Pancreatic cancer is notoriously difficult to treat — and in many cases leads to death just months after diagnosis. So it is no surprise that this headline created a stir: In a recent study, a new drug, daraxonrasib, was able to double the survival time of patients with pancreatic cancer.
Compared with patients who underwent chemotherapy, those treated with daraxonrasib not only lived longer, but also reported a better quality of life. The treatment also appeared to cause fewer severe side effects.
The study should be regarded as “a revolutionary breakthrough for patients with pancreatic cancer,” said Dietrich Ruess, Deputy Medical Director and Head of the certified Pancreatic Cancer Center at the Department of General and Visceral Surgery at Freiburg University Medical Center.
“In my view, this is one of the most important clinical developments in metastatic pancreatic cancer in many years,” said Dieter Saur, Professor of Translational Cancer Research at the Technical University of Munich and the German Cancer Research Center in Heidelberg.
Daraxonrasib targets the RAS gene
Experts expressed enthusiasm that daraxonrasib could specifically target the so-called RAS gene. This gene encodes a protein that drives cell growth and division. About 90% of people with pancreatic cancer carry a mutation in this gene. As a result, it remains permanently active, promoting tumor formation and growth.
Study participants who received daraxonrasib lived a median of 13.2 months from the start of treatment, compared with 6.6 months for patients in the chemotherapy control group.
Despite the excitement surrounding the study results, one important fact remains: Daraxonrasib does not cure pancreatic cancer. In most cases, the diagnosis still amounts to a death sentence.
“‘Promising’ is actually too strong a word,” said Susanne Weg-Remers, a physician and head of the Cancer Information Service at the German Cancer Research Center in Heidelberg.
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Pancreatic cancer: Few warning signs, poor survival prospects
Pancreatic cancer develops largely unnoticed. Patients often experience no symptoms at first, or only vague, nonspecific ones. These may include upper abdominal pain, back pain, nausea, digestive problems, loss of appetite and weight loss.
According to the Robert Koch Institute, about 20,000 people in Germany were diagnosed with pancreatic cancer in 2023. Nearly as many died from the disease.
“In an ideal situation — although unfortunately this is very rare — pancreatic cancer is detected early enough that it can still be surgically removed,” Weg-Remers said. In such cases, surgeons remove a large portion of the pancreas and, depending on the location of the tumor, may also remove parts of the duodenum and stomach.
Patients then receive chemotherapy and, in some cases, additional radiation therapy, Weg-Remers said. Researchers are also investigating using an mRNA vaccine designed to prevent the cancer from returning.
Even with surgery and chemotherapy, however, the outlook remains poor: Only 11% of patients are still alive five years after diagnosis.
Special screening measures for pancreatic cancer are not generally recommended. According to Weg-Remers, this is largely due to the pancreas’s difficult location deep within the body, between the abdominal cavity and the spine.
“With the diagnostic methods currently available that would be suitable for population-wide screening, it is very difficult to examine the pancreas effectively,” she explained.
Exceptions are made for people with a hereditary predisposition and families in which pancreatic cancer occurs more frequently than expected.
No effective treatment despite years of research
If the tumor can no longer be surgically removed — because it has metastasized and spread to other parts of the body — patients typically die within a matter of months. Chemotherapy may extend survival somewhat, but often at the cost of severe side effects.
For patients with advanced disease, treatment decisions are therefore highly individual, Weg-Remers said. Purely palliative care — involving medications to manage pain and digestive symptoms — is also an option.
Targeted drugs that attack specific features of a tumor and inhibit its growth are only available to a very limited extent, Weg-Remers said.
“Despite a great deal of research in recent years, we are still relatively close to the beginning.”
Part of the excitement surrounding daraxonrasib stems from this reality: At present, doctors have very few viable options for patients beyond giving them a little more time and making that time as comfortable as possible.
This article was originally written in German.
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