The treatment phase begins after completing one cycle of first-line chemotherapy. If receiving nab-paclitaxel and gemcitabine, this means one 28-day cycle has been completed. If receiving FOLFIRINOX, this means two 14-day cycles have been completed.

The study treatment will be administered alongside the ongoing chemotherapy. The treatment received will be either ponsegromab or placebo, which will be given as an injection solution.

The assignment to receive either the active medicine or placebo is determined randomly, and neither the treating physician nor the participant will know which treatment is being administered.

At week 12, several measurements and assessments will be conducted to evaluate the treatment effects.

Body weight will be measured and compared to the weight recorded at the beginning of the study.

A CT scan (or MRI if allergic to CT contrast) will be performed to assess body composition, including measurements of muscle and fat tissue at specific locations in the abdomen.

Questionnaires will be completed to assess appetite-related symptoms, physical function, fatigue, and any side effects experienced.

Physical activity levels will be measured, including the time spent in non-sedentary activities.

The status of the cancer will be evaluated through imaging to determine if the tumors have changed in size.

Performance status will be assessed to evaluate the ability to perform daily activities.

Throughout the study, regular monitoring will occur at scheduled visits.

Body weight will be measured at multiple time points to track changes over time.

Questionnaires about appetite, physical function, fatigue, and quality of life will be completed at various intervals.

Physical activity will continue to be monitored through measurements of activity levels.

Blood tests will be performed regularly to monitor safety and check for any abnormalities in laboratory values.

Vital signs such as blood pressure, heart rate, and temperature will be measured at each visit.

Electrocardiograms may be performed to monitor heart function.

Any adverse events or side effects will be recorded, including symptoms such as diarrhea, nausea, vomiting, decreased appetite, fatigue, and mouth sores.

CT scans (or MRI) will be repeated at scheduled intervals to continue monitoring the cancer and body composition.

Any changes to chemotherapy dosing, including dose reductions or interruptions, will be documented.

After completing the initial treatment phase, there may be an option to continue in an open-label extension phase.

In this phase, all participants will receive ponsegromab, and both the participant and the physician will know that the active medicine is being administered.

Body weight will continue to be measured and compared to the baseline measurements.

Safety monitoring will continue, including tracking of adverse events, serious adverse events, laboratory test abnormalities, and vital sign measurements.

The duration of participation in this extension phase will be determined by the study protocol and individual response to treatment.

Long-term outcomes will be monitored, including overall survival time from the start of the study.

The time until cancer progression will be assessed through regular imaging studies.

Information about the duration of any cancer response to treatment will be collected.

Follow-up may continue even after stopping the study treatment to gather information about long-term outcomes.