Pancreatic cancer pill doubles survival

Hello Nature readers,
This week, we learn of a pill for an aggressive form of pancreatic cancer that almost doubles survival, consider calls to reconsider how side effects are weighed in cancer treatment, and get the highlights from the American Society of Clinical Oncology annual meeting.

Pancreatic cancer pill doubles survival

An experimental drug for people with an advanced form of pancreatic cancer has reduced the risk of death by 60%, reduced pain and increased quality of life when compared with chemotherapy. Daraxonrasib extended life from 6.7 months to 13.2 months. It targets RAS proteins, which are mutated in 90% of pancreatic cancers and notoriously difficult to target. The 500-person trial “ticks all of the boxes”, says gastrointestinal oncologist Rachna Shroff. “I just started crying in clinic.” The findings were presented at the American Society of Clinical Oncology (ASCO) annual meeting over the weekend.

Breast cancer test could spare many chemo

Researchers have developed a genomic test that can spot who needs chemotherapy and who doesn't. The randomized trial enrolled 4,429 people over the age of 40 with hormone-positive breast cancer — which accounts for up to 80% of breast cancer cases globally — across six countries. It found that those with a low score on a genomic test called Prosigna, which analyses the activity of 50 genes in tumour tissue, could be safely treated with hormone therapy alone. The findings were presented at the ASCO annual meeting.

Close the children’s cancer treatment gap

“For an adult diagnosed with cancer today, the therapeutic landscape is almost unrecognizable from that of 15 years ago,” write cancer drug researcher Vivek Subbiah and paediatric oncologist Branko Cuglievan. “For children, it is not.” Children make up less than 1% of new cancer diagnoses each year, however cancer remains the leading cause of disease-related death in this group. The lag between drug availability for adults and children can be more than a decade. This slow and siloed drug development for paediatric cancers is “no longer defensible”, argue the authors. They call on industry leaders — as those who set the pace in drug development — to better serve the paediatric population.

Focus on kinases to find rare-cancer drugs

To tackle rare cancers, research should shift to a “mutation-centric, tissue-agnostic framework”, write a group of biology and cancer researchers. The authors argue that by shifting the focus to kinases — metabolism and cell-division proteins that are often mutated in cancers — researchers can look more broadly at similarities between rare and other cancers, and repurpose existing drugs.

It is time to stop downplaying toxicity

The tolerability of cancer treatments is too often decided by researchers, which can mislead patients, argues oncologist Bishal Gyawali. “When I mentioned to a patient that ‘side effects from this drug are supposed to be acceptable,’ she retorted ‘Acceptable to whom? It’s not acceptable to me.’ That was my moment of epiphany,” he writes. Upon interrogating the literature, Gyawali found that whether side effects were manageable was decreed by trial authors and not asked of trial participants. Out of 122 trials, none were found to report toxicities that were not manageable, regardless of their toxicity profile. “Until the philosophy of ‘shrink the tumor at any cost’ is changed to ‘care for the whole patient and offer the treatment most aligned with the patient’s goals’, patient outcomes will never be truly prioritized,” he writes.