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; Bj&#246;rnsson, 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; M&#229;nsson, C; Cab&#250;s, 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; Adeno-IPMN2Collaborative

Author(s): 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; Björnsson, 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; Månsson, C; Cabús, 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; Adeno-IPMN2Collaborative;
Details: Publication Year 2026-03-02,Volume 9,Issue #3,Page e263688
Journal Title: JAMA Network Open
Publication Type: Research article
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.
Publisher: JAMA Network
Keywords: Humans; Male; Female; Aged; Chemotherapy, Adjuvant/methods; Retrospective Studies; Middle Aged; *Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Fluorouracil/therapeutic use; Leucovorin/therapeutic use; *Pancreatic Neoplasms/drug therapy/mortality/surgery; Irinotecan/therapeutic use; Oxaliplatin/therapeutic use; Gemcitabine; Deoxycytidine/analogs & derivatives/therapeutic use; *Pancreatic Intraductal Neoplasms/drug therapy/mortality/surgery; *Adenocarcinoma, Mucinous/drug therapy/mortality/surgery
Department(s): Surgical Oncology
Publisher's Version: https://doi.org/10.1001/jamanetworkopen.2026.3688
Open Access at Publisher's Site: https://doi.org/10.1001/jamanetworkopen.2026.3688
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-04-07 12:09:47

Last Modified: 2026-04-07 12:10:00