Daraxonrasib in pancreas cancer.
RASolute 302 trial has rightly generated significant excitement at ASCO2026 and I share this excitement. Pancreatic cancer has for long been a challenge for oncologists and KRAS is the classic ‘undruggable’ target. Any advance here is notable and must be celebrated. However no trial is perfect and an honest appraisal will help design better studies and develop safer and more effective therapies. It is in this spirit that I delve into the details of trial.
I have just four points
1. 100% of people on the experimental drug eventually progress. There is no curative subset. This is disappointing and different than other agents such as immunotherapy, where there can be cures.
2. 15% of the control arm declines treatment but only 3% of the intervention arm does not recieve therapy. A difference of 12%. These people are likely not random dropouts but the highest socioeconomic status participants with best alternatives. The drop out is patient disappointment. Thus randomization is violated. We potentially have the bottom 9/10 participants (in terms of OS) compared against 10/10. (not all of these persons appear to be censored, which is good, but many are).
3. Gains in OS exceed PFS gains. This raises the question of whether experimental drug is followed by chemo while chemo is followed by hospice or some other palliative option. Thus some of the gains of the experimental drug may be due to this additional care. Yet post protocol treatments not reported to explore this further. Neither in the paper nor the supplemental appendix. This is unfortunate.
4. Daraxonrasib will be harder to give older frailer people due to side effects.
Overall: A significant step forward for patients with metastatic pancreatic cancer but much more needs to be accomplished for this disease. I hope this is only the first of other advances to come in the future.
Also continued best wishes to Ben Sasse whom I have long admired.
Nice to have back your thoughts like this
Dr. Prasad, you are a treasure. The wave of social media blasts declaring near cures from this are not small. But, as your voice accurately shows, it's not......
But, what does Ben Sasse's potential admirable qualities have to regard anything? One, because it shouldn't matter. And, next, because he had a chance to stop at that point an only slightly corrupt President during the Ukraine treason impeachment and didn't. Next, his UF Presidency stint was rife of the objectively wasteful overspending upon Washington based education consultations and nepotism make-work someone like you would critique soundly.
None of that means he deserves to die or suffer, but "admirable"? Perhaps he was doing it for some greater type of good that you are privy to? Because, that's not a descriptor I'd use. Only harp upon it because you worked for scoundrels and crooks (not Makary and he's where you are) and were hoping it would be different and it was not.
*There is a large-ish subset of people out there who adore data-driven truth and are classically conservative politically and get concerned over "thought police" and "political correctness" who simply can't support this outright grifting and fraud based administration for it's corruption, lies, and objective ineptitude -- you should be one of them.