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Chapter 356in this real world cohort without structured reporting as in randomized clinical trials. Third, the exact moment of disease progression (according to RECIST) was not structurally reported in the medical charts. This may have influenced PFS intervals, as detection of progressive disease may have been omitted in case of clinical deterioration. After sensitivity analysis, with death shortly after FOLFIRINOX termination redefined as a progression event, PFS was reduced by more than a month. Fourth, only the type of the first therapy adjustment (e.g. delay or dose reduction) after start of systemic treatment was registered for each treatment episode. No data were available about dose reductions at the start of treatment, dose intensity and toxicity separately which makes it difficult to draw conclusions about safety. At last, we cannot rule out an effect on OS of a local treatment. Patients who were treated with a FOLFIRINOX reintroduction more often were treated with an additional local therapy compared to patients who were treated with second line gemcitabine plus nab-paclitaxel and gemcitabine monotherapy (30 vs 11 and 3%). We found a favorable OS but also a large range of survival and treatment cycles after FOLFIRINOX reintroduction in our nationwide database. For example, one fifth of patients stopped FOLFIRINOX or died soon after start of FOLFIRINOX reintroduction, while others were treated for many months. In the patients with poor results after FOLFIRINOX reintroduction, the therapy-free interval after first line FOLFIRINOX was shorter (5.4 vs. 7.1 months) compared to patients who were treated > 30 days with FOLFIRINOX reintroduction. The findings of this study can be used as background information (in absence of RCTs for second line treatments after FOLFIRINOX) when reintroduction of FOLFIRINOX is considered in patients experiencing clinical benefit during first line FOLFIRINOX.ConclusionThe present study provides a nationwide overview about the use of reintroduction of FOLFIRINOX in routine daily practice after at least a 3 months therapy-free interval in patients with advanced PDAC. Reintroduction of FOLFIRINOX can be a reasonable approach for those who are in a sufficient clinical condition and experienced clinical benefit, preferable leading to the possibility of a longer therapy-free interval, and limited toxicity during first line FOLFIRINOX.