--- title: "Rasonque Sold $198M in Five Weeks, 7x Above Forecast" url: https://drugnews.com.tw/articles/2026-11-07-rasonque-pancreatic-cancer-launch-q3-pharmaengine-prmt5-en.html date: 2026-11-07 lang: en category: "商業分析系列" tags: ["pancreatic cancer","Rasonque","RAS inhibitors","PharmaEngine","PRMT5"] summary: "Rasonque booked $197.6M in about five weeks and reached 5,000+ U.S. patients. Second-line chemo goes first; next comes first line and RAS-plus-PRMT5 combos, a mixed picture for Taiwan's PharmaEngine." json: https://drugnews.com.tw/articles/2026-11-07-rasonque-pancreatic-cancer-launch-q3-pharmaengine-prmt5-en.json publisher: Drugnews｜藥時事 (https://drugnews.com.tw/) --- ## 三句看懂 - Rasonque's launch shows pancreatic cancer is a large market held down by chemotherapy; 2027 global net sales will exceed $2 billion. - Q3 included expanded-access conversions and stocking, yet it still beat Lumakras' first four months more than fourfold in a third of the time. - Rasonque cuts both ways for PharmaEngine (4162): second-line Onivyde is displaced first, first-line NALIRIFOX holds until RASolute 303 reads out, and its PRMT5 inhibitor PEP08 was still in Phase 1 as of November 2026. ## 關鍵數字（附來源） | 項目 | 數值 | 日期 | 來源 | |---|---|---|---| | FDA approval of Rasonque (daraxonrasib) | 2026-08-26 date | 2026-08-26 | FDA 2026-08-26 | | Rasonque Q3 2026 U.S. net product revenue (~5 weeks) | 197.6 USD million | 2026-11-04 | Revolution Medicines 2026-11-04 | | U.S. commercial patients from approval to Sept 30 | >5000 patients | 2026-11-04 | Revolution Medicines 2026-11-04 | | Share of U.S. PDAC covered lives with reimbursed claims | >90 % | 2026-11-04 | Revolution Medicines 2026-11-04 | | Wholesale acquisition cost per 30 days | 39800 USD | 2026-08-27 | Stocktwits 2026-08-27 | | RBC Q3 2026 U.S. revenue estimate | 28 USD million | 2026-08-27 | Stocktwits 2026-08-27 | | RBC long-term annual sales estimate | 11.5 USD billion | 2026-08-27 | Stocktwits 2026-08-27 | | RASolute 302 median OS, Rasonque vs chemo | 13.2 vs 6.7 months | 2026-08-26 | FDA 2026-08-26 | | RASolute 302 OS hazard ratio | 0.4 HR | 2026-08-26 | FDA 2026-08-26 | | Discontinuation due to TRAEs, Rasonque vs chemo (RAS G12) | 1.2 vs 11.2 % | 2026-05-31 | OncoDaily 2026-05-31 | | Patients supplied via expanded access before approval | >2000 patients | 2026-08-05 | Revolution Medicines 2026-08-05 | | Gross-to-net range (Q3 at low end) | 20-30 % | 2026-11-04 | Gloom 2026-11-04 | | Lumakras cumulative sales through Q3 2021 | 45 USD million | 2021-11-02 | Amgen 2021-11-02 | | Ipsen no longer expects Onivyde and Tazverik peak sales of | 500 EUR million | 2026-02-12 | Ipsen 2026-02-12 | | Vopimetostat + Rasonque ORR in MTAP-deleted PDAC (n=22) | 82 % | 2026-10-23 | pharmaphorum 2026-10-23 | | MTAP deletion share of pancreatic cancer | 18-40 % | 2026-10-23 | pharmaphorum 2026-10-23 | | CHMP positive opinion date | 2026-10-15 date | 2026-11-04 | Gloom 2026-11-04 | | Revolution Medicines Q3 2026 net loss | 407.5 USD million | 2026-11-04 | Revolution Medicines 2026-11-04 | | PharmaEngine 1H 2026 revenue | 4.98 TWD 100 million | 2026-08-06 | Fugle Research 2026-08-06 | | PharmaEngine 1H 2026 Europe/Asia royalties | 3.13 TWD 100 million | 2026-08-06 | Fugle Research 2026-08-06 | | Onivyde first-line regimen reimbursed by Taiwan NHI | 2025-12-01 date | 2026-08-06 | Fugle Research 2026-08-06 | The analysts were wrong by a factor of seven. In the week Rasonque was approved in late August, RBC Capital Markets pencilled in roughly $28 million of U.S. sales for the pancreatic cancer pill's first quarter. On November 4, Revolution Medicines reported $197.6 million in net product revenue, from about five weeks on the market. **Rasonque's launch shows that pancreatic cancer was never a small market of too few patients who live too short a time; it was a large market held down by four decades of chemotherapy. The drug will clear $2 billion in annual sales in 2027, and the fight now moves to first-line treatment and to RAS-plus-PRMT5 combinations, where Taiwan's PharmaEngine already has a horse in the race.