# Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms

## TL;DR

This study found that modern chemotherapy after surgery for a specific type of pancreatic cancer does not improve survival rates.

## Contribution

The study provides new evidence that contemporary adjuvant chemotherapy regimens do not improve survival in A-IPMNs.

## Key findings

- Adjuvant chemotherapy was not associated with improved overall survival in A-IPMNs patients.
- Contemporary regimens like GemCap and FOLFIRINOX showed no survival benefit over no chemotherapy.
- A randomized clinical trial is recommended to further evaluate treatment effectiveness.

## Abstract

This cohort study investigates the association of contemporary adjuvant chemotherapy regimens after resection in adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMNs) with overall survival.

What is the survival benefit associated with contemporary adjuvant chemotherapy regimens after resection in adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMNs)?

In this cohort study among 1321 patients with A-IPMNs, adjuvant chemotherapy was not associated with improved overall survival, regardless of adjuvant chemotherapy type.

Contemporary adjuvant chemotherapy was not associated with improved overall survival, and a randomized clinical trial is indicated.

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.

To evaluate the survival benefit associated with contemporary adjuvant chemotherapy regimens after resection in A-IPMNs between 2017 and 2023.

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.

Contemporary adjuvant chemotherapy regimens, such as gemcitabine-capecitabine (GemCap); 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX), modified FOLFIRINOX (mFOLFIRINOX), and S-1.

Overall survival (months).

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).

In this study, contemporary adjuvant chemotherapy was not associated with improved overall survival in A-IPMNs, and a randomized clinical trial is indicated.