Nursing Protocols for the New Oral RAS Inhibitor Daraxonrasib

The US Food and Drug Administration has approved daraxonrasib (Rasonque), a first-in-class once-daily oral tablet targeting multiple forms of the RAS protein, the key growth driver in most pancreatic adenocarcinomas. Pancreatic adenocarcinoma comprises 90% to 95% of the 67,000 new cases diagnosed annually in the United States, representing a disproportionately high share of cancer deaths due to late detection and limited options.

The expedited approval was granted 6.5 months ahead of schedule, following Breakthrough Therapy and Priority Review designations. This clinical breakthrough follows an expanded access protocol permitted in May, which enabled early patient access. In a multicenter trial of 500 adults with previously treated metastatic disease, daraxonrasib nearly doubled overall survival to 13.2 months compared to 6.7 months with standard chemotherapy.

Shifting Care: From Infusion Chair to Home

While these survival outcomes are unprecedented, shifting therapy from clinic infusion chairs to self-administered oral tablets requires an adjustment in care delivery. "Oral therapy moves treatment outside of your infusion chairs and your infusion centers," explained Yolanda Justal, MSN, APRN, FNP-BC, AOCNP, ACRP-CPI, a GI clinical research advanced practice registered nurse at the University of Miami Sylvester Comprehensive Cancer Center. "But it's not going to reduce the need for clinical oversight before the first dose."

Justal, in an interview with Oncology Nursing News, emphasized that establishing baseline assessments prior to initiating treatment is paramount. Clinicians must thoroughly evaluate a patient's baseline skin health, oral cavity, gastrointestinal status, and functional capacity. Because the drug's most common side effects include rash, diarrhea, stomatitis, nausea, vomiting, abdominal pain, fatigue, and decreased appetite, pre-emptive baseline mapping is vital to differentiating treatment-related toxicities from pre-existing disease symptoms.

Proactive Symptom Triage & Education

To support patients at home, clinical teams must provide robust self-management resources and clear triage pathways. Justal advised providing written instructions detailing symptom self-management.

"We're going to be providing patients with clear written instructions which explain which symptoms require a routine phone call," she noted. These instructions must separate minor toxicities—which can be delayed until the next business day or office visit—from emergent complications requiring immediate evaluation.

Additionally, communication must be frequent during early treatment phases when toxicities are most likely to surface. Justal recommended scheduling proactive follow-up calls within the first few weeks. Clinicians should provide patients with multiple communication pathways, including clinic contact numbers, digital messaging portals, and dedicated after-hours contacts.

Interprofessional Care Coordination

Managing toxicities requires collaboration among nurses, advanced practice providers (APPs), and pharmacists. "The nursing team, APP team, as well as our pharmacy teams ... need to provide a defined pathway so that the persons taking those calls and those inquiries know what symptoms need to be documented and how to document those symptoms," Justal advised. By standardizing symptom documentation and grading, care teams can intervene early, preventing unnecessary hospitalizations or premature, permanent discontinuation of this life-prolonging therapy.

References

1. US Food and Drug Administration. FDA Approves First in Class Targeted Therapy for Metastatic Pancreatic Cancer. FDA News Release. Published August 26, 2026. Accessed September 2, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-class-targeted-therapy-metastatic-pancreatic-cancer