** The approval story ran here in August. This piece is about the money: who underestimated it, whose territory it is taking, and where Taiwanese patients and Taiwanese companies stand. ## 01 | Five weeks, five thousand patients Start with the company's own figures. The FDA approved Rasonque (daraxonrasib) on August 26, 2026, for adults with metastatic pancreatic adenocarcinoma who have received at least one prior systemic therapy or who cannot tolerate multi-agent chemotherapy. Between approval and September 30, more than 5,000 unique patients in the U.S. received commercial drug. Third-quarter net product revenue was $197.6 million. This was not a handful of academic centers carrying the launch. Revolution Medicines says claims have been reimbursed across health plans covering more than 90% of U.S. pancreatic cancer covered lives. The National Comprehensive Cancer Network (NCCN) already lists Rasonque as a Category 1 preferred option for subsequent therapy. The price is not modest either. The company's wholesale acquisition cost is $39,800 per 30-day supply, close to $478,000 a year at list. RBC's two numbers at approval were about $28 million for the third quarter and roughly $11.5 billion in long-term annual sales. The first number was beaten seven times over. The second no longer looks outlandish. **This was pent-up demand released all at once.** ## 02 | Why it sold: doctors and patients had been waiting The first reason is that the efficacy gap is too wide to ignore. In the 500-patient Phase 3 RASolute 302 trial, median overall survival was 13.2 months with Rasonque versus 6.7 months with chemotherapy, a hazard ratio of 0.40. Median progression-free survival was 7.2 versus 3.6 months, and the objective response rate was 30% versus 11%. The second reason is tolerability. In the RAS G12 population presented at ASCO 2026, treatment-related adverse events led to discontinuation in 1.2% of Rasonque patients and 11.2% of chemotherapy patients. Grade 3 or higher treatment-related events occurred in 43.6% versus 57.5%. Peripheral neuropathy drove most chemotherapy discontinuations; rash and stomatitis were Rasonque's main problems. A daily pill at home instead of an infusion chair every two weeks is a quality-of-life difference for patients with metastatic disease. The third reason is that demand was already queued. Before approval, Revolution Medicines supplied drug to more than 2,000 patients through its expanded access program. After approval, those patients, a waitlist, and newly eligible patients converted to commercial prescriptions in the same quarter. Speed amplified all of this. The FDA used Real-Time Oncology Review and the Commissioner's National Priority Voucher pilot, and approved the drug about 6.5 months ahead of its goal date. Patients who would otherwise have waited until next year for the drug arrived in a single quarter. ## 03 | How much was one-off: do not multiply Q3 by four The obvious question is whether this was a one-time spike. Partly, yes. Revolution Medicines itself split third-quarter revenue into four sources: expanded access conversions, waitlisted patients, newly eligible patients and initial channel stocking. It called these finite early-launch dynamics. CFO Jack Anders said the channel ended the quarter with less than two weeks of inventory. Anthony Mancini said it was too early to draw conclusions about the normalized trajectory. Pricing will also erode a little. Gross-to-net deductions came in at the low end of a 20% to 30% range, and the company expects them to rise. Early patients were sicker, which means shorter treatment durations. Strip all of that out and the conclusion still holds. Compare it with the first drug in the same family. Amgen's Lumakras, the first approved KRAS inhibitor, launched at the end of May 2021 and booked cumulative sales of $45 million through the end of September. Rasonque did more than four times that amount in a third of the time. ![Fig. 1 | Early launch revenue: forecast, predecessor, actual](https://drugnews.com.tw/assets/articles/rasonque-pancreatic-cancer-launch-q3-pharmaengine-prmt5-en/figure-01.png) *Fig. 1: RBC's third-quarter estimate was about $28 million; Lumakras reached $45 million in roughly four months; Rasonque booked $197.6 million in about five weeks. Sources: Revolution Medicines 2026-11-04; Amgen 2021-11-02; Stocktwits 2026-08-27.