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Chapter 350were treated with first line FOLFIRINOX (n=1381, 66%), gemcitabine monotherapy (n=360, 17.2%), gemcitabine + nab-paclitaxel (n=250, 12%) or other/unknown regimens (n= 101, 4.8%). Six percent of patients were treated with a local therapy in addition to chemotherapy (stereotactic radiotherapy (SRT), radiofrequency ablation (RFA) or irreversible electroporation (IRE)). The majority of patients had died at the time of analysis (n=2066, 98.8%). Median OS from diagnosis differed significantly between patients who were treated with first line FOLFIRINOX (9.0 months; 95% confidence interval (CI), 8.5 to 9.4), gemcitabine + nab-paclitaxel (7.0 months; 95% CI, 6.1 to 7.9) and gemcitabine monotherapy (4.8 months; 95%CI, 4.3 to 5.2) (p<0.001). First line treatment was administered for a median of 2.6 months (range 0-21.2; n=1373, missing in 7), 2.3 (range 0-21.5; n=249, missing in 1) and 1.4 months (range 0-18.4; n=357, missing in 3) for respectively FOLFIRINOX, gemcitabine + nab-paclitaxel and gemcitabine monotherapy. Subsequent systemic therapy after first line FOLFIRINOXSubsequent systemic therapy after first line FOLFIRINOX was started in 388 patients (28% of 1381). A total of 119 patients (31% of 388) received FOLFIRINOX reintroduction (> 3 months treatment interruption after first line FOLFIRINOX); 155 patients (40%) were treated with second line gemcitabine + nab-paclitaxel and 67 patients (17%) with gemcitabine monotherapy (table 1). Other second line treatments were started in 46 patients (12%).FOLFIRINOX reintroductionIncidence and treatmentThe 119 patients who received FOLFIRINOX after > 3 months treatment interruption had a median age of 64 years and 57.1% presented with metastatic disease. The median therapy-free interval between the end of first line FOLFIRINOX and reintroduction was 7.0 months (range 3.1-35.7 months; p25-p75: 4.6-10.6 months). The number of FOLFIRINOX cycles for each treatment group is shown in table 2. Patients who were treated with FOLFIRINOX reintroduction received more often > 8 cycles of FOLFIRINOX in first line compared to all patients treated with FOLFIRINOX in first line (48 vs 27%). Patients received a median of 5 cycles during FOLFIRINOX reintroduction (range 1-28 cycles). While for each treatment episode the first treatment adjustment (if applicable) was documented, further information on dose reductions at the start of treatment, dose intensity, and toxicity of treatment were not documented. At least 64 of 119 patients (53.8%)