Background: In the phase III MPACT trial, nab-P + Gem demonstrated superior OS vs Gem (primary endpoint; median 8.5 vs 6.7 months; HR 0.72; P< 0.001) with manageable toxicity in pts with metastatic PC. The primary analyses were based on a cutoff of Sep 17, 2012, at which time 80% of pts had died. Here, we report an updated OS analysis (post hoc) and an assessment of pts with elevated NLR or elevated CA 19-9 at baseline, 2 accepted markers of poor prognosis. Methods: 861 pts with metastatic PC and a Karnofsky performance status ≥ 70 were randomized at 151 community and academic centers 1:1 to receive nab-P 125 mg/m² + Gem 1,000 mg/m² on days 1, 8, and 15 of each 28-day cycle or Gem 1,000 mg/m²weekly for 7 wks followed by 1 wk of rest (cycle 1) and then days 1, 8, and 15 of each 28-day cycle (cycle ≥ 2). The data for the OS analysis were collected through May 9, 2013. Baseline NLR and CA19-9 were measured in blood samples collected before treatment. Results: As of the updated data cutoff, 380 of 431 pts (88%) in the nab-P + Gem arm and 394 of 430 pts (92%) in the Gem-alone arm had died. OS was superior for nab-P + Gem in the intent-to-treat (ITT) population, and longer follow-up identified > 3-yr survivors in the nab-P + Gem arm (Table). In a pooled–treatment-arm analysis, a NLR ≤ 5 was associated with longer OS vs a NLR > 5 (median 9.1 vs 5.0 months; HR 1.839; P < 0.001). Median OS was longer with nab-P + Gem vs Gem for pts with a NLR > 5 and pts with CA 19-9 > 59 × upper limit of normal (ULN; Table). Conclusions: Updated data confirmed the treatment effect favoring nab-P + Gem for OS. Additional follow-up has identified long-term survivors in the nab-P + Gem arm. The improved OS for pts treated with nab-P + Gem who have a NLR > 5 or an elevated CA 19-9 supports the relative benefit of the combination, even for pts with markers of poor prognosis. Clinical trial information: NCT00844649.