The Safety of Cadonilimab: A Systematic Review and Single-Arm Meta-Analysis

Cadonilimab (AK104) is a bispecific antibody that simultaneously targets programmed cell death-1 and cytotoxic T-lymphocyte antigen-4. It has received approval for the treatment of cervical cancer and gastric/gastroesophageal junction cancer. This meta-analysis aims to assess cadonilimab's safety profile.

A systematic review of electronic databases was conducted to identify clinical trials that reported cadonilimab's safety data. Immune-related adverse events (irAEs) was the primary endpoint, and treatment-related adverse events (TRAEs) were the secondary endpoints. A single-group proportion meta-analysis was conducted by R software.

A total of 1271 patients across more than five cancer types in 11 clinical trials were included in this study. The incidence of any grade irAEs, grade ≥ 3 irAEs, irAEs leading to treatment discontinuation, and irAEs associated with mortality was 43.3% [95% confidence interval (CI), 33.3%-53.4%], 11.3% (95% CI, 9.5%-13.3%), 3.7% (95% CI, 1.5%-6.5%), and 0% (95% CI, 0%-0.4%), respectively. Hypothyroidism was the most common all-grade irAEs (13.3%, 95% CI, 8.9%-18.5%). The incidence of TRAEs was higher in the combined therapy group compared to the cadonilimab monotherapy group.

The irAEs associated with cadonilimab are generally manageable. When combining with other anticancer agents, physicians and pharmacists should be particularly aware of the potential increase in TRAEs.