diff --git a/litellm/responses/litellm_completion_transformation/transformation.py b/litellm/responses/litellm_completion_transformation/transformation.py
index 48b12a5fba9..e2ba8353591 100644
--- a/litellm/responses/litellm_completion_transformation/transformation.py
+++ b/litellm/responses/litellm_completion_transformation/transformation.py
@@ -1238,6 +1238,8 @@ class LiteLLMCompletionResponsesConfig:
             file_dict["file_data"] = item["file_data"]
 
         new_item: Dict[str, Any] = {"type": "file", "file": file_dict}
+        if "cache_control" in item:
+            new_item["cache_control"] = item["cache_control"]
         return new_item
 
     @staticmethod
@@ -1282,26 +1284,28 @@ class LiteLLMCompletionResponsesConfig:
                             )
                         )
                     elif item.get("type") == "input_image":
-                        content_list.append(
-                            dict(
-                                LiteLLMCompletionResponsesConfig._transform_input_image_item_to_image_item(
-                                    item
-                                )
+                        image_block = dict(
+                            LiteLLMCompletionResponsesConfig._transform_input_image_item_to_image_item(
+                                item
                             )
                         )
+                        if "cache_control" in item:
+                            image_block["cache_control"] = item["cache_control"]
+                        content_list.append(image_block)
                     else:
                         # Skip text blocks with None text to avoid downstream errors
                         text_value = item.get("text")
                         if text_value is None:
                             continue
-                        content_list.append(
-                            {
-                                "type": LiteLLMCompletionResponsesConfig._get_chat_completion_request_content_type(
-                                    item.get("type") or "text"
-                                ),
-                                "text": text_value,
-                            }
-                        )
+                        content_block: Dict[str, Any] = {
+                            "type": LiteLLMCompletionResponsesConfig._get_chat_completion_request_content_type(
+                                item.get("type") or "text"
+                            ),
+                            "text": text_value,
+                        }
+                        if "cache_control" in item:
+                            content_block["cache_control"] = item["cache_control"]
+                        content_list.append(content_block)
             return content_list
         else:
             raise ValueError(f"Invalid content type: {type(content)}")
diff --git a/tests/test_litellm/responses/litellm_completion_transformation/test_litellm_completion_responses.py b/tests/test_litellm/responses/litellm_completion_transformation/test_litellm_completion_responses.py
index 5d8ff8022e5..503a610e016 100644
--- a/tests/test_litellm/responses/litellm_completion_transformation/test_litellm_completion_responses.py
+++ b/tests/test_litellm/responses/litellm_completion_transformation/test_litellm_completion_responses.py
@@ -2170,3 +2170,86 @@ class TestEnsureOutputItemContentPartAdded:
 
         events = iterator._pending_response_events
         assert len(events) == 2
+
+
+class TestCacheControlPreservation:
+    def test_cache_control_preserved_in_content_transformation(self):
+        """cache_control injected by AnthropicCacheControlHook must survive
+        the Responses API -> Chat Completion content transformation."""
+        content = [
+            {
+                "type": "text",
+                "text": "hello",
+                "cache_control": {"type": "ephemeral"},
+            }
+        ]
+        result = LiteLLMCompletionResponsesConfig._transform_responses_api_content_to_chat_completion_content(
+            content
+        )
+        assert isinstance(result, list)
+        assert len(result) == 1
+        assert result[0]["cache_control"] == {"type": "ephemeral"}
+
+    def test_content_without_cache_control_unaffected(self):
+        """Content blocks that don't have cache_control should be unaffected."""
+        content = [{"type": "text", "text": "hello"}]
+        result = LiteLLMCompletionResponsesConfig._transform_responses_api_content_to_chat_completion_content(
+            content
+        )
+        assert isinstance(result, list)
+        assert len(result) == 1
+        assert "cache_control" not in result[0]
+
+    def test_cache_control_preserved_in_input_item_transformation(self):
+        """cache_control survives the full input-item -> messages transformation."""
+        input_item = {
+            "role": "user",
+            "content": [
+                {
+                    "type": "text",
+                    "text": "long context",
+                    "cache_control": {"type": "ephemeral"},
+                }
+            ],
+        }
+        messages = LiteLLMCompletionResponsesConfig._transform_responses_api_input_item_to_chat_completion_message(
+            input_item
+        )
+        assert len(messages) == 1
+        msg_content = (
+            messages[0].get("content")
+            if isinstance(messages[0], dict)
+            else getattr(messages[0], "content", None)
+        )
+        assert isinstance(msg_content, list)
+        assert msg_content[0]["cache_control"] == {"type": "ephemeral"}
+
+    def test_cache_control_preserved_for_input_file_block(self):
+        content = [
+            {
+                "type": "input_file",
+                "file_id": "file-abc123",
+                "cache_control": {"type": "ephemeral"},
+            }
+        ]
+        result = LiteLLMCompletionResponsesConfig._transform_responses_api_content_to_chat_completion_content(
+            content
+        )
+        assert isinstance(result, list)
+        assert len(result) == 1
+        assert result[0]["cache_control"] == {"type": "ephemeral"}
+
+    def test_cache_control_preserved_for_input_image_block(self):
+        content = [
+            {
+                "type": "input_image",
+                "image_url": "https://example.com/img.png",
+                "cache_control": {"type": "ephemeral"},
+            }
+        ]
+        result = LiteLLMCompletionResponsesConfig._transform_responses_api_content_to_chat_completion_content(
+            content
+        )
+        assert isinstance(result, list)
+        assert len(result) == 1
+        assert result[0]["cache_control"] == {"type": "ephemeral"}