* The difference comes down to addressable patients. KRAS G12C is a small slice of pancreatic cancer, and Lumakras competes in a subset of lung cancer. Rasonque's trial enrolled patients with and without detected RAS mutations, so its label covers essentially all second-line metastatic pancreatic cancer. ## 04 | Whose market it takes: second-line chemotherapy goes first Rasonque's competitor is not another targeted drug. It is chemotherapy. The control arm in RASolute 302 let physicians choose among four standard regimens: gemcitabine plus nab-paclitaxel, Onivyde (liposomal irinotecan) plus 5-FU, modified FOLFIRINOX, and FOLFOX. Those four combinations are close to the entire second-line toolbox today. Onivyde is the most telling name on that list. Taken through early clinical development by Taiwan's PharmaEngine and then licensed to Merrimack, it won U.S. approval in the second-line setting in 2015 and added a first-line approval, as part of the NALIRIFOX regimen, in February 2024. In its full-year results in February 2026, Ipsen, which sells Onivyde in the U.S., said it no longer expects Onivyde and Tazverik to reach €500 million in peak sales, citing competitive intensity and product lifecycle. That cut came six months before Rasonque launched; with a new class of targeted drug now on the market, second-line chemotherapy's runway only gets shorter. ![Fig. 2 | How Rasonque grips RAS](https://drugnews.com.tw/assets/articles/rasonque-pancreatic-cancer-launch-q3-pharmaengine-prmt5-en/figure-02.png) *Fig. 2: Rasonque first binds the intracellular protein cyclophilin A, then the pair clamps onto RAS in its active "on" state and shuts down the growth signal; no single-mutation test is required. Sources: FDA 2026-08-26; Revolution Medicines 2026-11-04.* ## 05 | The next front: first-line and RAS plus PRMT5 With second line taken, the larger prize is first line. First-line patients are more numerous, fitter and stay on treatment longer. Revolution Medicines' first-line Phase 3, RASolute 303, has completed U.S. enrollment and expects to finish global enrollment in the first half of 2027. For now, NCCN lists Rasonque only as "useful in certain circumstances" for treatment-naive metastatic disease. Until then, NALIRIFOX, FOLFIRINOX and gemcitabine combinations hold the first-line market. Lung cancer is a second prize not yet in the revenue line. NCCN already lists Rasonque as a Category 2A targeted option for metastatic non-small cell lung cancer with KRAS G12, G13 or Q61 mutations. The lung Phase 3, RASolve 301, will close all sites by the end of November and expects an initial readout in 2027. A win there would turn Rasonque from a single-tumor drug into a multi-tumor franchise. A faster route is also emerging: pairing Rasonque with a PRMT5 inhibitor. Roughly 18% to 40% of pancreatic cancers have lost a gene called MTAP, which makes the tumor unusually dependent on the enzyme PRMT5. At ESMO in October, Tango Therapeutics reported that its PRMT5 inhibitor vopimetostat plus Rasonque produced an 82% objective response rate in 22 previously treated patients with MTAP-deleted pancreatic cancer. At nine months, 88% of those patients were alive and progression-free. Tango plans to start a front-line Phase 3 in the first half of 2027. Revolution Medicines' Asian partner BeOne Medicines also announced in August that it will test its own MTA-cooperative PRMT5 inhibitor with Rasonque. ![Fig. 3 | The pancreatic cancer treatment map is being redrawn](https://drugnews.com.tw/assets/articles/rasonque-pancreatic-cancer-launch-q3-pharmaengine-prmt5-en/figure-03.png) *Fig. 3: Rasonque is replacing chemotherapy in second line; first line awaits RASolute 303, and MTAP-deleted patients may move straight to a RAS-plus-PRMT5 doublet. Sources: Revolution Medicines 2026-11-04; pharmaphorum 2026-10-23.