Retrospective study of neoadjuvant therapy for invasive intraductal papillary mucinous neoplasms compared with pancreatic ductal adenocarcinoma

Invasive intraductal papillary mucinous neoplasms (I-IPMNs) are considered more indolent than conventional pancreastic ductal adenocarcinoma (PDAC). The role of neoadjuvant therapy (NAT) in I-IPMNs is not clear. A retrospective study at the University of Colorado Hospital (Aurora) investigated overall survival impact of NAT in I-IPMNs compared with PDAC. Among 500 patients (413 PDAC, 87 I-IPMN), 289 PDAC and 34 I-IPMN patients received NAT. In the entire cohort, I-IPMN patients showed slightly longer median overall survival than the PDAC patients (30.2 versus 28.1 months; p=0.04). Among the resectable patients (n=311), NAT was associated with longer OS in PDAC (61.9 versus 34.2 months; p<0.001) but not in I-IPMN (not reached versus 47.9 months; p=0.74). Survival did not differ between NAT-treated resectable I-IPMN and PDAC (p=0.95). In the borderline resectable/locally advanced cohort treated with NAT (n=183), OS was similar between I-IPMN and PDAC (17.1 versus 22.0 months; p=0.69). The authors conclude that in resectable I-IPMN, NAT was not associated with improved survival.