A groundbreaking once-daily pill nearly doubled median survival compared with chemotherapy in a major trial involving patients with previously treated metastatic pancreatic cancer — and St. Louis’ Siteman Cancer Center helped test the new treatment.
But the medical breakthrough comes with a staggering price.
Rasonque, the brand name for daraxonrasib, has a wholesale list price of $39,800 for a 30-day supply — almost $478,000 for a year of treatment. The drug’s developer, Revolution Medicines, set the price. Insurance coverage and financial assistance programs can substantially reduce what patients pay out of pocket.
The cost and access questions take on added significance for Black Americans, who have the nation’s highest pancreatic cancer incidence and death rates.
Pancreatic cancer is one of the deadliest forms of cancer, in part because it often is not discovered until it has spread. Only about 14% of patients overall are alive five years after diagnosis. For patients whose cancer has spread to distant parts of the body, the five-year survival rate is just over 3%.
The American Cancer Society estimates that more than 67,000 people in the United States will be diagnosed with pancreatic cancer this year and more than 52,000 will die from the disease.
The FDA approved Rasonque on Aug. 26 for certain adults with metastatic pancreatic adenocarcinoma, the most common form of pancreatic cancer. The first-of-a-kind drug targets RAS proteins — long considered difficult to target with drugs — and offers new hope after decades of limited treatment options.
Washington University’s Siteman Cancer Center helped evaluate the targeted therapy and offered it to qualified patients during clinical trials before it was made widely available.
Dr. Kian-Huat Lim, director of gastrointestinal oncology at WashU Medicine and a nationally recognized specialist in pancreatic cancer care and research at Siteman, served as site principal investigator for the international Phase 3 RASolute 302 clinical trial evaluating daraxonrasib.
“We are national leaders in investigator-initiated trials, and we have proven results as scientists and clinical trialists,” Lim said, touting Siteman’s expertise. “In addition, we see many patients from throughout the region who are diagnosed with pancreatic cancer.
“In other words, we have the expertise as clinicians to care for these patients and the ability to offer them the latest options.”
In the late-stage trial offered at Siteman and other sites, 500 patients whose metastatic pancreatic cancer had progressed after initial treatment were randomly assigned to receive daraxonrasib or another round of chemotherapy.
Patients receiving daraxonrasib had a median overall survival of 13.2 months, compared with 6.7 months for those receiving additional chemotherapy. The study also found that 30% of patients receiving daraxonrasib experienced substantial tumor shrinkage, compared with 11% receiving chemotherapy.
“We are prolonging life in patients who previously had no other good option other than another rather toxic chemotherapy with limited efficacy or clinical trials,” Lim said.
For Black patients, the new treatment comes against a backdrop of longstanding disparities.
National Cancer Institute data show Black men are diagnosed with pancreatic cancer at a rate of 18 per 100,000 and die from the disease at a rate of 15 per 100,000, both higher than the rates for white men. Black women also have higher pancreatic cancer incidence and death rates than white women.
The drug’s massive wholesale price does not mean patients will receive a $39,800 bill each month. How much they ultimately pay will depend on their insurance coverage and eligibility for financial assistance.
Revolution Medicines has established its (ON)Path patient support program to help patients prescribed Rasonque navigate insurance coverage and financial assistance. The program includes assistance for eligible commercially insured patients and a patient assistance program.
Medicare beneficiaries also have some protection from the drug’s high price. Under recent federal drug pricing reforms, Medicare Part D patients have a $2,100 annual limit on out-of-pocket spending for covered prescription drugs in 2026. After reaching that threshold, they pay no additional cost sharing for covered Part D drugs for the remainder of the year.
Medicare beneficiaries also can spread their out-of-pocket prescription costs over monthly payments rather than paying the entire amount at the pharmacy.
Those protections, however, do not guarantee that every patient will have the same access to the drug. Coverage requirements, insurance and eligibility for assistance can affect how patients obtain and pay for treatment.
Rasonque also is not for every pancreatic cancer patient. The FDA approved it for adults with metastatic pancreatic adenocarcinoma who have received at least one previous systemic treatment or who are not candidates for treatment with multiple systemic drugs.
The drug also can cause serious side effects. The FDA lists common side effects including rash, diarrhea, inflammation of the mouth, nausea, fatigue, vomiting, abdominal pain, swelling, decreased appetite and bleeding.
Still, for patients with advanced pancreatic cancer who previously had few good options after their initial treatment stopped working, the new drug offers something particularly valuable: more time.
“We are prolonging life,” Lim said.
Sylvester Brown Jr. is the Deaconess Foundation Community Advocacy Fellow.