| Rank | Pathway / Axis | Cancer Cells | Normal Cells | TSF | Primary Effect | Notes / Interpretation |
| 1 | Wnt/β-catenin |
↓ (model-dependent) | ↔ | R/G |
Reduced proliferation / stemness programs |
Frequently cited repurposing axis; relevance highest in Wnt-dependent contexts. |
| 2 | STAT3 |
↓ (model-dependent) | ↔ | R/G |
Anti-survival transcription blockade |
Often presented as a central anti-tumor signaling node in repurposing literature. |
| 3 | PI3K/AKT/mTOR |
↓ (model-dependent) | ↔ | R/G |
Reduced anabolic survival signaling |
Commonly co-reported with Wnt/STAT3 effects; may contribute to cytostatic phenotypes. |
| 4 | PAK1-linked signaling |
↓ (model-dependent) | ↔ | R/G |
Reduced migration / growth signaling |
Repurposing reviews highlight PAK1 as a putative node; tumor-type dependence is high. |
| 5 | Autophagy |
↑ or ↔ (context-dependent) | ↔ / ↑ (stress-dependent) | R/G |
Stress adaptation vs growth suppression |
Often cytostatic; can support survival or contribute to death depending on context. |
| 6 |
Glycolysis / Warburg (glucose uptake, lactate output) |
↓ (model-dependent; secondary to energy stress; high concentration only) |
↔ / ↓ (high concentration only) |
R/G |
Reduced glycolytic flux / lactate production |
Often downstream of mitochondrial ATP stress and PI3K/AKT/mTOR inhibition; not a uniformly demonstrated primary ivermectin target and typically requires higher experimental exposure. |
| 7 | Apoptosis (intrinsic; caspases) |
↑ (model-dependent; high concentration only) | ↔ / ↑ (high exposure) | R/G |
Programmed cell death |
Typically downstream of pathway inhibition/stress; exposure gap common. |
| 8 | ROS |
↑ or ↔ (context-dependent) | ↔ | P/R |
Secondary stress contributor |
Not a canonical primary target; can emerge downstream of stress signaling. |
| 9 | NRF2 (protective vs resistance role) |
↔ / ↑ (adaptive; context-dependent) | ↔ / ↑ (adaptive) | R/G |
Stress-response adjustment |
Secondary; could blunt efficacy if antioxidant adaptation dominates. |
| 10 | HIF-1α |
↔ / ↓ (model-dependent) | ↔ | G |
Not a consistent primary axis |
Reported variably; treat as secondary unless tumor model is hypoxia-driven. |
| 11 | Ferroptosis |
↔ (insufficiently established) | ↔ | R/G |
Not canonical |
Not a standard ivermectin-first claim; include only with specific supporting studies. |
| 12 | Ca²⁺ signaling |
↔ | ↔ | P/R |
No primary role |
Include only if a model explicitly measures Ca²⁺/ER-stress endpoints. |
| 13 | Clinical Translation Constraint |
↓ (constraint) | ↓ (constraint) | — |
Exposure + evidence + BBB safety context |
Most tumor-directed effects are preclinical and often high-concentration. PK/food effects (high-fat meal ↑ exposure), CYP3A4 metabolism, and P-gp BBB protection (neurotoxicity risk if impaired/inhibited) are key constraints; oncology trials remain early. |