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UpToDate® and Oncology Times are collaborating to present select newly released UpToDate Oncology content synopses, such as the examples below. UpToDate is the premier evidence-based, clinical support resource used by oncology professionals and healthcare practitioners worldwide to make informed clinical decisions at the point of care. Please note that the examples below are accurate as of the month/year indicated next to each topic excerpt. To ensure you are accessing the most current clinical information, subscribe to UpToDate. For a limited time, you can receive an additional 30 days added to an annual or longer personal subscription term when you visit go.uptodate.com/ot30 and enter promo code OT30. This offer is valid through August 31, 2025. Pertuzumab retreatment for HER2-positive advanced breast cancer (May 2025) For patients with advanced HER2-positive breast cancer, data support trastuzumab retreatment after progression on a prior trastuzumab-containing regimen, but few data exist regarding pertuzumab. In prior reporting of a randomized trial in patients who had received pertuzumab, trastuzumab, and chemotherapy as first- or second-line therapy, those assigned to pertuzumab, trastuzumab, and clinician's choice of chemotherapy (PTC) experienced a progression-free survival benefit relative to trastuzumab and chemotherapy. Now, with longer follow-up of approximately 26 months, median overall survival was also longer in the PTC group (36 vs. 27 months).1 For patients with advanced HER2-positive breast cancer and progression on prior PTC, we consider resumption of pertuzumab and trastuzumab with a different cytotoxic chemotherapy partner to be an acceptable later-line option. Aspirin use for Stage I to III PIK3CA-mutated colorectal cancer (May 2025) For patients with treated Stage I to III colorectal cancer (CRC) and a somatic (tumoral) PIK3CA mutation, studies are evaluating the benefits of aspirin. In a placebo-controlled randomized trial of over 600 patients with Stage I to III PIK3CA-mutated colorectal cancer who completed surgery, low-dose aspirin (160 mg daily) for 3 years reduced the recurrence rate for those with PIK3CA mutations in exon 9 or 20 (8 vs. 14%).2 Among those with other PI3K pathway alterations, it reduced both recurrence rates (8 vs. 17%) and disease-free survival (89 vs. 79%). For patients with Stage I to III CRC who complete surgery and have a somatic PIK3CA mutation, we suggest low-dose aspirin to be continued for 3 years. Nivolumab plus ipilimumab for advanced hepatocellular carcinoma (May 2025) For patients with advanced unresectable and metastatic hepatocellular carcinoma (HCC), studies are evaluating nivolumab plus ipilimumab as initial therapy. In a randomized trial of almost 700 patients with unresectable HCC and no prior systemic therapy, nivolumab plus ipilimumab improved overall survival relative to sorafenib or lenvatinib (median 24 vs. 21 months) but increased Grade 3 to 4 toxicity rates (25 vs. 13%).3 Based on these data, the US FDA approved nivolumab plus ipilimumab for the initial treatment of adult patients with unresectable or metastatic HCC.4 While we continue to suggest initial treatment with either atezolizumab plus bevacizumab or tremelimumab plus durvalumab in this population due to lower likelihood of toxicity, we consider nivolumab plus ipilimumab to be an appropriate alternative for select patients. Eribulin in HER2-positive breast cancer (April 2025) For patients with metastatic HER2-positive breast cancer, standard initial therapy includes a taxane and HER2-targeted therapy, but there are limited data regarding alternative chemotherapy agents. In a randomized trial, eribulin demonstrated similar median progression-free survival as a taxane (14 vs. 13 months) when used as the initial chemotherapy backbone in patients receiving trastuzumab and pertuzumab. Although eribulin caused more Grade ≥3 neutropenia and peripheral sensory neuropathy, there were lower rates of infusion reactions, skin-related toxicity, diarrhea, and edema.5 These data support eribulin as an alternative chemotherapy backbone with a different toxicity profile to taxanes for patients with metastatic HER2-positive breast cancer. Disclaimer: This content is provided for reference purposes only and represents a portion of an UpToDate topic. This content is only accurate as of the date it was published. You may not rely on the above content, or any information cited here as being applicable to specific patient circumstances. All topics are continuously updated as new evidence becomes available and subject to our peer-review process. To ensure you are accessing the most current clinical information, subscribe to UpToDate today at go.uptodate.com/ot30 or sign into your existing UpToDate account if you are a current subscriber.