Could Lower Doses of Immunotherapy Cut Cancer Costs?

September 30, 2025

Summary: Using lower doses of certain immunotherapy medications could save billions.

Source: Bloomberg September, 2025

Keytruda (pembrolizumab) and Opdivo (nivolumab) are widely used immunotherapy drugs for cancers once considered untreatable. Both are PD-1 inhibitors that help the immune system recognize and attack tumors. Keytruda is available intravenously and as a subcutaneous injection, while Opdivo is intravenous only. They are approved for melanoma, lung cancer, kidney cancer, head and neck cancers, Hodgkin lymphoma, mesothelioma, and several other malignancies.

These therapies are extremely costly—often exceeding $200,000 per year. If effective, they may be continued for the rest of a patient’s life.

Bloomberg reports that oncologists in Israel and India are using substantially lower doses, with encouraging results. Keytruda’s original FDA label included weight-based dosing, but the manufacturer shifted to flat dosing in the U.S. and discontinued smaller vial sizes. Clinical trials testing lower doses are now underway in Europe.

Implications for employers:

• Lower dosing of checkpoint inhibitors might generate significant savings, although not if pharmaceutical companies charge the same amount regardless of dose.

• Pharmaceutical companies have little incentive to study dose reductions that might reduce revenue.

• Keytruda and Opdivo lose primary patent protection in 2028, though secondary patents or litigation may delay biosimilar competition.

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Views expressed in Employer Coverage are purely my own.