Main Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy and currently ranks as the fourth leading cause of cancer-related death worldwide 7 , with a 5-year survival rate below 5%. Locally advanced PDAC (LAPC) is an intermediate stage that is found in roughly 30% of PDAC cases at diagnosis. These tumours are mostly unresectable due to vascular involvement, even though they lack distant metastases. LAPC has been sparsely studied, as these patients are usually excluded from metastatic trials and are not eligible for neoadjuvant or peri-operative trials owing to a poor resection rate. As a result, current treatment options for LAPC are limited, even in first line 8 . Median overall survival (OS) for LAPC is about 12–17 months (ref. 9 ), despite systemic chemotherapy regimens such as FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan and oxaliplatin) or gemcitabine-based combinations, which generally yield a median PFS of 6–10 months (LAP-07; NEOPAN) 10 , 11 .…