Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Medical Oncology

Background:

• Adjuvant chemotherapy following pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMNs) lacks robust evidence.
• The survival benefit of contemporary chemotherapy regimens in this specific patient population remains unclear.

Purpose of the Study:

• To evaluate the survival benefit of contemporary adjuvant chemotherapy regimens after pancreatic resection in A-IPMNs.
• To assess the impact of specific regimens like gemcitabine-capecitabine (GemCap), FOLFIRINOX, modified FOLFIRINOX (mFOLFIRINOX), and S-1.

Main Methods:

• Retrospective international, multicenter cohort study involving 69 centers.
• Included patients who underwent resection for A-IPMNs between 2017 and 2023.
• Propensity score matching was used to compare outcomes between chemotherapy and no-chemotherapy groups.

Main Results:

• Among 1321 patients, adjuvant chemotherapy was administered to 59.1%, with 72.6% receiving contemporary regimens.
• Adjuvant chemotherapy, including contemporary regimens, was not associated with improved overall survival compared to no chemotherapy (P=.58).
• No significant survival benefit was observed across different chemotherapy regimens or disease characteristics.

Conclusions:

• Contemporary adjuvant chemotherapy regimens do not appear to improve overall survival in patients with A-IPMNs.
• A randomized clinical trial is warranted to definitively establish the role of adjuvant chemotherapy in this setting.