Daraxonrasib in Pancreatic Cancer: What Oncology Nurses Need to Know

Following the landmark results of the RASolute 302 trial, Mary Larsen, MSN, RN, OCN, a clinical trials nurse at Memorial Sloan Kettering Cancer Center, shared her perspective on the shift in pancreatic cancer care in an interview with Oncology Nursing News.

Having spent five years specifically in pancreas cancer clinical trials after working on a GI med-surg floor, Larsen noted that the emergence of daraxonrasib has "offered a lot more hope" to a patient population with historically limited options.

A new era of hope

The therapy is particularly relevant because, as Larsen stated, "almost everyone has a KRAS mutation with pancreas cancer," and the trial data, which looked at the second line of treatment, showed a near-doubling of the median overall survival.

Larsen adds that there is further "hope and excitement" in "the thought that maybe we could even get more better data still" as researchers look toward the first-line setting.

Managing the transition to oral therapy

The shift from IV chemotherapy to an oral regimen like daraxonrasib introduces new dynamics in patient education. However, Larsen noted that "the administration of the drug is pretty simple."

“Daraxonrasib is just dosed once a day. So there's a pretty wide window — we do want it to be as close to 24 hours apart as possible, but it’s pretty wide window,” she said. “We tell patients it could be up to four hours earlier or four hours later. So, if you're taking it 10 a.m., you could take it from 6:00 a.m. to 2 p.m. That makes it a little easier. You can take it with or without food, that makes it easier in your life, you don't have to time it around meals. You don't have to time it around other medications.”

To monitor compliance while the drug is "still in a research setting," Larsen's team utilizes a pill diary.

Proactive side effect protocols

A hallmark of daraxonrasib is a rash which requires "pretty robust education on the rash prevention." Larsen detailed the proactive nursing care plan: “We give an oral antibiotic. We give two topical steroid creams. We tell patients to use SPF sunscreen every day, especially if they're going outside, just to keep the skin as moist as possible because it seems like the skin really dries out, and then that rash can get more inflamed because it's not healing.”

The antibiotics used can occasionally cause GI discomfort, leading to tricky conversations when patients are also experiencing GI effects from the daraxonrasib itself. However, Larsen finds that patients “want to do whatever they can to prevent the rash."

Similarly, for stomatitis and mouth sores, nurses implement preventive oral care from the start. “We do recommend good oral hygiene with regular brushing, flossing, and we recommend starting with saltwater rinses, baking soda rinses right away. We also give patients a steroid mouth rinse right away.”

Larsen notes that "because this drug is so exciting in the news, everyone wants it really badly. People are really eager and willing to follow whatever education."

Counseling and adherence

Despite the potential for localized toxicities, Larsen reports high motivation among her patients. “I personally have never had a conversation with someone about stopping the drug altogether because of side effects. People are happy to be on the treatment, generally. A lot of people are having their cancer actually respond really well.”

When side effects become moderate, the strategy shifts toward management rather than discontinuation. “We'll just tell patients take a week off from the pill, sometimes even longer, and usually everything heals up, the rash heals up, the mouth sores heal up, they also get these sores at the fingertips and those heal up,” Larsen said.

Advice for the community

With the U.S. Food and Drug Administration (FDA) having granting expanded access, Larsen encouraged community oncology nurses to "look for sites that are accruing" and stay in touch. Her primary clinical advice for those managing these patients is to maintain high "awareness about the rash and the mucusitis" and to remember the efficacy of treatment interruptions: “Sometimes, the dose reduction or that short hold is like really the most helpful thing instead of trying more and more topicals. That just sometimes doesn't do as much as taking a couple days off from the medication.”