What’s new in prostate and pancreatic cancer treatment?

Dr Daleen Geldenhuys updates us on the latest breakthroughs in prostate and pancreatic cancer treatment presented at the 2026 ASCO Annual Meeting.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

About ASCO

The American Society of Clinical Oncology (ASCO) is the world’s leading professional organisation for physicians and oncology professionals caring for people with cancer. The 2026 ASCO Annual Meeting took place in Chicago, Illinois from 29 May to 2 June.

Prostate cancer treatment

Groundbreaking and practice-changing results are kept for the plenary session. This year ASCO didn’t disappoint, and the final results of the Phase 3 PROTEUS trial was presented. The anti-cancer medication, apalutamide, is already available and unlike other trials presented at the meeting, with the right motivation, this could change the lives of prostate cancer patients now.

Prostate cancer patients are stratified into certain risk categories (low, intermediate, and high risk) at the time of diagnosis. 

The treatment for patients with high-risk prostate cancer is a radical prostatectomy  but relapse occurs within five years in 50% of patients.

Trial objective

The Phase 3 PROTEUS trial evaluated the addition of apalutamide (oral androgen receptor blocker) plus androgen deprivation therapy (ADT) given before and after radical prostatectomy for high-risk localised or locally advanced prostate cancer.

There were dual endpoints; the one being complete disappearance of the cancer in the prostate when the surgery was performed.

Standard of care at the present time is surgery alone. The trial compared ADT (GNRH analogues/injections to prevent testosterone production) as a control arm. The trialists believed patients wouldn’t agree to a trial where they may not receive any therapy at all except for the prostatectomy, therefore the control arm had to offer treatment other than just observation.

The trial design

Patients were randomised into two groups. One group receiving ADT and apalutamide for six months prior to surgery versus ADT alone, followed by surgery and then completing another six months with the same protocol in the adjuvant setting. 

The trial was designed to answer the question: Did the combination therapy improve the pathological outcome where there was no cancer cells detected at the time of removal of the prostate? 

This endpoint was reached: 8.9% of patients had no detectable cancer and another 30.6% had tumour smaller than an ypT2. This indicates that after undergoing hormone therapy, the tumour has either completely disappeared or is microscopic, with no cancer found in the surgical specimen.

Secondary endpoint: The five-year metastases survival was 78.2% in the combination arm and 73.5% in the control arm (ADT) alone, compared to 50% as mentioned. 

Recovery of testosterone levels after completion of the therapy was around 80% at eight months. 

The reality is that patients who relapse   will receive ADT lifelong and this trial with limited duration of therapy will ensure that more men will enjoy relapse-free survival.

Always ask about new treatment regimens

Patients should always feel free to ask  what is new in the treatment of their cancers. Valuable research is done with the patient in mind. Always feel free to discuss news articles and other information with your practitioner. The results and trial data of the PROTEUS study is available online.

Pancreatic cancer treatment

Known as one of the deadliest cancers, pancreatic cancer often presents with little warning that something may be wrong, with no active protocols in place to identify who  is at risk and no screening tests in place to find the cancer at an early stage. Even when caught early, the outcome is still devastating.

The plenary session at ASCO received a standing ovation from the large oncology community who attended the conference and news spread fast around the globe  about a new treatment. An oral targeted medication, daraxonrasib, promises to make a difference in overall survival.

All cancers have different pathways and oncologists often ask for next-generation sequencing (NGS) testing. NGS is an advanced laboratory method that scans a tumour’s DNA or RNA for hundreds of genetic mutations at once. This comprehensive genomic profiling helps doctors identify actionable targets for personalised cancer treatments. We have been struggling to find a RAS target that will treat more mutations.

Daraxonrasib

Daraxonrasib is an oral RAS inhibitor of mutant and wild-type RAS. It has improved overall survival and progression-free survival in RAS mutant pancreas cancer patients, but also in the entire trial group which included RAS wild-type.

Compared to chemotherapy of choice in the control arm, daraxonrasib improved median overall survival to 13.2 months versus 6.7 months (chemo group) and median progression free survival to 7.3 months versus 3.5 months (chemo group). 

The treatment was second line. In other words, the patients received prior chemotherapy and progressed on the treatment before being allowed to participate in this trial.

Side effect profile

High incidence of cutaneous side effects, such as a rash and sore mouth. Diarrhoea, nausea, and vomiting are common, but these side effects were usually graded as 1 or 2. It has a lower incidence of Grade 3 adverse events compared to chemotherapy.

This is the first anti-RAS treatment that   isn’t limited to a specific mutation and  seems to be effective whether the mutation is present or not.

This is a giant step in the treatment of pancreas cancer. Our challenge is to fast-track the medication through regulatory authorities, make the medication available, affordable, and to manage the side effects in an acceptable manner.

Dr Daleen Geldenhuys is a specialist physician and medical oncologist who works at West Rand Oncology Centre at Flora Clinic and the ICON Unit at Johannesburg Surgical Hospital. She treats patients with all types of cancer and enjoys clinical research, and is a member of SASMO, SASTECS, ESMO and ENETS.

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