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Meta-Analysis
. 2025 Aug;27(8):3465-3476.
doi: 10.1007/s12094-025-03851-y. Epub 2025 Feb 22.

Cabazitaxel versus abiraterone or enzalutamide for metastatic castration-resistant prostate cancer following docetaxel failure: a systematic review and meta-analysis

Izael Pereira da Silva #  1 , Lucas Guimarães Campos Roriz de Amorim #  2 , Gabriel Vieira Piredda  3 , Marcelo Mass-Lindenbaum  4 , Francisco Cezar Aquino de Moraes  5 , Pedro F S Freitas  6 , Bárbara Vieira Lima Aguiar Melão  7 , Helisandro Montenegro Brandão  8 , Karine Martins da Trindade  9   10
Affiliations
Meta-Analysis

Cabazitaxel versus abiraterone or enzalutamide for metastatic castration-resistant prostate cancer following docetaxel failure: a systematic review and meta-analysis

Izael Pereira da Silva et al. Clin Transl Oncol. 2025 Aug.

Abstract

Purpose: Treatment for metastatic castration-resistant prostate cancer (mCRPC) includes chemotherapy and inhibition of the androgen receptor pathway. However, the optimal treatment sequence in this scenario is not yet fully understood. Therefore, we conducted a systematic review and meta-analysis comparing cabazitaxel versus abiraterone or enzalutamide for efficacy and safety outcomes as second-line therapy in mCRPC patients after docetaxel failure.

Methods: We searched PubMed, Embase, and Cochrane databases for interventional studies comparing cabazitaxel versus abiraterone or enzalutamide for patients with mCRPC who have experienced treatment failure with docetaxel as their first-line therapy. We computed hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Eight studies, comprising 1,897 patients were included, of whom 548 (28.8%) received cabazitaxel. Mean follow-up time ranged from 3 to 16.4 months. Median age ranged from 68.1 to 73.9 years in the cabazitaxel group, and 68.0 to 73.1 years in the abiraterone or enzalutamide group. In our meta-analysis, cabazitaxel significantly improved progression-free survival (PFS) rates (HR 0.60; 95% CI 0.47-0.78; p < 0.001) compared to abiraterone or enzalutamide. There were no differences between groups in overall survival (HR 0.76; 95% CI 0.46-1.24; p = 0.27), therapy-related grade ≥ 3 adverse events (AEs) (OR 3.00; 95% CI 0.72-12.40; p = 0.12), and PSA decline ≥ 50% (OR 1.20; 95% CI 0.51-2.80; p = 0.67).

Conclusions: In this systematic review and meta-analysis of men with mCRPC after docetaxel failure, second-line therapy with cabazitaxel was associated with a longer PFS compared with abiraterone or enzalutamide, though without a significant difference in OS.

Keywords: Abiraterone acetate; Androgen deprivation therapy; Antiandrogen; Cabazitaxel; Castration-resistant prostate cancer; Enzalutamide.

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Conflict of interest statement

Declarations. Conflict of interests: All authors report no relationships that could be construed as a conflict of interest. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. Ethical approval: No ethical approval was required for this systematic review with meta-analysis, as all data were already published in peer-reviewed journals. Furthermore, no patients were involved in the design, conduct, or interpretation of our study. Informed consent: For this type of study, no informed consent is required.

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