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Zoldonrasib + gemcitabine + nab-paclitaxel is an investigational combination regimen being evaluated for the first-line treatment of patients with previously untreated metastatic pancreatic ductal adenocarcinoma (PDAC) harboring a KRAS G12D mutation. The regimen combines zoldonrasib (RMC-9805), an oral, mutant-selective, covalent tri-complex RAS(ON) G12D inhibitor developed by Revolution Medicines, with standard-of-care chemotherapy consisting of gemcitabine (a nucleoside metabolic inhibitor) and nab-paclitaxel (an albumin-bound formulation of paclitaxel). Zoldonrasib acts as a molecular glue that recruits cyclophilin A to form a complex that selectively binds and inhibits the active, GTP-bound state of the KRAS G12D mutant protein, thereby blocking downstream oncogenic signaling. In a Phase I/II study (RMC-GI-102), the combination demonstrated an objective response rate of 61% and a disease control rate of 90% in patients with first-line metastatic pancreatic cancer. This combination is being further evaluated in the global, randomized Phase III RASolute 305 trial.
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