How do you manage toxicities in patients with mPDAC receiving daraxonrasib?

In our experience, we have found several strategies effective:

• Rash: Doxycycline 100 mg twice daily, avoid all sun exposure and use sunscreen, apply hydrocortisone 2.5% twice daily to face and upper chest and back and neck apply emollient moisturizer to arms, legs, hands, feet at least twice daily.
• Nausea: Start an antiemetic for at least the first week prior to pills.
• Mucositis: Nothing seems to work perfectly well. Baking soda 1 teaspoon: salt 1 teaspoon: 4 cups water mouth rinse multiple times daily, soft tooth brush, avoiding all spicy/hot/painful foods. Once it starts, only dose holds seem to help, then restart. I have had someone have this for 12+ months, and we just keep holding/restarting. I am thinking about experimenting with ora...

Agree with Dr. @Dr. First Last. In addition:

• Dexamethasone mouth rinse can help, to some extent, with mucositis. I ask patients to start it at the first hint of mucositis, including increased oral mucosa sensitivity
• Holding early if mucositis is not quickly responding to Dex rinse or rash is grade 2 or painful is important
• Upon restarting daraxonrasib, I lower the dose to 200 mg per day if side effects were severe, especially if they developed quickly upon starting treatment
• Doxycycline may cause abdominal discomfort. Taking it with food can help. Another option with fewer GI side effects is Minocycline