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Chapter 3541c.Figure 1. a. OS (from diagnosis) by subsequent treatment group; FOLFIRINOX reintroduction, nabpaclitaxel + gemcitabine and gemcitabine monotherapy. b. OS after start of FOLFIRINOX reintroduction. c. PFS after start of FOLFIRINOX reintroduction. DiscussionThis retrospective cohort study focused on FOLFIRINOX reintroduction after a minimum of 3 months therapy-free interval following first line palliative FOLFIRINOX for advanced PDAC. Patients who were treated with FOLFIRINOX reintroduction (119 of 1381 patients who received first line FOLFIRINOX) had a favorable median OS of 23 months from diagnosis and 8.3 months from reintroduction of FOLFIRINOX with a median therapy-free interval of 7 months between first line and FOLFIRINOX reintroduction. Combination chemotherapy until adverse events or disease progression necessitate a therapeutic change is the established standard treatment for PDAC (12). To our knowledge this is the first study that focuses on reintroduction of FOLFIRINOX after a treatment interruption following first line palliative FOLFIRINOX, although a maintenance approach after induction chemotherapy is explored in several studies. Support was found in the PANOPTIMOX-PRODIGE trial for maintenance fluorouracilleucovorin after 4 months induction FOLFIRINOX in metastatic PDAC although this strategy did not reduce chemotherapy-induced neurotoxicity (13). Another maintenance strategy for metastatic disease was investigated in the randomized SEQUENCE phase I/II trial, exploring standard gemcitabine/nab-paclitaxel versus alternating maintenance gemcitabine-nab-paclitaxel and modified FOLFOX, resulting in improved OS (13.2 v 9.7 months; HR, 0.68; p = .02) for the alternating