Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms.

Lucocq, J.; Haugk, B.; White, S.; Marchegiani, G.; Holmberg, M.; Zerbi, A.; Pagnanelli, M.; Lu, Z.; Inoue, Y.; Choi, M.; Kang, CM.; Visser, B.; Corpelijn, L.; Andersson, B.; Bereza-Carlson, P.; Bjornsson, B.; Wennerblom, J.; Labori, KJ.; Goh, BKP.; Hartman, V.; Ahmad, S.; Patel, S.; Berrevoet, F.; Mortensen, K.; Roberts, K.; Ausania, F.; Lynch, C.; Gupta, A.; Bertrand, C.; Kleeff, J.; Addeo, P.; Bellotti, R.; Ven Fong, Z.; Friess, H.; Koea, J.; Gomez, D.; Gordon-Weeks, A.; Doria, C.; Tzimas, G.; Franklin, O.; Mansson, C.; Cabus, SS.; Bhogal, RH.; Pathak, S.; Honselmann, KC.; Balakrishnan, A.; Harrison, E.; Mann, K.; Gill, AJ.; Mittal, A.; Samra, J.; Athwal, T.; Loveday, B.; Teh, C.; Bhardwaj, N.; Menon, K.; Thapa, P.; Matsumoto, I.; Jamieson, N.; Rebours, V.; Descourvieres, C.; Davidson, B.; Soreide, K.; Pandanaboyana, S.

Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms.

All Authors

Lucocq, J.

Haugk, B.

White, S.

Marchegiani, G.

Holmberg, M.

Zerbi, A.

Pagnanelli, M.

Lu, Z.

Inoue, Y.

Choi, M.

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LTHT Author

Pathak, Samir

LTHT Department

Abdominal Medicine & Surgery
General Surgery

Publication Date

2026

Item Type

Journal Article Multicenter Study

Subject

ANTINEOPLASTIC COMBINED CHEMOTHERAPY PROTOCOLS , CHEMOTHERAPY , PANCREATIC NEOPLASMS

Abstract

Importance: Adjuvant chemotherapy regimens may be administered after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMNs), although the evidence supporting their use is limited. Objective: To evaluate the survival benefit associated with contemporary adjuvant chemotherapy regimens after resection in A-IPMNs between 2017 and 2023. Design, Setting, and Participants: This retrospective cohort study was an international, multicenter study with 69 participating centers across Europe, North America, South America, and the Asia-Pacific region. Patients undergoing resection for A-IPMNs were included. Data were analyzed from May to August 2025. Intervention: Contemporary adjuvant chemotherapy regimens, such as gemcitabine-capecitabine (GemCap); 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX), modified FOLFIRINOX (mFOLFIRINOX), and S-1. Main Outcome and Measure: Overall survival (months). Results: Among 1321 patients (median [IQR] age 70 [63 to 76] years; 713 males [54.0%] and 608 females [46.0%]), 781 patients (59.1%) received adjuvant chemotherapy, while in 181 patients (13.7%) it was omitted due to poor patient fitness. Of patients who received adjuvant chemotherapy, 568 patients (72.6%) received contemporary regimens, including GemCap (232 patients [29.7%]), FOLFIRINOX (176 patients [22.5%]), mFOLFIRINOX (71 patients [9.1%]), and S-1 (70 patients [9.0%]). The median (IQR) follow-up for the cohort was 64.2 (40.4 to 85.0) months, and the median overall survival was 73.8 months (95% CI, 66.4 to 81.9 months). After 90-day landmark analysis and exclusion of patients ineligible for chemotherapy, adjuvant chemotherapy vs no adjuvant chemotherapy (propensity score-matched populations, 243:243 patients) was not associated with improved overall survival (median, 82.3 months; 95% CI, 78.2 months to not applicable [NA] vs not reached; 95% CI, 75.3 months to NA; P = .58). Contemporary regimens vs no adjuvant chemotherapy (propensity score-matched populations, 309:309 patients) was not associated with longer survival, and a mean survival benefit greater than 4.2 months over 5 years was excluded (difference in restricted mean survival, 1.26 months; 95%, -1.72 to 4.24 months). Treatment outcomes did not vary by chemotherapy regimen or disease characteristic (eg, N stage or carbohydrate antigen 19-9 level). Conclusions and Relevance: In this study, contemporary adjuvant chemotherapy was not associated with improved overall survival in A-IPMNs, and a randomized clinical trial is indicated.