Brad Dugai thought his pancreatic cancer was gone.
After chemotherapy through Riverside Health System and radiation treatment in Miami, his scans showed no sign of cancer for several months. But in July 2025, pain in his groin and leg led him back to his oncologist.
A scan showed the cancer had returned in a lymph node near his pancreas. Dugai, who lives on Gwynn’s Island in Mathews County, was restaged as having Stage 4 pancreatic adenocarcinoma.
Today, Dugai said his cancer is no longer visible on CT scans after taking daraxonrasib, an investigational targeted cancer drug he accessed through a clinical trial at Duke Pancreatic Cancer Center.
But getting there required traveling about 3 ½ hours from his rural community.
Now, a federal expanded access program could make the drug easier to reach for some patients outside major cancer centers, because eligible patients may be able to receive it through their local oncologist.
Dugai’s cancer journey started in spring 2024, when he felt pressure in his abdomen and pain in his back.
At first, he thought it might be from working out.
He waited a few weeks. The pain did not go away.
In May 2024, just before a family trip to California, Dugai went to the emergency room at Riverside Walter Reed Hospital in Gloucester. A scan showed what doctors suspected was pancreatic cancer.
The diagnosis came as a shock.
“It was nothing that I had a family history of, or didn’t have any lifestyle indicators to point to it,” Dugai said.
After he was restaged in 2025, his local oncologist told him to look for a clinical trial.
That led him to Duke Pancreatic Cancer Center, where he began taking daraxonrasib, the investigational targeted pancreatic cancer drug developed by Revolution Medicines.
Dugai said the pain in his groin and leg disappeared within one day of his first dose. He later stopped chemotherapy and continued taking daraxonrasib as a daily pill.
His CT scans have since shown continued shrinkage in the cancerous lymph node, he said.
Dugai is now considered to have no evidence of disease.
Pancreatic cancer is not among the most commonly diagnosed cancers in the U.S., but it is one of the deadliest.
The National Cancer Institute estimates roughly 67,500 people will be diagnosed in the U.S. this year, and more than 52,000 people will die from it. The five-year relative survival rate is about 14%.
Ryne Ramaker, a senior fellow in gastrointestinal oncology at Duke Cancer Center who focuses on pancreatic cancer, said treatment options for advanced pancreatic cancer have historically been limited.
Before daraxonrasib, Ramaker said many patients relied on combinations of chemotherapy drugs. Those treatments often require patients to come in for infusions every two weeks and can cause difficult side effects.
By comparison, daraxonrasib is a pill patients take at home after they begin treatment.
Daraxonrasib is not fully FDA-approved. But in May, the FDA allowed the manufacturer to begin an expanded access treatment protocol for some patients with previously treated metastatic pancreatic ductal adenocarcinoma, an aggressive form.
Expanded access, sometimes called compassionate use, allows eligible patients to receive an investigational drug outside a clinical trial. Under the program, licensed physicians submit requests to the company on behalf of patients.
Ramaker said the program could be especially relevant for rural patients, who may live far from major cancer centers or infusion clinics.
“If it’s a drive for patients to get to the clinic to get infusions and regular laboratory monitoring, while you’re on chemotherapy, this drug provides a lot of convenience,” Ramaker said. “You’re coming to the clinic less.”
Ramaker said any oncology clinic or provider can apply for access through the protocol, as long as the patient meets the criteria. Patients generally must have advanced disease and have already progressed on one line of therapy.
“Just because I live in a rural space doesn’t mean I don’t have access to good quality care,” Dugai said.
The drug can still have side effects. Dugai said he developed a severe skin rash, which doctors later helped control with medication. Ramaker said rash is the main side effect doctors are watching, along with possible changes in blood counts and liver function.
Ramaker said researchers are still studying how best to dose the drug, manage side effects and determine when patients should receive it.
