Efficacy of Early Switching From Docetaxel to Cabazitaxel in Castration-Resistant Prostate Cancer

Cabazitaxel is a taxane agent associated with fewer symptomatic adverse events than docetaxel in treating castration-resistant prostate cancer (CRPC), yet it is typically reserved for post-docetaxel failure. This study assessed whether early switching from docetaxel to cabazitaxel could improve clinical outcomes.

Beginning in 2019, a treatment approach was adopted wherein patients with CRPC were switched to cabazitaxel after three cycles of docetaxel, regardless of response. Patients who initiated docetaxel between February 2019 and March 2022 were classified as the switch group, while those who started between September 2014 and February 2019 were designated as the historical non-switch group. Chemotherapy duration, number of chemotherapy cycles, and adverse events were compared. Progression-free survival (PFS), time to failure of both taxanes, and overall survival (OS) were analyzed using propensity score matching.

The switch and non-switch groups included 36 and 37 patients, respectively. The switch group received significantly more chemotherapy cycles (p = 0.043) and had a longer cumulative chemotherapy duration (p = 0.035), even when including chemotherapy administered in subsequent lines. The cumulative incidence of peripheral neuropathy was significantly lower in the switch group (p = 0.037). Within the switch group, symptomatic adverse events, including fatigue, anorexia, and alopecia, were significantly reduced after switching to cabazitaxel. PFS was significantly prolonged in the switch group (p = 0.002), although time to failure of both taxanes and OS did not differ significantly between groups.

Early switching to cabazitaxel after three cycles of docetaxel may reduce symptomatic adverse events, including peripheral neuropathy, while enabling longer chemotherapy exposure and improved PFS in patients with CRPC.