Docetaxel Rechallenge vs Cabazitaxel in mCRPC: VA Cohort Study

A retrospective cohort study published January 2, 2026, in JAMA Network Open compared docetaxel rechallenge to cabazitaxel in 669 patients with metastatic castration-resistant prostate cancer treated in the Veterans Affairs healthcare system from 2010 to 2023. All patients had received at least three cycles of initial docetaxel without disease progression and then one intervening systemic therapy before second-line taxane treatment.
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The primary outcome was overall survival from the start of second-line therapy. Docetaxel rechallenge resulted in a median survival of 12.3 months compared to 9.6 months with cabazitaxel, with a hazard ratio of 0.81 (95% CI, 0.55-0.99; P = .04) after inverse probability of treatment weighting adjustment. PSA response rates showed 9.8% of docetaxel rechallenge patients achieved a ≥90% decline compared to 3.0% with cabazitaxel (P < .001), while ≥50% PSA decline rates were similar at 8% and 9% (P = .31).
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Time to next systemic treatment or death was 10.7 months with docetaxel rechallenge versus 8.9 months with cabazitaxel (P = .2). Time on treatment did not differ significantly (2.1 months versus 2.6 months; P = .56). Subsequent use of platinum chemotherapy, immunotherapy, and PARP inhibitors was comparable between groups.
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The study population had a median age of 72 years, with 73% bone metastases, 18% visceral metastases, and common comorbidities including chronic kidney disease (39%) and diabetes (38%). Limitations include the retrospective design and applicability primarily to patients without prior docetaxel progression.

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