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Patients are randomized 1:1 to Arm A (mFOLFOX + nivolumab 240\u2009mg every two weeks + ipilimumab 1\u2009mg\/kg every six weeks in parallel or Arm B (mFOLFOX). Subsequently, patients are randomized 1:2 to Arm A1 (identical to Arm A) or Arm A2 (three cycles of mFOLFOX followed by nivolumab + ipilimumab). In Arm C all patients receive FLOT + nivolumab. Primary endpoint is progression-free survival. Secondary endpoints include overall survival and objective response rate. Median progression-free survival (months) is: Arm A\/A1, 5.8; Arm A2, 4.0; Arm B, 6.6 and Arm C, 7.0.Toxicity is manageable across all arms, with higher rates in arms receiving dual checkpoint inhibition. Here we show that chemotherapy with dual checkpoint inhibition in parallel increases toxicity without improving efficacy, while FOLFOX followed by immunotherapy is insufficient. FLOT with nivolumab appears feasible and shows promising efficacy. 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I declare the authors have no competing interests as defined by Nature Portfolio, or other interests that might be perceived to influence the interpretation of the article. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2072"}}