This retrospective research aims to assess the efficacy and safety of cadonilimab in the first-line treatment of recurrent or metastatic cervical cancer (CC).The analysis included 25 patients with recurrent or metastatic CC. Each patient received at least two doses of cadonilimab (10mg/kg every three weeks). Among them, one patient received cadonilimab as monotherapy, 15 received targeted therapy, 20 received chemotherapy, and 13 underwent local radiotherapy. The study evaluated the objective response rate (ORR) and the disease control rate (DCR) along with the treatment-related adverse events (TRAEs).The ORR was 76.0 % (19/25, 95 % confidence interval [CI]: 54.5-89.8 %), comprising six complete and 13 partial responses. Additionally, two patients exhibited stable disease, resulting in a DCR of 84.0 % (21/25, 95 % CI: 63.1-94.8 %). All patients developed at least one TRAE. The most frequent TRAEs included anemia (84.0 %), elevated levels of AST and ALT (36.0 %), and leukopenia (64.0 %). Most adverse events were of grades 1-2, with no treatment-related deaths reported. Immune-related adverse events were all grades 1-2 and occurred in nine patients (36.0 %). These included hypothyroidism (n = 5, 20.0 %), hyperthyroidism (n = 4, 16.0 %), immune myocarditis (n = 1, 4.0 %), immune pneumonia (n = 1, 4.0 %), and rash (n = 1, 4.0 %). The incidence of grade 3 leukopenia and thrombocytopenia was elevated in the radiotherapy group in contrast to the non-radiotherapy group, but this contrast did not exhibit statistical significance.Cadonilimab combined with other therapies was acceptable, with encouraging antitumor activity in patients with recurrent or metastatic CC who have undergone radical treatment. Further studies are needed to confirm the long-term outcomes.Copyright © 2025. Published by Elsevier Inc.