APT Cardiac Safety — SCE Medical Oncology MCQ

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EasyBreast CancerAPT Cardiac SafetySCE Medical Oncology

A 55-year-old woman with early-stage HER2-positive breast cancer (T1c N0) receives adjuvant paclitaxel + trastuzumab (APT regimen). After completing 1 year of trastuzumab, she asks about the risk of cardiac events. What is the approximate rate of symptomatic cardiac events with this de-escalated regimen?

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Correct answer: A — <1% symptomatic heart failure — the APT regimen has a very favourable cardiac safety profile compared with anthracycline-containing regimens

The APT trial reported <1% rate of symptomatic heart failure and approximately 3% asymptomatic LVEF decline with weekly paclitaxel × 12 + trastuzumab for 1 year in stage I HER2+ breast cancer. This favourable cardiac profile (no anthracycline exposure) is a key advantage of the de-escalated APT approach for low-risk HER2+ disease. Regular LVEF monitoring (every 3 months during trastuzumab) remains recommended.

Reference: ESMO 2024 Early Breast Cancer; APT trial Tolaney et al NEJM 2015