Neoadjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer management is debated, especially regarding neoadjuvant chemotherapy (NAT).
• The role of NAT in IPMN-derived pancreatic cancer remains controversial, necessitating further investigation.

Purpose of the Study:

• To evaluate the efficacy and role of neoadjuvant chemotherapy (NAT) in IPMN-derived pancreatic cancer.
• To compare outcomes between upfront surgery and NAT followed by resection.

Main Methods:

• Retrospective analysis of 1,019 patients with IPMN-derived pancreatic cancer from eight international centers (2000-2023).
• Comparison of clinicopathologic data between patients treated with upfront surgery (US) versus NAT.
• Kaplan-Meier and Cox-regression analyses for overall survival (OS) and recurrence-free survival (RFS).

Main Results:

• Of 1,019 patients, 76 (7%) received NAT, presenting with more advanced resectability stages and higher CA19-9 levels.
• Overall survival (OS) was not significantly different between US and NAT groups (38.0 vs. 27.5 months, P=0.121).
• Pathological treatment response and CA19-9 normalization post-NAT correlated with improved survival; N2 disease, elevated CA19-9, and R1 margin were independent predictors of OS after NAT.

Conclusions:

• Neoadjuvant chemotherapy (NAT) followed by resection is valuable for borderline resectable and locally advanced IPMN-derived pancreatic cancer.
• The benefit of NAT in resectable IPMN-derived pancreatic cancer is uncertain and may require personalized treatment strategies.
• CA19-9 normalization and pathological response serve as indicators of biological treatment effect in IPMN-derived pancreatic cancer.