The randomized controlled trial of daraxonrasib, published in the New England Journal of Medicine and presented at ASCO 2026, enrolled 500 patients with previously treated metastatic pancreatic ductal adenocarcinoma and demonstrated a median overall survival of 13.2 months versus 6.7 months with chemotherapy. This double-arm RCT design strengthens causal inference compared with prior observational series on KRAS inhibitors, though the open-label structure introduces potential bias in quality-of-life reporting. Revolution Medicines' sponsorship creates clear financial conflicts of interest that warrant scrutiny of subgroup analyses showing prolonged treatment duration. While the drug addresses the KRAS G12 mutations present in over 90% of cases, earlier-phase data on sotorasib (NEJM 2022, n=38) revealed rapid resistance via secondary mutations, a pattern likely to recur here and explaining the noted waning efficacy. The American Cancer Society's 2025 surveillance data underscore stagnant 13% five-year survival, highlighting how this oral agent could expand surgical candidacy if neoadjuvant trials succeed, yet expanded-access programs risk exacerbating disparities absent equitable distribution frameworks.