ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Translational Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1646818
This article is part of the Research TopicEmerging Targeted and Immunotherapeutic Strategies in Oncology: From Solid Tumors to Hematologic MalignanciesView all articles
Cadonilimab in combination with chemotherapy for HER2-negative advanced gastric or gastroesophageal junction adenocarcinoma: A cost-effectiveness analysis
Provisionally accepted
- Department of Pharmacy, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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The COMPASSION-15 trial confirmed the safety and effectiveness of cadonilimab, a bispecific antibody targeting both programmed death 1 (PD-1) and cytotoxic T lymphocyte antigen-4 (CTLA-4), in treating human epidermal growth factor receptor 2 (HER2) negative advanced gastric or gastroesophageal junction adenocarcinoma (G/GEJA). Notably, it demonstrated significant survival benefits even in the low programmed death ligand 1 (PD-L1) expression subgroup, overcoming the limitations of current immunotherapy. This study aims to comprehensively evaluate its cost-effectiveness.The cost-effectiveness of cadonilimab plus chemotherapy compared to chemotherapy alone was evaluated using a partitioned survival model with a 10-year time horizon, based on data from the COMPASSION-15 trial. Incremental cost-effectiveness ratio (ICER) was estimated to ascertain the cost-effectiveness. Furthermore, subgroup analysis stratified by PD-L1 combined positive score (CPS) thresholds, as well as sensitivity and scenario analyses, were performed.The estimated ICER value was $35,613.34/quality-adjusted life-year (QALY) for the entire cohort, $21,142.58/QALY for the high PD-L1 expression subgroup (CPS ≥ 5), and $45,000.62/QALY for the low PD-L1 expression subgroup (CPS < 5). Only the high PD-L1 expression subgroup achieved the cost-effectiveness, as its ICER value was below the willingness-topay (WTP) threshold of $24,600/QALY. Sensitivity and scenario analyses demonstrated the robustness of the result.In China, incorporating cadonilimab with chemotherapy was found to be more costeffective as a first-line treatment for HER2-negative advanced G/GEJA in the PD-L1 CPS ≥ 5 subgroup. Nevertheless, it was not cost-effective for either the entire cohort or the PD-L1 CPS < subgroup. These findings can provide valuable insights for future pricing strategies and healthcare decision-making.
Keywords: Cadonilimab, partitioned survival model, Cost-Effectiveness, PD-L1 expression, gastric or gastroesophageal junction adenocarcinoma
Received: 14 Jun 2025; Accepted: 18 Jul 2025.
Copyright: © 2025 Xiang, Li and XIA. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wei Li, Department of Pharmacy, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
QIAO XIA, Department of Pharmacy, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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