Is it safe to administer cabazitaxel to a patient with mCRPC who developed grade 3 pneumonitis from docetaxel?

In general, the answer is yes, as these are distinct therapies with distinct toxicities. Both are formulated in TWEEN80 solvent and can cause allergic reactions and anaphylaxis, and this is the only adverse event that I would strongly consider avoiding cabazitaxel if this event was experienced in a patient treated with docetaxel. However, even then, inpatient desensitization to docetaxel or cabazitaxel can be successfully completed. For pneumonitis, it is unclear if this is related to the drug or solvent, and thus, I would consider cabazi in this circumstance once the pneumonitis has resolved and assuming limited alternative options such as PSMA-Lu177 or clinical trials. I would consider cabazi 20 mg/m2 in this circumstance given lower G3 and higher toxicities as was seen in the PROSELICA and FIRSTANA trials comparing these doses post-FDA approval. The use of concurrent prednisone may also reduce this toxicity.