Sugiyama Yuya, Tanabe Hiroki, Tachibana Shion, Iribe Kohei, Yuzawa Sayaka, Iwaki Hiroyuki, Yoshida Yukinori, Fujiya Mikihiro
Department of Gastroenterology, Sunagawa City Hospital, Sunagawa, Hokkaido, Japan.
Division of Gastroenterology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Gastric Cancer. 2025 Apr 3. doi: 10.1007/s10120-025-01607-9.
A 73-year-old male patient presented with anemia and was diagnosed with unresectable advanced gastric cancer with distant lymph node metastases. The biopsy specimen showed a poorly differentiated adenocarcinoma. Immunohistochemistry was negative for human epidermal growth factor receptor 2, positive for claudin- 18, and revealed a preserved mismatch repair status. A regimen of capecitabine, oxaliplatin, and zolbetuximab was chosen as the primary chemotherapy regimen. On day 2, the patient started complaining of nausea and decreased appetite, and his symptoms gradually worsened. Esophagogastroduodenoscopy performed on day 11 revealed an erythematous and edematous mucosa with white secretions throughout the stomach. A histopathological examination revealed epithalaxia at the surface and severe inflammatory cell infiltration in the lamina propria. These endoscopic and histological findings indicated zolbetuximab-related gastritis. His symptoms improved three weeks after the discontinuation of chemotherapy. Endoscopic and pathological improvements of the gastritis were confirmed three months after the discontinuation of zolbetuximab. This report describes the first case of prolonged severe gastrointestinal symptoms with severe gastritis caused by zolbetuximab, as demonstrated by endoscopic and histopathological evidence.
一名73岁男性患者因贫血就诊，被诊断为无法切除的晚期胃癌伴远处淋巴结转移。活检标本显示为低分化腺癌。免疫组化结果显示，人表皮生长因子受体2阴性，claudin-18阳性，错配修复状态保留。选择卡培他滨、奥沙利铂和zolbetuximab方案作为一线化疗方案。第2天，患者开始抱怨恶心和食欲下降，症状逐渐加重。第11天进行的食管胃十二指肠镜检查显示，整个胃黏膜呈红斑和水肿，有白色分泌物。组织病理学检查显示表面上皮脱落，固有层有严重炎症细胞浸润。这些内镜和组织学表现提示为zolbetuximab相关胃炎。化疗停药三周后，他的症状有所改善。停用zolbetuximab三个月后，胃炎的内镜和病理表现得到改善。本报告描述了首例经内镜和组织病理学证据证实的由zolbetuximab引起的伴有严重胃炎的长期严重胃肠道症状病例。
