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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 November 30, 2025. Regional nodal irradiation after neoadjuvant chemotherapy for breast cancer (September 2025) For patients who receive neoadjuvant therapy for breast cancer, the approach to adjuvant regional nodal irradiation (RNI) therapy is being evaluated. In a randomized trial, over 1,600 patients with clinical T1-3N1 cancers who had node-negative disease after neoadjuvant chemotherapy were assigned to RNI or no RNI.1 Patients who had undergone breast-conserving surgery received whole-breast irradiation irrespective of their assignment, while patients who underwent mastectomy received chest wall irradiation only if assigned to the RNI group. At a median follow-up of 60 months, locoregional recurrences, distant recurrences, and overall survival were similar with and without RNI. For patients presenting with T1-3N1 disease who have a complete nodal response to neoadjuvant therapy, nodal radiation can typically be omitted, although individualization is appropriate, given the relatively short follow-up of this study. Endoscopic resection in patients with esophageal varices (August 2025) For patients with esophageal varices, the bleeding risk related to endoscopic resection (ER) of early esophageal lesions may be high; however, studies suggest that ER may be safe if preventive measures are taken. In a systematic review of 42 studies including over 180 patients with esophageal varices and early esophageal neoplasia who underwent ER, prophylaxis included endoscopic band ligation or sclerotherapy, direct varix coagulation, or transjugular intrahepatic portosystemic shunt placement.2 Rates of periprocedural or delayed bleeding were relatively low (6% and 3%, respectively), whereas radical and curative resection rates were high (86% and 72%, respectively). While these data are promising, use of ER in patients with varices may be limited by severity of liver disease, other comorbidities, and the availability of endoscopic expertise. Aspirin for stage I to III PIK3CA-mutated colorectal cancer (August 2025) For patients with treated stage I to III colorectal cancer (CRC) and a somatic (tumoral) phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutation, studies are evaluating the benefits of aspirin. In preliminary results of 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 (hazard ratio 0.45; 8% vs. 14% for those with PIK3CA mutations in exon 9 or 20).3 Among those with other PI3K pathway alterations, it reduced recurrence rates (8% vs. 17%) and improved 3-year disease-free survival (89% vs. 79%). For patients with stage I to III CRC who complete surgery and have a somatic PIK3CA mutation, we now suggest low-dose aspirin, to be continued for 3 years. Breastfeeding after breast cancer (August 2025) Data regarding breastfeeding after breast cancer are limited. In a study including 313 patients who interrupted adjuvant endocrine therapy for pregnancy after early hormone receptor-positive breast cancer and had at least one live birth, 63% of patients breastfed, mostly from the contralateral breast.4 The cumulative incidence of a breast cancer event at 24 months from first on-study live birth was 3.6% among those who breastfed and 3.1% among those who did not, a difference that was not statistically significant. Although follow-up is limited, these data provide early reassurance to patients who wish to pursue breastfeeding after breast cancer. Adagrasib in KRAS G12C-mutated non-small cell lung cancer (August 2025) Adagrasib irreversibly binds Kirsten rat sarcoma viral oncogene homolog (KRAS) G12C in its inactive state and has previously shown activity in patients with KRAS G12C-mutated, locally advanced or metastatic non-small cell lung cancer (NSCLC). Now, in a randomized trial in 453 such patients previously treated with both platinum-based chemotherapy and immunotherapy, adagrasib improved median progression-free survival relative to docetaxel (5.5 vs. 3.8 months).5 Grade ≥3 treatment-related adverse events were similar. For patients with advanced NSCLC with a KRAS G12C mutation that has progressed on a prior line of therapy, adagrasib is one of our preferred treatment options. 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. 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