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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/ot30and enter promo code OT30. This offer is valid through December 31, 2025. Chemotherapy in older patients with hormone receptor-positive, HER2-negative breast cancer (September 2025) The benefit of adjuvant chemotherapy for older patients with hormone receptor (HR)-positive, HER2-negative breast cancer is unclear. In a randomized trial in patients ≥70 years old with such cancers that were classified as high risk according to a genomic signature, overall survival (OS) rates at 8 years with and without chemotherapy were 73% and 68%, a difference that was not statistically significant.1 Nevertheless, the trial was underpowered to detect small differences in OS, it included many low-volume tumors and potentially frail patients, and it used a genomic signature that is not routinely used. As such, while adjuvant chemotherapy generally provides little to no benefit in older patients with HR-positive, HER2-negative disease, we still consider its use on an individual basis in selected high-risk, fit patients. Peptide receptor radionuclide therapy for metastatic pheochromocytoma and paraganglioma (October 2025) For patients with metastatic pheochromocytoma or paraganglioma, there are limited prospective data on the use of peptide receptor radionuclide therapy (PRRT) due to the rarity of this disease. In an open-label, phase II trial of almost 40 patients with metastatic pheochromocytoma or paraganglioma treated with PRRT using lutetium Lu-77 dotatate, the partial response rate was 28%, and the best treatment responses were achieved approximately 11 months after completing PRRT.2 We consider PRRT to be an acceptable option for initial therapy in patients with diffuse, unresectable, metastatic pheochromocytoma or paraganglioma who are symptomatic or have progressive disease and who are ineligible for or decline chemotherapy. Increasing incidence of appendiceal adenocarcinoma in the U.S. (October 2025) Although appendiceal cancer is a rare malignancy, its incidence is increasing in the U.S. In a retrospective cohort study of approximately 4,900 patients in the U.S. diagnosed with appendiceal adenocarcinoma between 1975 and 2018, the age-specific incidence rate of this cancer was three to four times higher among the patients born in the 1980s compared with those born in the 1940s.3 These data contribute to the growing evidence documenting an increase in appendiceal cancer in the U.S., and further studies are necessary to determine potential causes. Use of biparametric MRI in males with a clinical suspicion for prostate cancer (October 2025) In males with a clinical suspicion for prostate cancer, studies are investigating the use of biparametric magnetic resonance imaging (MRI), which omits intravenous (IV) contrast, as an alternative to standard multiparametric MRI imaging, which includes IV contrast. In a prospective trial of 490 males with a rising prostate-specific antigen (PSA) or abnormal digital rectal examination, biparametric MRI and multiparametric MRI detected similar rates of both clinically significant (29.2% vs. 29.6%) and insignificant prostate cancer (9.2% vs. 9.6%).4 Although the use of biparametric MRI is promising due to the ability to reduce costs and increase scanner throughput, additional investigation is required prior to the widespread adoption of biparametric MRI. No benefit of upfront ipilimumab/nivolumab in MGMT-unmethylated glioblastoma (October 2025) Despite encouraging single-arm studies of checkpoint inhibitors in patients with newly diagnosed glioblastoma, randomized trials have not confirmed a benefit. In a trial of 159 patients with O6-methylguanine-deoxyribonucleic acid (DNA) methyltransferase (MGMT)-unmethylated glioblastoma receiving standard radiation, concurrent and adjuvant administration of ipilimumab plus nivolumab vs. temozolomide resulted in similar median progression-free survival (7.7 vs. 8.5 months).5 Overall survival was approximately 13 months in both groups, with >50% alive at last follow-up. Outside of clinical trials, we do not use upfront immunotherapy in patients with glioblastoma. 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. 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