Managing Rash and Stomatitis With Daraxonrasib in Pancreatic Cancer

Results from the Phase 3 RASolute 302 study presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting have positioned daraxonrasib as a potential new standard of care for patients with previously treated metastatic pancreatic adenocarcinoma (mPDAC).

While the oral RAS(ON) multi-selective inhibitor demonstrated unprecedented improvements in overall survival (13.2 months vs. 6.7 months with chemotherapy), its unique safety profile requires proactive nursing intervention.

In an interview conducted on-site at ASCO, study co-author Shubham Pant, MD, MBBS, Professor of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, detailed the primary toxicities oncology nurses must prepare to manage.

The challenge of acneform rash

According to Pant, the most prevalent side effect of daraxonrasib is an acneform rash, which often appears on the face. Data from the RASolute 302 trial showed that approximately 90% of patients experienced a rash of any grade, with 13.7% to 15% reaching Grade 3 severity.

"We have to give them prophylaxis with steroid creams and with doxycycline, which is an antibiotic," Dr. Pant explained, emphasizing the importance of early intervention.

Nurses play a vital role in monitoring patients closely for the development of these skin changes. If a significant rash occurs, management strategies include utilizing additional topical or systemic agents, holding the drug, or restarting at a modified dose.

Addressing stomatitis and GI toxicities

Beyond dermatologic issues, stomatitis (mouth sores) was the second most common Grade 3 or higher treatment-related adverse event (TRAE), occurring in 12.0% of the daraxonrasib arm. Other gastrointestinal symptoms, such as nausea and diarrhea, were reported but were generally less severe.

"Those are the two main toxicities," Pant noted, referring to the rash and stomatitis.

Despite these events, daraxonrasib was generally well tolerated compared to standard cytotoxic chemotherapy. Grade 3 or higher TRAEs were lower in the daraxonrasib group (43.6%) than in the chemotherapy group (57.5%), which was more frequently associated with neutropenia (18.2%) and anemia (16.4%).

Nursing implications for treatment continuity

For oncology nurses, the manageable safety profile of daraxonrasib is reflected in the low treatment discontinuation rate. Only 1.2% of patients receiving daraxonrasib discontinued therapy due to TRAEs, significantly lower than the 11.2% discontinuation rate seen with chemotherapy.

Furthermore, patients maintained a high median dose intensity of 93.1%, suggesting that with proper supportive care, such as the prophylactic steroids and antibiotics mentioned by Pant, patients can successfully remain on this life-extending therapy.

References

1. Wolpin BM, Wainberg ZA, Hendifar A, et al. Daraxonrasib, a RAS(ON) multi-selective inhibitor vs chemotherapy in previously treated metastatic pancreatic adenocarcinoma (mPDAC): Primary and final analysis from the phase 3 RASolute 302 study. Presented at: 2026 ASCO Annual Meeting; May 29-June 2, 2026; Chicago, IL. Abstract LBA5.