ESMO Congress 2026

Docetaxel's foundational role in prostate cancer comes from the TAX 327 phase III trial, which demonstrated in hormone-refractory metastatic prostate cancer that docetaxel 75 mg/m² every three weeks plus prednisone significantly reduced death risk versus mitoxantrone plus prednisone (HR 0.76, 95% CI 0.62–0.94, P=0.009) ^[5]. This established docetaxel as the standard chemotherapy backbone for advanced prostate cancer, with subsequent intensification strategies using it as control or component.

This ESMO meeting presented multiple new datasets involving docetaxel. PEACE-1 phase III long-term follow-up (median 7.7 years, n=1173) showed that in de novo metastatic hormone-sensitive prostate cancer, adding abiraterone plus prednisone to standard of care (ADT ± docetaxel) significantly improved overall survival (OS HR 0.75, 95% CI 0.65–0.87, P=0.0001); in the ADT+docetaxel subgroup median OS was 6.2 vs 4.4 years, 8-year OS 40.3% vs 27.1%, high-volume subgroup 8-year OS 38% vs 20%, interaction P=0.56. The TRIDA real-world study assessed darolutamide+ADT+docetaxel in mHSPC, median follow-up 11 months, 18-month survival 86.5%, 16.2% progressed to CRPC, safety similar to ARASENS. PR21 phase III compared ¹⁷⁷Lu-PSMA-617 versus docetaxel in mCRPC; patient-reported quality of life (FACT-P) was stable with Lu-PSMA but declined with docetaxel, side-effect bother "quite a bit/very much" 15% vs 41%, rPFS no significant difference. Himalayas-1 phase III (n=600) in abiraterone-failed mCRPC compares rinzimetostat+darolutamide versus physician's choice (ARPI or docetaxel), primary endpoint rPFS. BNT324-03 phase III (N≈736) pits B7-H3 ADC Elfe-D against docetaxel head-to-head in taxane-naïve mCRPC after 1–2 ARPIs, dual primary endpoints rPFS and OS.

These data advance understanding in two directions: first, PEACE-1 with nearly 8-year follow-up confirms the long-term survival benefit of triplet intensification (abiraterone+ADT+docetaxel) in de novo mCSPC regardless of metastatic volume, reinforcing the principle of early, full-intensity intensification; second, PR21 with patient-reported outcomes as core narrative demonstrates Lu-PSMA's quality-of-life advantage over docetaxel in the mCRPC first-line chemotherapy setting, providing non-survival endpoint support for treatment sequencing. Meanwhile, Himalayas-1 and BNT324-03 are still recruiting, respectively exploring PRC2 inhibitor combined with ARPI and B7-H3 ADC against docetaxel control, reflecting docetaxel remains the standard comparator for novel agent development.

Limitations include: PEACE-1 despite long follow-up lacks detailed triplet toxicity accumulation and subsequent therapy heterogeneity in the abstract; TRIDA is a single-arm real-world cohort with only 11-month follow-up, OS immature; PR21 centers on quality-of-life narrative, rPFS no difference and OS data pending; Himalayas-1 and BNT324-03 remain in recruitment, efficacy and safety both await confirmation. Optimal triplet selection, biomarker-guided sequencing, and balancing accessibility with toxicity still require further evidence.