The most honest record of how my oncology practice has changed may be hiding in the least glamorous place: my EMR smart phrases.
Like many oncologists, I keep a personal library of these behind commands I type constantly: .pancreas2l, .breastneoadj, .tnbcmet. They’re more than just shortcuts. They’re how I stay current with rapidly evolving treatment paradigms. I genuinely can’t imagine practicing without them.
In clinical oncology, we often have to explain the same data repeatedly, though in personalized ways. A patient wants to know the schedule. A spouse asks about median survival. A daughter asks whether the benefit is real. It may be the tenth conversation of my day, but it is the first time that family has heard it. Smart phrases help me deliver accurate statistics, trial names, and toxicities consistently.
But smart phrases have one major flaw: they age.
The EMR never tells us that a smart phrase I created three years ago is now obsolete. For example, the neoadjuvant treatment paradigm for bladder cancer changed twice in a matter of less than 12 months, from chemotherapy to chemo immunotherapy to the current antibody drug conjugate (ADC)/immunotherapy combination of enfortumab vedotin/pembrolizumab. That is why, after big meetings like the American Society of Clinical Oncology (ASCO), I try to update my smart phrases, as my conversation with my next patient may be different. Although the process of updating smart phrases seems like clerical documentation maintenance, I have come to look at it as an annual harvest of the years-long clinical research that is presented in the form of practice-changing abstracts at national meetings.
Some years, and for some cancers, the harvest has been abundant. My smart phrases for cancers like melanoma and HER2/neu positive breast cancer have become more optimistic because treatments have become more effective.
Pancreatic cancer has been different.
For years, my pancreatic cancer smart phrases were among the least exciting to update. Although there were many new treatment regimens, the language stayed guarded: palliative intent, limited options, modest benefit, and median survival measured in months. A 2024 Lancet Oncology essay summarized the frustration in its title: metastatic pancreatic cancer had seen “25 years of innovation with little progress for patients.”
This year, pancreatic cancer treatment had its biggest moment ever. At ASCO 2026, the Phase 3 RASolute 302 trial evaluated Daraxonrasib, an oral RAS(ON) multiselective inhibitor, against investigator’s-choice chemotherapy in previously treated metastatic pancreatic ductal adenocarcinoma. In the RAS G12 population, median overall survival was 13.2 months with daraxonrasib versus 6.6 months with chemotherapy. In the overall trial population, it was 13.2 versus 6.7 months. The hazard ratio for death was 0.40 in both groups. Progression-free survival and response rate also improved, and treatment-related discontinuation was lower with daraxonrasib than with chemotherapy, according to the RASolute 302 publication.
The deeper significance is not just that an oral agent beat chemotherapy in the second-line setting. It is that oncogenic RAS – long considered undruggable and responsible for driving most pancreatic cancers – may finally be clinically targetable. The old question was often “What chemotherapy can this patient still tolerate?” The new one is “Can we suppress the dominant oncogenic driver?”
One positive trial does not erase the remaining questions around approval, access, sequencing, resistance, and real-world tolerability. Pancreatic cancer remains a formidable disease. But caution should not make us numb to progress, or its celebration!
So here is the smart phrase I recently saved:
.pancreas2l: Data from RASolute 302 showed that daraxonrasib improved OS vs chemotherapy in previously treated mPDAC — 13.2 vs 6.6 mo in RAS G12 and 13.2 vs 6.7 mo overall; HR 0.40 in both groups. Serious side effects occurred in fewer patients in the Daraxonrasib group.
Although this smart phrase represents a small portion of a clinic note, it feels historic. I will be enjoying this smart phrase for now and hoping that this update will be the first of many to come, as we enter the era of RAS inhibition in pancreatic cancer.
I think we should all update our smart phrases regularly, no matter what specialty of medicine we’re in. It’s a simple way to keep our notes and our thinking aligned with the pace of progress in medicine. We owe it to our patients.
What smart phrases will you be updating this year? Share in the comments.
Dr. Wishwdeep Dhillon is a medical oncologist and hematologist at Honor Health Cancer Care in Gilbert, AZ. His areas of interest include breast cancer and pancreatic cancer. Dr. Dhillon has a special interest in AI adoption to improve quality of care. He writes for his cancer wellness blog at www.completeremission.com
Image by Anton Vierietin / Shutterstock
