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Purpose The purpose of this study was to evaluate 18F-FDG-PET/CT as an early and late interim imaging biomarker in patients with pancreatic ductal adenocarcinoma (PDAC) who undergo first-line systemic therapy. Methods This was a prospective, single-center, single-arm, open-label study (IRB12-00077. Patient receiving first line chemotherapy were planned to undergo a baseline 18F-FDG-PET/CT (PET1), early interim 18F-FDG PET/CT (PET2) and late interim 18F-FDG-PET/CT (PET3). ROC selected and established (mPERCIST / RECIST1.1) cut-offs for