
↓ |
G |
Uncertain exposure and dose-limiting toxicity |
Poor solubility, variable absorption, extensive metabolism, uncertain tumor exposure, absence of a validated human dose, veterinary formulation variability, and reported severe hepatocellular injury substantially limit translation. |