Pancreatic cancer has a 13% five-year survival rate. Last Sunday, a room full of oncologists at ASCO gave a standing ovation to a pill that doubled survival time. The drug targets KRAS mutations — present in 92% of pancreatic cancers and found across colorectal, lung, and other tumours. A Canadian oncologist from Princess Margaret was the one invited to put it in context. It's not available yet. But your patients are already Googling it. Good morning. 🫡
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A Pill Just Did What Chemo Couldn't
Daraxonrasib doubled pancreatic cancer survival. The room stood up.
What happened: A Phase III trial of daraxonrasib — a once-daily oral pill — doubled median survival in advanced pancreatic cancer from under seven months to roughly thirteen, halting or reversing tumour progression in nearly a third of patients versus 10% on chemotherapy. Published in the NEJM on Sunday. Presented at ASCO 2026 in Chicago to a standing ovation. Dr. Jennifer Knox from Princess Margaret Cancer Centre in Toronto was the invited discussant. "A game changer in pancreatic cancer."
So what: There has never been a targeted therapy approved for pancreatic cancer — ever. Daraxonrasib blocks KRAS mutations, present in 92% of pancreatic cancers, using a passenger protein to get inside the cell and shut down the signal that makes tumours grow. The five-year survival rate for this disease is 13%. Some trial participants are still alive. That's the headline. KRAS mutations also show up in colorectal and lung cancers — this isn't one drug for one disease. It's the beginning of a class.
Now what: FDA review is underway. No Health Canada submission confirmed. Oral oncology typically flows through cancer centre pharmacies or specialized distribution loops — it won't be sitting on your regular shelf. That said, patients often show up at their community pharmacy first, prescription in hand, with no idea where to go next. Knowing how to route them — whether that's Ontario's Exceptional Access Program, a regional cancer network, or a specialty distributor — is the practical skill here. And when they walk in having Googled daraxonrasib at midnight, you just need to not look surprised when they mention the name.
⚡ Rapid Fire
💊 Generic Ozempic boxes are showing up — and they're enormous. Apotex and Dr. Reddy's generic semaglutide are hitting shelves across Canada. The drug is roughly a third the price of brand — great for patients. Less great for your fridge. The generic box is nearly twice the size of the Ozempic pen. Supply is patchy — some pharmacies are fully stocked, some are still waiting on allocations. And the DIN on the Apotex box looks like it was stamped on by hand in a hurry, which it probably was. If your patients ask "is it the same thing?" — yes. Same molecule, same pen format, same injection. The box is just bigger and uglier.
🧪 Starting October 1, pharmacists can therapeutically substitute controlled substances. New federal regulations will replace the s.56 class exemption that expires September 30. The headline: pharmacists will have the authority to therapeutically substitute one controlled substance for another — where permitted by provincial or territorial regulation. This is permanent authority, not a pandemic workaround. Central fill barriers for controlled substances are also being removed. The catch? The feds are giving the green light, but how quickly your provincial college actually updates their regulations to let you use it is a different timeline entirely. Four months out. Worth checking where your province stands.
🌙 Melatonin for kids — the Slenyto confusion is real. As of September 2025, Health Canada added melatonin to the Prescription Drug List — but only Slenyto, the extended-release formulation indicated specifically for insomnia in children aged 2–17 with ASD or Smith-Magenis syndrome. The gummies, the chewables, the drops at Costco — still OTC, still regulated as Natural Health Products, still unaffected. The confusion is that many pharmacists and most parents don't know this distinction exists. And it's about to get more complicated: Health Canada has signalled it intends to propose broadening the restriction to melatonin sold for any pediatric sleep use. The consultation hasn't dropped yet — but it's coming. Watch for it.
📡 Abbott's FreeStyle Libre just got a second number — ketones. Not here yet, but watch this. Abbott received European CE mark for the Libre Duo — the world's first sensor that continuously monitors both glucose and ketones simultaneously. No finger prick. No urine dipstick. Real-time ketone data, 24/7. The 15-day adult version and a 10-day version for kids 2 and up are heading to select European markets this year. FDA review is underway with approval expected in the second half of 2026. Health Canada hasn't moved yet — this is not coming to your counter anytime soon. But it matters. DKA catches are going to start happening in real time for patients using this device. Early DKA symptoms — nausea, fatigue, malaise — are routinely mistaken for other things, and that delay kills. When this eventually lands in Canada, your T1D patients will ask before their endocrinologist has even heard of it. Worth knowing the name now.
🤖 A mystery company accidentally spent $500M on AI in one month. No usage limits. No spending cap. Just vibes. The identity is unknown but the scale narrows it to only the very largest corporations on earth. Amazon, separately, had to shut down its internal AI leaderboard after employees were caught running up token counts doing meaningless tasks — including using AI to check the weather. We don't have a pharmacy angle on this one. It's just genuinely unhinged and you deserve to know.
THE PICK: 💡 Open Evidence — think of it as the version of ChatGPT that only reads peer-reviewed journals. You ask a clinical question — "alternatives if metformin causes diarrhea," "latest evidence on X" — and it surfaces a synthesized answer with links to the actual studies behind it. No hallucinations from random internet content. Pulls exclusively from PubMed, NEJM, JAMA, and major clinical guidelines. Scored 100% on the USMLE. Free for verified healthcare professionals. Built with US physicians in mind so Canadian verification may vary — but worth signing up and testing. If UpToDate costs money you don't have and Google Scholar takes time you don't have, this sits right in between.
💬 Counter Talk
McKesson put animated ads inside the ordering portal. Not subtle sidebar ads. Animated. Spinning. The kind you'd see on a 2003 celebrity gossip site between "Who wore it better?" and a flashing "YOU ARE THE 1,000,000th VISITOR" banner. You're mid-order, trying to source a backordered product your patient's been waiting on, and the screen looks like early internet. The drug supply portal — the one you have no choice but to use — now has production value somewhere between a pop-up ad and a MySpace page. Nobody asked for this.
That's it. If this landed, forward it to a pharmacist who'd get it. If something was wrong, missing, or worth arguing about — hit reply. We read everything at [email protected].
— The Sig Happens Team 💊