A new drug for pancreatic cancer may give patients more time

US Food and Drug Administration (FDA) approved daraxonrasib at the end of August for the treatment of pancreatic cancer that has spread. The medicine is not yet in use in Finland.

What does the result really mean to the patients?

Assistant Chief Medical Officer of Oncology Pia Österlund considers the result promising. He works at Tampere University Central Hospital and is a professor at Uppsala University.

Österlund still exceeds expectations. Daraxonrasib does not cure pancreatic cancer that has spread, but it can slow its progression and prolong life by months.

The drug is a second-line treatment, i.e. it is given when the cancer has progressed despite previous treatment. Earlier at this stage, the additional benefit brought by new medicines has often remained for about one and a half or two months.

In summer in a published study median survival was 13.2 months for those who received daraxonrasib and 6.7 months for those who received chemotherapy. The study, published in The New England Journal of Medicine, was funded by Revolution Medicines, which developed the drug.

The tumor shrank in about a third of those who received the drug, and the pain also worsened more slowly than with chemotherapy.

“The result is significant,” says Österlund.

Result however, it does not mean that every pancreatic cancer patient would get about half a year more life expectancy with the drug.

The numbers are average. For an individual patient, the additional time brought by the treatment cannot be accurately predicted.

In addition, the participants in the study were really fit patients whose vital functions had to be in order.

Österlund emphasizes that a significant number of people with pancreatic cancer never make it to second-line medical treatment due to the disease or their general condition.

However, according to him, the new medicine could be considered for a large part of those patients in good health, for whom second-line medical treatment is generally suitable.

Oral the medicine taken through the mouth does not mean that the treatment is harmless or light.

Since the medicine is taken daily, the side effects can be continuous. For example, nausea, diarrhea, fatigue and skin symptoms can burden everyday life in a different way than occasional chemotherapy side effects.

“If there is nausea all the time, it reduces the quality of life significantly more than even worse nausea that is only a day or two after the drip,” says Österlund.

Treating the side effects requires new skills from both doctors and patients.

New the medicine has its mode of action. It affects the gene (KRAS), which regulates cell growth via the Ras protein, so the drug only works in patients with this mutation.

When the gene in question is mutated, the protein can remain continuously active, in which case it sends the cell an order to grow. Daraxonrasibi aims to silence this command.

In the past, a mutation in the KRAS gene meant that certain treatments did not work. Now the same mutation can be harnessed as a treatment.

The importance of the drug can therefore extend beyond pancreatic cancer. According to Österlund, in bowel cancer, for example, the KRAS mutation is present in about half of the patients. Medicines targeting the Ras protein are also being studied in their treatment.

New it will take at least two years to get the drug available to Finnish patients, Österlund estimates.

Price can be a threshold issue. It will be clearly cheaper in Europe than in the US, where the monthly price is $40,000. The price will be multiple times compared to the current pancreatic cancer chemotherapy. The exact price is not yet known.

However, the exact price is not yet known.

in Finland around 1,400 people get sick with pancreatic cancer every year.

If the cancer cannot be removed by surgery, the prognosis is limited. More than half have less than a year to live, but some live for years with treatment.