Daraxonrasib explained: The experimental pill giving new hope against pancreatic cancer

For decades, pancreatic cancer has been one of oncology’s toughest challenges. It is notoriously silent in its early stages and resistant to treatment later. If the disease progresses after first-line chemotherapy, options become extremely limited. Experts say it carries one of the poorest survival rates among major cancers. Now, a new experimental pill, daraxonrasib, offers a rare glimmer of hope.

Presented at the 2026 ASCO meeting and published in the New England Journal of Medicine, the phase III RASolute 302 trial found that daraxonrasib nearly doubled the survival of patients compared with standard chemotherapy. What was encouraging was that survival improved in patients with previously treated metastatic pancreatic cancer. Cancers are called metastatic when they spread from their original location to other parts of the body.

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The study is important as pancreatic cancer accounts for roughly 2.1% of all cancer cases in India. It generally has a poor prognosis because up to 95% of patients are diagnosed at an advanced stage, when surgical removal is no longer possible.

The study, which experts like Dr Sameer Kaul, an eminent oncologist at Indraprastha Apollo, New Delhi, call a "breakthrough", showed that patients receiving the drug achieved a median survival of 13.2 months compared with 6.7 months in the chemotherapy group, while also experiencing fewer severe side effects and a better quality of life.

Why is this different?

The excitement isn’t simply because patients lived longer.

Daraxonrasib targets RAS, a family of proteins that has long been considered one of cancer biology’s “undruggable” targets. More than 90% of pancreatic cancers harbour KRAS mutations, making the RAS pathway central to tumour growth. Unlike earlier drugs that target only specific KRAS mutations, daraxonrasib acts against multiple active RAS variants, potentially benefiting a broader group of patients.

Researchers believe this represents a shift from treating pancreatic cancer with increasingly toxic chemotherapy to precision medicines called targeted therapies, which only attack cancer cells in the body.

Firstpost spoke to Dr Kaul to understand why this discovery is a milestone and why drug authorities around the world have approved it for 'compassionate use' even before the trials are completed.

Not a cure, experts say, but a milestone

Q: Pancreatic cancer has long been regarded as one of the most difficult cancers to treat. Why are these trial results generating so much excitement?

Dr Kaul: Pancreatic cancer is one of the most lethal cancers we treat. While it may not be among the most common cancers on paper, in a typical oncology outpatient clinic, I see five to six patients with pancreatic cancer every day. Sadly, for many of them, the average survival is only seven months to a year.

What makes daraxonrasib exciting is that it offers hope even in advanced, metastatic pancreatic cancer, where patients have already received chemotherapy and have very limited treatment options.

Q: How does the pill work? Will all patients with pancreatic cancer be eligible for it?

This drug will benefit only those patients whose tumours carry the specific KRAS mutation. That is why molecular testing has become absolutely essential before deciding on treatment.

Cancer develops because of changes, or mutations, in molecular pathways inside cells. Today, with technologies such as next-generation sequencing, we can identify many of these mutations and target them with precision medicines.

Ideally, every cancer biopsy should undergo molecular testing because many of these mutations are now actionable. If we identify them, we can offer patients newer, more personalised treatments that can extend survival.

Q: How is this different from chemotherapy? How clinically meaningful is the survival reported with it?

Earlier, our treatments were much broader. Now we are targeting the exact mutation that is driving the cancer in an individual patient. That is the essence of personalised oncology.

The improvement in survival is clinically very meaningful. When patients who would otherwise survive about seven months live substantially longer, it makes an enormous difference, not just to the patient but to the entire family.

Unlike chemotherapy, which affects many healthy dividing cells in the body, targeted therapies are designed to act mainly on cancer cells. That is why their side effects are generally milder, and patients often have a better quality of life.

Q: Are there any side effects?

Like all targeted therapies, daraxonrasib does have side effects, including skin reactions, diarrhoea, mild gastrointestinal symptoms and liver enzyme abnormalities. However, these are usually manageable with regular monitoring.

Q: So would you call this a breakthrough?

This is certainly a breakthrough. I call it a breakthrough because I see these patients every day in my clinic, and until now, many of them had no effective options once chemotherapy stopped working. Now, for the first time, a meaningful option has emerged, even though the drug is still being studied.

At present, the best evidence supports the use of daraxonrasib in combination with chemotherapy. Future studies may explore combinations with immunotherapy or other targeted agents. Besides pancreatic cancer, the drug is being tried for other cancers such as lung and colon cancer.

Q: Assuming regulatory approvals, what challenges do you foresee regarding affordability and access, especially in countries like India?

The biggest challenge in India is affordability. Right now, this treatment is like owning a Bentley or a Porsche. It is available, but only for those who can afford it.

We have seen this story before with other cancer drugs. As competition increases, patents expire, and Indian manufacturers develop biosimilars or generics, prices are likely to fall, and access should improve.

Q: What message would you give to patients and families who are reading headlines describing daraxonrasib as a “game changer”?

My message to patients is simple: if your oncologist advises molecular testing on your biopsy sample, take that advice seriously. These tests can identify treatment options that simply would not be available otherwise.

The future of cancer treatment is personalised medicine. The more we understand the biology of each patient’s tumour, the better we can match them with therapies designed specifically for their cancer.