Pancreatic cancer is extremely difficult to treat – and many cases result in death just months after diagnosis. So it’s no surprise that this headline caused a stir: In a recent studyA new drug, daraxonrasib, was able to double the survival time of pancreatic cancer patients.
Compared to patients undergoing chemotherapy, those treated with daraxonrasib not only lived longer, but also reported a better quality of life. The treatment also appears to have reduced serious side effects.
Dietrich Ruess, MD, deputy medical director and head of the certified Pancreatic Cancer Center in the Department of General and Visceral Surgery at Freiburg University Medical Center, said the study should be considered “a revolutionary breakthrough for pancreatic cancer patients.”
“In my view, this is one of the most important clinical developments in metastatic pancreatic cancer in many years,” said Dieter Sauer, 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 excitement 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 have a mutation in this gene. As a result, it remains permanently active, promoting tumor formation and growth.
Study participants who received daraxonrasib lived an average of 13.2 months from the start of treatment, while patients in the chemotherapy control group lived an average of 6.6 months.
Despite the excitement surrounding the study results, one important fact remains: daraxonrasib does not cure pancreatic cancer. In most cases, the diagnosis is still a death sentence.
“‘Promising’ is really too strong a word,” said Suzanne Weg-Remmers, MD, a physician and head of the cancer information service at the German Cancer Research Center in Heidelberg.
Pancreatic Cancer: Some Warning Signs, Poor Survival Chances
Pancreatic cancer goes largely unnoticed. Patients often experience no symptoms initially, or experience only vague, non-specific symptoms. 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 will be diagnosed with pancreatic cancer in 2023. Approximately the same number of people died from this disease.
“In an ideal situation – although unfortunately this is very rare – pancreatic cancer is detected early enough that it can still be removed surgically,” Wegh-Remmers said. In such cases, surgeons remove a large portion of the pancreas and may also remove parts of the duodenum and stomach, depending on the location of the tumor.
Weg-Remmers said patients then receive chemotherapy and, in some cases, additional radiation therapy. Researchers are also investigating using an mRNA vaccine designed to prevent cancer from returning.
However, even with surgery and chemotherapy, the outlook remains poor: only 11% of patients are alive five years after diagnosis.
Special screening measures for pancreatic cancer are usually not recommended. According to Weg-Remmers, this is primarily due to the pancreas’ difficult location within the body, between the abdominal cavity and the spinal cord.
“With currently available diagnostic methods that would be suitable for population-wide screening, it is very difficult to screen the pancreas effectively,” he explained.
Exceptions are made for people with hereditary predisposition and families in which pancreatic cancer occurs more often than expected.
No effective treatment despite years of research
If the tumor can no longer be removed surgically – because it has metastasized and spread to other parts of the body – patients usually die within a few months. Chemotherapy can extend survival somewhat, but often at the cost of serious side effects.
Wegh-Remmers said that for patients with advanced disease, treatment decisions are highly individualized. Purely palliative care – which includes medications to manage pain and digestive symptoms – is also an option.
Targeted drugs that attack specific characteristics of a tumor and stop its growth are only available to a very limited extent, Weg-Remmers said.
“Despite considerable research in recent years, we are still relatively close to the beginning.”
Part of the excitement around Daraxonrasib stems from this reality: Currently, doctors have very few viable options for patients except to give them a little more time and make that time as comfortable as possible.
This article was originally written in German.