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Chapter 1: What breakthrough was announced for pancreatic cancer treatment?
This is The Guardian.
Each May, the American Society of Clinical Oncology annual meeting is held in Chicago. Cancer researchers from around the world gather together to share the latest advances. And 2026 was a bit of a blockbuster year. One study pointed the finger at poor sleep in fuelling the global rise in cancer diagnoses in the under 50s.
Another shared a groundbreaking genomic test that could spare millions of breast cancer patients chemotherapy. Then there was a cancer jab that eradicated entire tumours. But there was one presentation with results so striking that the audience got to their feet and cheered. A clinical trial of a daily pill for the world's deadliest cancer found it doubled survival times.
To date, pancreatic cancer has proved extremely hard to treat.
Chapter 2: What current treatment options exist for pancreatic cancer patients?
But this drug could herald a new era for patients. So today, a game-changing moment for pancreatic cancer. From The Guardian, I'm Madeleine Finlay and this is Science Weekly. Professor Noreen Starling, you're a consultant medical oncologist and director of the Royal Marsden Clinical Trials Unit and one of your specialisms is pancreatic cancer.
So what kind of treatment options are available right now for pancreatic cancer and how effective are they?
So currently, the majority of patients we see in the UK and worldwide with pancreatic cancer present with advanced pancreas cancer that has already spread where surgery doesn't really have a role. Maybe we see one in 10 or slightly more patients who present with operable pancreatic cancer.
So for the majority of patients with advanced disease today, and for really the last couple of decades, chemotherapy drug treatment has been the mainstay of our treatment approach. But these aren't curative treatments. They help us to help patients live longer and better with pancreatic cancer.
Chapter 3: Why is pancreatic cancer considered one of the hardest cancers to treat?
But This is one of the most challenging cancers to treat. The average survival for patients with advanced pancreatic cancer is about a year, sometimes more, sometimes less.
And why is pancreatic cancer so hard to treat?
It presents often late at an advanced stage. And even for the patients who have operable disease at a microscopic level, the cancer's already managed to break off, which is why we see so much relapse even after surgery and chemotherapy.
But there's another factor that makes pancreatic cancer so difficult to treat, and it's to do with mutations in a gene called KRAS.
So 90% of patients with pancreatic cancer, so 9 out of 10 patients, have a mutation in KRAS. And this mutation really is the dominant driver of pancreatic cancer. This gene that drives the cancer to grow and develop has been considered undruggable.
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Chapter 4: How do KRAS mutations affect pancreatic cancer treatment?
The KRAS gene is part of the RAS family of genes. These provide the instructions to make RAS proteins, which act as on and off switches for cell growth and division. Genetic mutations can mean RAS proteins get stuck in the on mode, leading to overactive cell growth and division, and ultimately cancer.
Scientists spent decades trying to develop drugs to switch off Ras proteins, but there's something about them that makes them difficult to target.
The Ras protein is tricky because the protein is pretty smooth. Now you might think, why does that make it challenging to drug? Well, good drug targets often have these deep pockets that you can design a drug to fit and nestle into that pocket. And by doing so, switch off the protein and switch off that signal. But these pockets are pretty shallow and smooth.
Scientists had to look for other, more circuitous ways to get around these shallow, smooth pockets and bind their drugs to Ras proteins.
Chapter 5: What is the significance of the drug Deraxanracib in clinical trials?
But after decades of work, they did it and proved KRAS and the rest of the Ras proteins could be switched off. And last week, the next big breakthrough was announced at the annual meeting of the American Society of Clinical Oncology in Chicago.
Honestly, it was a spine-tingling moment. I was in the room, thousands of listeners in the room as the data were presented. What we saw was a major breakthrough for the treatment of pancreatic cancer, and the results were so stunning that the presenter received a standing ovation as he was presenting the data, not even at the end of the presentation.
This excitement was sparked by the results from a Phase 3 randomised control trial of a drug called Deraxanracib, a tablet the patients take once a day.
So half of the patients received another chemotherapy and half of the patients received the oral tablet therapy and the results were just jaw-dropping. So in this group of patients, survival was doubled, going for an average of about six months to over 13 months.
We saw tumour shrink in the patients who have the Dyraxone RACIP tablets, a good shrinkage of over 30% of patients compared to about 10% of patients with chemotherapy. And really importantly for patients, not only were they living longer, but they felt better.
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Chapter 6: How does Deraxanracib work to treat pancreatic cancer?
There was a reduction in pain and improvement in symptoms for a good amount of time.
So this drug has had incredible results, but... Noreen, how exactly does it work?
The way it works is very clever and it's quite different to sort of the traditional drug inhibitor. So a drug interacts with the protein that you want and shuts it down. It does it in a more sneaky way. So it binds to a chaperone protein called cyclophenol A and forms a bond with that. And then that doublet, if you like, blocks the activated state of Ras.
It's forming a kind of molecular glue to shut Ras down and stop it providing the signal for the cancer cell to grow.
So this drug uses another protein to form a molecular glue that grabs and shuts down KRAS and the other members of the RAS family.
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Chapter 7: What are the implications of this treatment for future cancer therapies?
It's exciting science and this clinical trial is just the beginning of exploring how it could be used to help patients.
There are so many more important questions now for our patients with pancreatic cancer. So the trial is very specifically for the group of patients who've had chemotherapy previously and it has stopped working. One of the next important questions is, okay, what about the patients who've just been diagnosed with advanced stage four pancreatic cancer?
Does dyraxonracib, this oral therapy, work for those patients? Does it improve survival and symptoms and how patients feel as the first line of treatment? But then going back to how do we actually prevent pancreatic cancer becoming advanced, what about those patients with operable pancreatic cancer and But it doesn't stop there.
There are many other questions about what are the other combinations of this sort of drug, duraxone and racib, but indeed other drugs that are also rapidly coming through clinical trials. For me, this is really the key that unlocks the transformative treatment potential for pancreatic cancer.
Chapter 8: When might patients expect access to this new treatment?
So it's going to be a really busy clinical trials landscape. That is wonderful. We've been looking for that in pancreatic cancer for such a long time. I think it's a triumph for science and it's a triumph for patients.
The fact that in this trial, patients saw a doubling of survival time, which is just, it's so huge when you're faced with having to think about how long you might have left. Others in similar situations hearing about Derax and Rassib now will no doubt be asking themselves, well, when am I going to be able to get hold of this?
So in your mind, I know this is a little bit like asking how long is a piece of string, but But when do you think this could become available to patients?
There's two answers to that. One is the length of time it takes in terms of the regulator to review the data in order to allow the drug to be available. And within every jurisdiction, there will also need to be reimbursement considerations. And for the UK, that will be a nice appraisal, which looks at benefit and resource and cost. That timeline can vary.
You know, I would hope that we can see progress within this next year or certainly within the next couple of years. But it's such an important breakthrough. I would hope the system can move quickly in regard to this.
Coming up, could the approach behind this drug work for other cancers?
Thank you.
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