When Ben Sasse, a former U.S. senator (R-Neb.), learned he had metastatic pancreatic cancer, he quickly chose action over comfort. Whatever he could do to save his life, for as long as he could, he wanted to try it. Perhaps his only option, doctors told him, was to enroll in a clinical trial.
“If we were to have much of a chance of living longer than the three to four months they were giving us at that point, we were going to need to get into an aggressive trial,” Sasse told STAT last month.
That turned out to be an early phase clinical trial testing Revolution Medicines’ daraxonrasib as first line therapy. Since Revolution Medicines, or Rev Med as many call the company, published its first early phase data on this next-generation targeted therapy, the pancreatic cancer community has been abuzz about the drug. Even before the company published positive topline Phase 3 results on Monday, pancreas cancer experts have been confident that approval will come.
Those topline results are encouraging for that prediction. The trial, RASolute 302, showed daraxonrasib alone can significantly improve the survival of advanced pancreatic cancer patients to 13.2 months versus 6.7 on chemotherapy for second line therapy. Going to daraxonrasib even earlier as a frontline therapy, as Sasse has done, may have even greater benefits over chemotherapy.
It may have already extended his life beyond the few months that he initially thought he would get when he received the diagnosis last December, Sasse said. “Given what the prognosis was,” he said, “and given what the tables say about pancreatic cancer, this experience has seemingly extended both quantity and quality of life.”
STAT Plus: Revolution Medicines touts ‘unprecedented’ data for pancreatic cancer pill
STAT spoke with Sasse about his experience on daraxonrasib for an upcoming feature looking at the breakthrough behind the new drug. This interview has been edited for length and clarity.
How did you first learn you had pancreatic cancer?
I just started with two main symptoms in October. A lot of significant back pain. I’m not the toughest guy, but grew up working on the farm. I’m used to some aches and pains. But I knew something was weird because the pain was significant. I’d feel these pressures in my back that would radiate, and would end up with weird stomach cramping. It was like 70% of all waking hours — shooting pain would start in the back and go to the front, and the front would have me doubled over.
I just thought I had pulled a bunch of muscles. We did blood tests. Nothing showed up. My doctor said, OK, let’s get you scheduled for some scans. He called me on a Friday morning. My kid was graduating from college the next day. He was stressed, worried, but not wanting to give me big bad news over the phone. I said, give me the hardest facts.
He said, “your torso has got a lot of tumors. And we’ve got a mass in the pancreas that is very significant.”
What was it like to learn that?
I wanted to focus on my kids, so I said, let’s schedule biopsies for the next Monday. It felt clearly like this was not going to work. Theology was issue one. As a Christian, there’s a phrase: to live is Christ and to die is gain. Issue two was thinking about, how do I love all my kids and wife in the time I have left. It felt like it wasn’t the right choice to let my kid’s graduation be stolen, so I didn’t want to reflect on it for 36 hours. We weren’t good at that.
How did you learn about the trial? What was the process like getting onto it?
I found MD Anderson and Memorial Sloan Kettering were the two places where we could figure out the genetic profile of my tumor fast. The next six days, we went for a day and a half at both. Nobody was saying I could live from what I have from traditional chemo. That seemed obvious; pancreatic survival rates are terrible.
I heard this pitch from the team at MD Anderson and traveled to Memorial Sloan Kettering. Dr. Eileen O’Reilly [of MSK] had been defined for me as the No. 1 pancreatic cancer doctor in the U.S. I’m getting a chance to meet with her, she agreed to see us. She basically said, if you have a shot to get into the trial, I’d take it. It became clear I was waiting around for them to say yes to me.
What was it like to be on the drug?
I’ve had lots of clinical benefits. It’s hard to unbundle the benefits of the morphine and early benefits of the trial. I’d been in so much pain. The second thing, when you start this kind of treatment, they said the tumor will fight back. I got on the daraxonrasib and my back pain is back and it was terrible. At the same time, I’m on morphine. Bob Wolff [medical oncologist at MD Anderson] told me it’s a good sign the tumor is responding. I also started having massive facial bleeding. I had to pause and get antibiotics, then get back on the drug.
Now, my CA 19-9 levels have completely collapsed. [A common blood marker of pancreatic cancer. Falling levels can be a sign cancer is responding to treatment.] So that’s awesome. It was 8,100, north of 8,000, when I started on the trial. This week [mid-March] I fell from 579 to 374. That’s huge. Something like 60% tumor volume reduction. My pain is way, way down.
When you think about this trial, it’s testing one of the first major advances for pancreatic cancer in decades. What does that mean to you to be part of it?
First of all, I’m incredibly grateful to the folks who dedicate their time and talent to this research. My team, Bob Wolff and Shubham Pant at MD Anderson, are great. The purpose of a trial is not the individual care of a single patient, but the benefits of getting data to advance the next generation for clinical care. I understood that.
But I’m incredibly grateful to the whole team at MD Anderson and the way they’ve treated us. It’s been amazing care. The fact I don’t have to be permanently hospitalized. I can get out of the hospital, get extended time with my family.
