Comparative efficacy and safety of cabazitaxel versus other taxanes: a systematic review and meta-analysis.

BACKGROUND AND

OBJECTIVES

This systematic review addresses uncertainty around cabazitaxel's effectiveness, safety, and optimal dosing compared to other taxanes, aiming to guide personalized treatment and improve patient outcomes.

METHODS

A meta-analysis of randomized controlled trials (RCTs) assessed the efficacy and safety of cabazitaxel, including tumor response, survival rates, and toxicity profiles. Trials were identified from several databases, and the bias was evaluated by using the Cochrane RoB 2 tool. Review Manager (RevMan 5.4) was used for heterogeneity testing, sensitivity analyses, pooling hazard ratio (HR) and risk ratios (RR) with 95% confidence intervals (CI), and publication bias assessment.

RESULTS

This meta-analysis included 10 trials with 3,377 patients. Cabazitaxel demonstrated no significant overall survival (OS) (HR = 1.03, 95% CI 0.92-1.14) or progression-free survival (PFS) (HR 1.07, 95% CI 0.92-1.24) benefit over other taxanes but had higher grade 3-5 treatment-related adverse events (TEAEs) (RR = 1.68, 95% CI 1.16-2.42). Tumor responses showed slightly higher partial responses (RR = 1.19, 95% CI 0.97-1.45) and increased progressive disease response (PDR) (RR = 1.60, 95% CI 1.15-2.23), with nonsignificant complete responses and stable disease. Subgroup analyses revealed no significant difference in OS or PFS for prostate and breast cancer. However, in head and neck cancer, cabazitaxel was associated with worse outcomes. 20 mg/m2 dose had a better safety profile, while 25 mg/m2 increased neutropenia (RR = 1.80, 95% CI 1.65-1.96) and anemia (RR = 1.45, 95% CI 1.01-2.09). In metastatic castration-resistant prostate cancer (mCRPC), cabazitaxel appeared more effective than non-taxane comparators in available trials.

CONCLUSIONS

Cabazitaxel shows no OS or PFS advantage over other taxanes and higher toxicity. 20 mg/m2 is safer than 25 mg/m2. It remains an option when other taxanes are contraindicated, not tolerated, or exhausted, with possible benefit over non-taxanes in mCRPC and worse outcomes in head and neck squamous cell carcinoma (HNSCC). Dosing and monitoring should be individualized. Further research should refine patient selection, dosing, and toxicity management.