# Treatment landscape from first‐ to third‐line therapy and quality of life data of patients with pancreatic cancer from the prospective German PARAGON (Platform for Outcome, Quality of Life, and Translational Research on Pancreatic Cancer) registry (IKF‐PARAGON study)

## TL;DR

This study analyzed treatment patterns and quality of life in pancreatic cancer patients across multiple therapy lines in Germany.

## Contribution

The study provides detailed patient flow and QoL data across first to third-line therapies in pancreatic cancer.

## Key findings

- Median overall survival for first-line therapy was 10.6 months.
- Quality of life was maintained during first-line treatment despite aggressive therapies.
- Patient age, toxicity, and disease progression influenced treatment termination.

## Abstract

Pancreatic cancer (PCA) is the third leading cause of cancer‐related death in Europe. Despite recent therapeutic advances, patients experience rapid health deterioration. Based on previous results, the Platform for Outcome, Quality of Life, and Translational Research on Pancreatic Cancer—PARAGON (NCT04119362) was initiated to investigate the whole life cycle of PCA patients. Between November 2019 and October 2021, 469/479 screened patients were enrolled in 46 sites. Demographic, clinical, and quality of life (QoL) data were collected. The treatment landscape was depicted using Sankey diagrams. Median overall survival (mOS) for all patients in first line was 10.6 months (95% confidence interval [CI], 9.2–11.7 months). With mFOLFIRINOX as first‐line treatment, mOS was 11.3 months (95% CI, 8.6–13.5 months), with gemcitabine/nab‐paclitaxel 10.5 months (95% CI, 8.3–12.9 months). The mean Global Health Status for patients that proceeded from first to second line did not substantially deteriorate during first line. Predictive variables for proceeding from first to second‐line therapy were reasons for ending first‐line treatment (patient's wish, toxicity, and progressive disease) and age. In summary, we were able to show in detail patient flows and QoL data throughout all therapy lines, which will help to further understand the major clinical checkpoints of the disease.

Pancreatic cancer often is diagnosed at advanced stages. As a result, treatment regimens frequently are aggressive, with substantial side effects that impact quality of life (QoL). This study examined the treatment landscape, from neoadjuvant therapy to palliative care, in the context of QoL among pancreatic cancer patients in Germany. Most patients initiated therapy with palliative intent. The predominant first‐line regimens were gemcitabine/nab‐paclitaxel, modified FOLFIRINOX, and gemcitabine monotherapy, with notable differences in treatment efficacy. QoL, although lower than the general population, was maintained during first‐line treatment. Treatment termination was influenced by factors such as age, toxicity, disease progression, and patient wish.