But a new drug appears poised to improve the prognosis for many patients with advanced pancreatic cancer — and two local hospitals will be among the first to distribute it.

On Tuesday, Intermountain Health announced at a press briefing in Murray that 10 Intermountain Hospitals in Utah, Colorado and Montana — including McKay-Dee Hospital in Ogden and Intermountain Health Layton Hospital in Layton — will be part of the Expanded Access Protocol to provide eligible patients with advanced pancreatic cancer access to daraxonrasib.

“This is a true paradigm shift in how we treat pancreatic cancer,” Dr. Mark Lewis, director of gastrointestinal oncology at Intermountain Health, said at Tuesday’s briefing. “I can’t remember the last time I saw such a positive leap forward in the treatment of pancreatic cancer. This really does appear to be a game changer in the treatment of this terrible disease.”

Speaking with the Standard-Examiner on Wednesday, Lewis said a couple factors make pancreatic cancer exceedingly hard to fight.

“All cancer by definition is mutated, and over 90% of pancreas cancer contains within it a mutation called RAS,” he said. “Until this summer, we were unable to directly treat RAS. We didn’t have a medicine that could treat that mutation specifically, so we were using chemotherapy quite indiscriminately, I would say. The other problem is location. The pancreas is located towards the back of the abdomen. It’s extremely hard to access anatomically, and it tends to be relatively silent at first when a cancer develops, to the point that we find 85% or so of these cases when the tumor has already metastasized.”

He said that, by the time it is discovered, there’s usually little that can be done.

“This year, just for context, something like 60,000 Americans will be diagnosed with pancreas cancer, and about 50,000 will die of it,” he said.

Enter daraxonrasib.

“It’s a pill that directly targets the RAS mutation,” Lewis said. “And again, the reason this is such a leap forward for us is we’ve never been able to target this mutation before.”

He said previously this was done with chemotherapy, which itself could be a very intensive treatment.

“We’ve only been able to give chemo, which kills fast-growing cells,” he said. “It doesn’t specifically target the mutation. And also, these are patients that now don’t have to come and get intravenous chemo every two weeks, which was previously our cycling.”

Lewis said it’s part of a growing understanding within oncology.

“There’s an emerging awareness in oncology that we need to be very, very protective of patients’ time,” he said. “So one measurement we have is called time toxicity — how much time are you taking away from the patient being at home, with their family, or even working, when they’re getting their intravenous treatment? So the pill is appealing, because it’s oral; it’s taken daily.”

According to a press release about Tuesday’s press briefing, “results of the clinical trial of 500 patients were presented at the American Society of Clinical Oncology annual conference in May. The study found that as a second line of treatment, daraxonrasib doubled survival time for patients with metastatic pancreatic cancer, increasing it from 6.7 months to 13.2 months. ”

Lewis said there’s a reason the 10 hospitals were chosen to help start administering the drug.

“We’re in this gap between knowing this drug works and FDA approval,” he said. “But in the meantime, we need a mechanism whereby patients can get access to the pill, so it’s called an Expanded Access (Protocol). What it means is every patient is essentially participating in a clinical trial in which they are the only patient. And the reason that it’s the 10 sites (across the West) is you need to have an oncologist on site who’s essentially willing then to be the leader of that clinical trial.  And we’re very lucky at Intermountain. That means across our 10 hospitals so far and counting, we can do this in Utah, we can do this in Colorado, we can do this in Montana.”

He said other locations across the country will be  participating in the Early Access Protocol for daraxonrasib, which will become available at the 10 participating Intermountain Health hospitals next week.

“The company that makes this drug submitted their application to the FDA for approval on July 22,” he said. “And the reason that matters is usually drug approvals like this take about six weeks, so that’s why I think the final approval will come in September.”

After final approval, the drug will be available at any clinic or hospital where an oncologist can prescribe it.

Lewis said that while many in the public may wonder why an extra year is something to write home about, it makes sense for those who are impacted by pancreatic cancer.

“The best feeling is when you meet with a patient and you can give them legitimate optimism,” he said. “Already online after yesterday’s (announcement) — and understandably — people look at this and say, ‘Oh, this is only only a year of life and people who are still incurable,’ and those things are true. Things look very differently when it’s you or your family, I have to say. And again, the value proposition of an oral treatment that gives you essentially double our current longevity and keeps you hopefully out of the clinic and hospital as much as possible. That’s very, very appealing.”

He was quick to stress that while there are reasons to be excited about the advent of daraxonrasib, it comes with some realities.

“This is the very first drug that can do this,” he said. “Usually what happens in our field is the first drug is usually the most toxic and often the least effective. So I like where this is going. I think we now know that we can target this mutation and I think we’ll get better at it.”

Lewis said it isn’t even the first time a pill was tried for pancreatic cancer treatment — though daraxonrasib still seems to suggest a major improvement.

“Basically for 30 years, since the late 90s, the only thing we’ve had to offer pancreas cancer patients was intravenous chemo,” he said. “There was pretty famously an attempt to use a pill in 2005 and the pill only extended life by two weeks. So again, a year seems like a big deal compared to two weeks.”

He also noted that the patients in the study had also utilized intravenous chemotherapy prior to utilizing daraxonrasib . However, studies are underway to see if the pill works on its own from day one.

“What we don’t know yet, and trials are ongoing, is, ‘Well, can you just use this pill by itself first?'” he said. “That’ll be a really interesting question to answer, because if that becomes evident, then we won’t need to do intravenous chemo maybe at all. Now, we’re not there yet, and that’s a huge leap.”

With FDA daraxonrasib’s approval likely in the coming months, Lewis said he feels that this is only the next step in what will be many steps forward in treating pancreatic cancer.

“For years, this RAS mutation was held up as the ultimate example of the mutation that we just couldn’t target,” he said. “We knew it was there. We couldn’t do anything about it. And at the conference where this new drug was announced, walking into that conference, I heard so many of my colleagues saying, ‘You know, now nothing is undruggable.’ Like, if this is something we can treat, then we can treat any mutation, and I kind of stand by that. Oncologists are maybe prone to being optimists. I’m a very reasonable optimist, I hope, and I think this is very reasonably optimistic. This is the start of us improving outcomes for pancreas cancer patients.”