* ## 06 | Taiwan: PharmaEngine holds first-line chemo and a PRMT5 bet For Taiwanese patients, access runs through BeOne. On August 10, Revolution Medicines granted BeOne rights to Rasonque and three other RAS(ON) drugs in "select Asian markets," excluding Japan and South Korea. Neither company has said whether Taiwan is included. Rasonque has no Taiwan approval and no public filing timetable. The stakes are real. Taiwan's Ministry of Health and Welfare said in June that pancreatic cancer was the seventh leading cause of cancer death in 2025, and one of only three cancers whose age-standardized mortality rate rose. Among Taiwan-listed companies, PharmaEngine (4162) is the most directly tied to this shift. Its earnings engine is Onivyde: royalties on sales in Europe and Asia outside the U.S. and Taiwan, plus its own Taiwan sales; Ipsen handles the U.S. In the first half of 2026, revenue was NT$498 million, up 30%, and net income NT$271 million, up 126%, or EPS of NT$1.89. European and Asian royalties were NT$313 million, up 25%. Its strength is in first line. The Onivyde NALIRIFOX regimen has been reimbursed by Taiwan's National Health Insurance since December 1, 2025, and a Japanese approval could come by the end of 2026. Until RASolute 303 reads out, first line remains chemotherapy's ground. PharmaEngine's own pipeline is more interesting. Its PEP08 is an MTA-cooperative PRMT5 inhibitor of the same class as Tango's and BeOne's, designed for MTAP-deleted tumors and now in Phase 1 in Australia and Taiwan. The company has also reported synergy with its CHK1 inhibitor PEP07 in animal models. So Rasonque cuts both ways for PharmaEngine: second-line Onivyde is the first to be displaced, while the first-line NALIRIFOX regimen holds until RASolute 303 reads out. PEP08 targets the hottest combination in the field, but it is still in Phase 1, at least a full stage behind Tango, which plans to start Phase 3 in the first half of 2027. ![Fig. 4 | Where Taiwan sits in the shift](https://drugnews.com.tw/assets/articles/rasonque-pancreatic-cancer-launch-q3-pharmaengine-prmt5-en/figure-04.png) *Fig. 4: PharmaEngine earns Onivyde royalties and Taiwan sales in first line and is developing its own PRMT5 inhibitor, PEP08, for MTAP-deleted tumors; some Asian rights to Rasonque sit with BeOne. Sources: Fugle Research 2026-08-06; Revolution Medicines 2026-08-10; Ministry of Health and Welfare 2026-06-22.* ## 07 | What could cool the launch The risks, in one place. The first is treatment duration. The early wave of patients was sicker, real-world duration will run shorter than in the trial, and the fourth quarter is the first clean read without expanded-access conversions. The second is side-effect management: how well community oncologists handle rash, stomatitis and diarrhea will drive persistence. The third is price. A list price near $478,000 a year will be negotiated down, and more slowly, in Europe. ## 08 | The 2027 math: a $2 billion threshold Revolution Medicines lost $407.5 million in the third quarter and ended it with $3.65 billion in cash and marketable securities, before $250 million from the first Royalty Pharma debt tranche in October. It does not need money. It needs to prove the third quarter was not a firework. Rasonque's global net sales will exceed $2 billion in 2027, but not because the third quarter can be multiplied by four. Strip out the one-offs first. The CFO put quarter-end channel inventory at under two weeks. Even if two full weeks of the $197.6 million were stocking, underlying demand over the five weeks was at least $28.2 million a week, or about $1.47 billion a year. That is the floor. Getting from the floor to $2 billion takes 36% more, from two sources: new second-line patients arriving in the U.S. every month, and a European launch after the CHMP's positive opinion on October 15. The lung cancer trial, RASolve 301, will not read out until 2027 and is left out of this math. The number that would overturn this view is the fourth-quarter report due in February 2027. With 13 weeks and no initial stocking, a quarter below $300 million would mean weekly demand fell under $23 million, and the floor implied by the third quarter would not hold. 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