Pancreas cancer: How 92% becomes 45% in 15%

Tango therapeutics

Recently, I was sad to see Ben Sasse appears to have progressed on Daraxonrasib and is getting chemotherapy.

The former senator has been open about his treatment, which included some chemotherapy prior to the Ras inhibitor and is now on Gem-Abraxane, which is sadly not curative in this setting (2+ line, metastatic pdac). Here is one study

There is deservedly a lot of enthusiasm in pancreas cancer, after decades of no new options Ras appears to be one, and Tango is reporting impressive results. Yet, the headline obscures some facts.

92% response in pancreas cancer!

92 % is 11 of 12, but only 9 of 12 are confirmed objective responses — so the response rate is more accurately stated as 75%.

Oh, but the trial is only for MTAP deleted and Ras mutant which is about ~10-20% of pancreas cancer , and 8 people were followed for less than 14 weeks and excluded

See the fine print

“59 patients with previously treated MTAP-deleted and RAS-mutant pancreatic ductal adenocarcinoma (PDAC) or non-small cell lung cancer (NSCLC) were treated with a vopimetostat-based combination with either daraxonrasib (n=20 PDAC; n=5 NSCLC) or zoldonrasib (n=34 PDAC)”

So the response rate is 45% RR 9/20 in MTAP-D and Ras-m PDAC, compared to 30% for daraxonrasib alone in the relapsed setting.

This is not meant to be discouraging, but to point out that there is still an unmet need here. The median DOR is not reported. It is 8.2 months for daraxonrasib alone.

And sadly, what is not stated, is that 100% of these patients will eventually have disease progression and die.

If you're 53 years old and you get pancreas cancer, it's certainly better to live 2 years than one, but both are a tragedy. And we should be honest that a person may lose 29 or 30 years of life by having this disease, irrespective of the new advances.