For the first time in decades, doctors treating pancreatic cancer at MD Anderson Cancer Center at Cooper have reason for optimism.
In August, the U.S. Food and Drug Administration approved Rasonque (daraxonrasib), a once-daily pill for advanced pancreatic cancer. In a major clinical trial, patients taking the drug had a median survival rate of more than 13 months, compared with 6.7 months for those receiving standard chemotherapy.
While a 13-month survival rate still sounds daunting, it represents a breakthrough for targeted therapy, which focuses on specific proteins that drive cancer growth. Chemotherapy, in comparison, attacks all rapidly dividing cells in the body, both cancerous and healthy. The addition of Rasonque to treatment showed a clear, measurable advantage over chemotherapy alone.
“This is the first step in a revolution in the way we treat pancreatic cancer,” said Dr. Jamin Morrison, head of the hematology/medical oncology division at MD Anderson Cancer Center at Cooper.
Rasonque targets proteins in the RAS gene family, including KRAS, which is the most commonly mutated driver of pancreatic cancer, found in more than 90% of cases.
When researchers presented the Rasonque trial results at the American Society of Clinical Oncology (ASCO) annual meeting earlier this year, thousands of oncologists applauded and gave them a standing ovation.
An estimated 67,530 new cases of pancreatic cancer will be diagnosed in the U.S. this yar, and 52,740 people will die from the disease. Pancreatic cancer makes up about 3% of all U.S. cancers, but its five-year survival rate of 13% is the lowest of any major cancer. Still, that’s more than triple the 4% rate in the 1990s.
Most people are diagnosed at a late stage. Symptoms like jaundice, weight loss, or abdominal pain often appear only when the disease has already spread. Less than 20% of patients are candidates for surgery because the cancer has usually spread beyond the pancreas at diagnosis, according to information from the American Cancer Society.
At MD Anderson at Cooper, medical oncologists work with surgical and radiation specialists to determine the best treatment path for each patient. The team meets weekly to review patients and coordinate treatment decisions. Often Morrison and Dr. Young Ki Hong, head of surgical oncology, meet with patients in the same location.
Patients at MD Anderson at Cooper had access to Rasonque before regulatory approval through an expanded-access program. The cancer center, which is a fully integrated clinical partner with the University of Texas MD Anderson Cancer Center in Houston, is also running a clinical trial testing KRAS-targeted treatment earlier, potentially as a patient’s initial therapy.
“This is not a miracle drug. We’re still dealing with a very difficult situation,” Morrison said. “But a lot of exciting work is being done.”
Jefferson Health also had an expanded-access program for Rasonque, from mid-June until the FDA approved it. Dr. Eduardo Fernandez, a medical oncologist at Jefferson, said patients on the drug have shown dramatic drops in the tumor marker CA 19-9, sometimes by 50% after a month of treatment.
“A real home run,” Fernandez said. “An unbelievable, transformative therapy for patients.”
Rasonque is only one of several advances changing how doctors approach pancreatic cancer.
MD Anderson at Cooper’s team already uses histotripsy, a noninvasive technology approved by the FDA in 2023, to treat liver cancer. The therapy destroys cancer cells with ultrasound waves. MD Anderson at Cooper plans to start a histotripsy trial for pancreatic cancer next year, according to Dr. Hong.
Currently, surgery offers the only potential cure for pancreatic cancer, but only about 20% of pancreatic cancer patients qualify for surgery. Even with surgery, there has been progress. Virtua Health recently became the first in New Jersey to provide a robotic-assisted version of the Whipple procedure, a complex surgery to treat pancreatic cancer.
“Robotics bring greater precision, which can result in better outcomes and fewer complications,” said Dr. Ely Sebastian, a pancreatic and hepatobiliary surgeon at Virtua.
Some tumors cannot be safely removed, even if they haven’t spread, when they wrap around or invade major blood vessels. MD Anderson at Cooper’s histotripsy trial will focus on these cases. The idea is to treat the tumor with histotripsy, potentially exposing the artery safely and making surgery possible.
MD Anderson at Cooper also offers the EXPAND trial, which uses radiation targeted at small cancer cells that break loose from the original tumor, so that doctors can later consider surgery on the main pancreatic tumor.
Together, these advances are giving doctors new ways to treat pancreatic cancer, and in some cases, making surgery possible for more patients.
“It’s only because of advancements of systemic treatment that we can now be bold in treatment of aggressive cancer,” Hong said.
For information about MD Anderson Cancer Center at Cooper, go to cooperhealth.org/center/md-anderson-cancer-center-cooper
