Toxicities of taxane-based chemotherapy in prostate cancer

Despite recent developments in the treatment of advanced prostate cancer (PCa), taxanes, including docetaxel (DOC) and cabazitaxel (CBZ), remain pivotal in management. DOC has shown efficacy for patients with metastatic hormone-sensitive prostate cancer, whereas CBZ plays a key role in the post-DOC setting. However, taxane-based therapies are associated with significant toxicities. We aimed to provide a comprehensive overview of the incidence, risk factors, and management strategies for taxane-related toxicities to optimize outcomes.

Neutropenia and febrile neutropenia are life-threatening complications. Primary prophylactic granulocyte-colony stimulating factor (G-CSF) is recommended for CBZ. In contrast, evidence of its use with DOC is limited but should be considered for high-risk patients. Other common toxicities, such as nausea/vomiting, fatigue, neuropathy, and skin disorder, are generally nonlife-threatening but can significantly impair patients' quality of life (QoL). Tailored patient selection and individualized management strategies are essential for minimizing toxicities and ensuring treatment continuity.

Despite the wide-ranging toxicities of taxanes, they remain a cornerstone in advanced PCa treatment. Preventing and managing severe neutropenia, febrile neutropenia, and QoL-impairing toxicities are essential for maintaining treatment continuity and achieving optimal outcomes.