Docetaxel Rechallenge After Chemohormonal Therapy in High-Volume Metastatic Castration-Sensitive Prostate Cancer

Docetaxel has been widely used in the treatment of both metastatic castration-resistant and castration-sensitive prostate cancers. However, limited evidence exists regarding the efficacy of docetaxel rechallenge (DR) in patients with metastatic castration-resistant prostate cancer (mCRPC) following prior chemohormonal therapy for high-volume metastatic castration-sensitive prostate cancer (mCSPC). This study aimed to evaluate clinical outcomes in such patients. Among 32 patients with high-volume mCSPC treated with chemohormonal therapy between 2020 and 2022, five underwent DR after progression to mCRPC. A retrospective review was performed to assess patient characteristics, changes in prostate-specific antigen (PSA) levels, and treatment-related adverse events. The median follow-up period was 26 months, and the median age at DR initiation was 74 years. The median time to progression to mCRPC was 27 months (range: 7-41 months). DR was administered as either first- or second-line therapy for mCRPC. Treatment was discontinued in two patients due to disease progression. A ≥50% decline in PSA levels was observed in two patients who received docetaxel as the first-line mCRPC therapy (40%). Grade 3 fatigue occurred in two patients, with low-grade alopecia being the most common adverse event. DR may provide limited clinical benefits in selected patients with mCRPC following prior chemohormonal therapy, particularly when treatment options are constrained. However, due to the small size and variability in response, the therapeutic role of the modality remains uncertain. Well-designed prospective studies with larger cohorts are needed to better define the clinical value of DR and establish evidence-based criteria for patient selection.