Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms
(2026) In JAMA Network Open 9(3). p.1-15- 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... (More)
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.
(Less)
- author
- Lucocq, James
; Haugk, Beate
; White, Steven
; Marchegiani, Giovanni
; Holmberg, Marcus
; Zerbi, Alessandro
; Pagnanelli, Michele
; Lu, Zipeng
; Inoue, Yosuke
; Choi, Munseok
; Kang, Chang Moo
; Visser, Brendan
; Corpelijn, Lieke
; Andersson, Bodil
LU
; Bereza-Carlson, Paulina
LU
; Björnsson, Bergthor
; Wennerblom, Johanna
; Labori, Knut Jørgen
; Goh, Brian K.P.
; Hartman, Vera
; Ahmad, Syed
; Patel, Sameer
; Berrevoet, Frederik
; Mortensen, Kim
; Roberts, Keith
; Ausania, Fabio
; Lynch, Calum
; Gupta, Amit
; Bertrand, Claude
; Kleeff, Joerg
; Addeo, Pietro
; Bellotti, Ruben
; Ven Fong, Zhi
; Friess, Helmut
; Koea, Jonathan
; Gomez, Dhanny
; Gordon-Weeks, Alex
; Doria, Cataldo
; Tzimas, Georgios
; Franklin, Oskar
; Månsson, Christopher
; Cabús, Santiago Sánchez
; Bhogal, Ricky Harminder
; Pathak, Samir
; Honselmann, Kim Christin
; Balakrishnan, Anita
; Harrison, Ewen
; Mann, Kulbir
; Gill, Anthony J.
and Mittal, Anubhav
(Less) - author collaboration
- publishing date
- 2026-03-02
- type
- Contribution to journal
- publication status
- published
- in
- JAMA Network Open
- volume
- 9
- issue
- 3
- article number
- e263688
- pages
- 1 - 15
- publisher
- American Medical Association
- external identifiers
-
- scopus:105034601862
- pmid:41893840
- ISSN
- 2574-3805
- DOI
- 10.1001/jamanetworkopen.2026.3688
- language
- English
- LU publication?
- no
- id
- 58544f8c-411c-4eba-87ca-bc67d7ff4d3f
- date added to LUP
- 2026-08-28 18:10:07
- date last changed
- 2026-09-01 03:26:27
@article{58544f8c-411c-4eba-87ca-bc67d7ff4d3f,
abstract = {{<p>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.</p>}},
author = {{Lucocq, James and Haugk, Beate and White, Steven and Marchegiani, Giovanni and Holmberg, Marcus and Zerbi, Alessandro and Pagnanelli, Michele and Lu, Zipeng and Inoue, Yosuke and Choi, Munseok and Kang, Chang Moo and Visser, Brendan and Corpelijn, Lieke and Andersson, Bodil and Bereza-Carlson, Paulina and Björnsson, Bergthor and Wennerblom, Johanna and Labori, Knut Jørgen and Goh, Brian K.P. and Hartman, Vera and Ahmad, Syed and Patel, Sameer and Berrevoet, Frederik and Mortensen, Kim and Roberts, Keith and Ausania, Fabio and Lynch, Calum and Gupta, Amit and Bertrand, Claude and Kleeff, Joerg and Addeo, Pietro and Bellotti, Ruben and Ven Fong, Zhi and Friess, Helmut and Koea, Jonathan and Gomez, Dhanny and Gordon-Weeks, Alex and Doria, Cataldo and Tzimas, Georgios and Franklin, Oskar and Månsson, Christopher and Cabús, Santiago Sánchez and Bhogal, Ricky Harminder and Pathak, Samir and Honselmann, Kim Christin and Balakrishnan, Anita and Harrison, Ewen and Mann, Kulbir and Gill, Anthony J. and Mittal, Anubhav}},
issn = {{2574-3805}},
language = {{eng}},
month = {{03}},
number = {{3}},
pages = {{1--15}},
publisher = {{American Medical Association}},
series = {{JAMA Network Open}},
title = {{Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms}},
url = {{http://dx.doi.org/10.1001/jamanetworkopen.2026.3688}},
doi = {{10.1001/jamanetworkopen.2026.3688}},
volume = {{9}},
year = {{2026}},
}