Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms
Year: 2026
Type: article
Study design: Observational Study
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.
Source: JAMA Network Open
Authors: James Lucocq, Beate Haugk, Steven White, Giovanni Marchegiani, Marcus Holmberg, Alessandro Zerbi, Michele Pagnanelli, Zipeng Lu, Yosuke Inoue, Munseok Choi, Chang Moo Kang, Brendan Visser, Lieke Corpelijn, Bodil Andersson, Paulina Bereza-Carlson, Bergthor Björnsson, Johanna Wennerblom, Knut Jørgen Labori, Brian K. P. Goh, Vera Hartman, Syed Ahmad, Sameer Patel, Frederik Berrevoet, Kim Mortensen, Keith Roberts, Fabio Ausania, Calum Lynch, Amit Gupta, Claude Bertrand, Joerg Kleeff, Pietro Addeo, Ruben Bellotti, Zhi Ven Fong, Helmut Friess, Jonathan Koea, Dhanny Gomez, Alex Gordon-Weeks, Cataldo Doria, Georgios Tzimas, Oskar Franklin, Christopher Månsson, Santiago Sánchez Cabús, Ricky Harminder Bhogal, Samir Pathak, Kim Christin Honselmann, Anita Balakrishnan, Ewen Harrison, Kulbir Mann, Anthony J. Gill, Anubhav Mittal, Jas Samra, Tejinderjit Athwal, Benjamin Loveday, Catherine Teh, Neil Bhardwaj, Krishna Menon, Prabin Thapa, Ippei Matsumoto, Nigel Jamieson, Vinciane Rebours, Clemence Descourvieres, Brian Davidson, Kjetil Soreide, Sanjay Pandanaboyana, Adeno-IPMN2 Collaborative, Ajit Kumar, Hüseyin Fahri Martlı, Geert Roeyen, Pantelis Antonakis, Konstantinos Bramis, Carol González, James Halle-Smith, Shi Lam, Ivan L’Official-German, Tina Bergner, Edoardo Rosso, Valentina Valle, Pier Cristoforo Giulianotti, Mathew Morreau, Saxon Connor, Alexandra Dili, Maria Sotiropoulou, Stylianos Kapiris, Matta Kuzman, Ahmet Çağrı Büyükkasap, Gökhan Uludağ, Mustafa Kerem, Mari-Claire McGuigan, Tarak Chouari, Ahmet Dogul, Dogukan Dogu, Artur Rebelo, Franziska Bernadette Holewik, Roxana Plesa-Furda, Omero Pereira da Costa Filho, Fernando Revoredo, Ilias Galanis, Dhiresh Maharjan, Poya Ghorbani, Max Lind, Katsuya Ami, Aarathi Vijayashanker, Tareq Alsaoudi, Linda Lundgren, Katrina Ellisa, Paul Hong, Archit Gupta, Congde MartinXu, Georgios Konstantoudakis, Thalis Christophides, Matthew McGuinness, Eleanor Spurring, Yasuhito Iwao, Sheraz Yaqub, Martin Pirklc, Ruhi Vaitha, Riccardo Pellegrini, Giampaolo Perri, Navneet Tiwari, Andrea Sheel, Amy Sheen, Krishna Kotecha, Daisy Evans, Omid Ghamarnejad, Gregor A. Stavrou, Rikhilroy Patel, Dimitrios Karavias, Mihaela Misca, John Hammond, Marcus Thomas Thor Roalso, Faiza Soomro, Asif Halimi, Timothy Kendall, Visad Patel, Dunja Stankić, Nikica Grubor, Pieter Dries, Charlotte Hein, Julia Betram, Rosetta Jacob, Gregory Wilson, Souheil Redas, Aiste Gulla, Augustas Poškus, Paula Mosert, Ugnė Šilinskaitė, Chang Moo Kang, Takaaki Furukawa, Yuki Hirose, Lingdi Yin, Xue Liu, Lars Standaert, Tegan Kay, Kenji Nishida, Vivek Peddakota
Institutions: Edinburgh Royal Infirmary, Freeman Hospital, University of Padua, Karolinska Institutet, Humanitas University, Jiangsu Province Hospital, Nanjing Medical University, The Cancer Institute Hospital, Japanese Foundation For Cancer Research, Yonsei University, Yongin Severance Hospital, Stanford Cancer Institute, Stanford University, Skåne University Hospital, Linköping University, University of Gothenburg, Oslo University Hospital, University of Oslo, Singapore General Hospital, National Cancer Centre Singapore, Antwerp University Hospital, University of Cincinnati, Ghent University Hospital, University Hospital of North Norway, Hospital Clínic de Barcelona, Universitat de Barcelona, All India Institute of Medical Sciences Rishikesh, UCLouvain, University Hospital in Halle, Martin Luther University Halle-Wittenberg, Hôpital d'Hautepierre, Innsbruck Medical University, Universität Innsbruck, Mayo Clinic Comprehensive Cancer Center (Arizona), North Shore Hospital, National Health Service, Nottingham University Hospitals NHS Trust, Capital Health, Hygeia Hospital, Uppsala University, Hospital de Sant Pau, Royal Marsden Hospital, St James's University Hospital, University Hospital Schleswig-Holstein, University of Lübeck, Cambridge University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, The University of Sydney, Royal North Shore Hospital, Royal Stoke University Hospital, Peter MacCallum Cancer Centre, Makati Medical Center, Leicester General Hospital, King's College Hospital, Kindai University, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Université Paris Cité, Hôpital Beaujon, Royal Free London NHS Foundation Trust, The Royal Free Hospital, Stavanger University Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W7141358279