Sasaki Akinori, Yamaba Tomohiro, Tachibana Ayu, Kimura Rika, Uchiyama Gaku, Yoshioka Tsubasa, Okamoto Risa
Department of Gastroenterology Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan.
Department of Oncology Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan.
DEN Open. 2025 Aug 22;6(1):e70189. doi: 10.1002/deo2.70189. eCollection 2026 Apr.
Recently, zolbetuximab combined with chemotherapy has been approved as a first-line treatment for advanced gastric cancer (GC). However, to date, no endoscopic images demonstrating endoscopic complete response (eCR) to zolbetuximab plus chemotherapy have been reported. Herein, we report the case of an 80-year-old man who presented with epigastric pain and loss of appetite and was diagnosed with undifferentiated GC and peritoneal metastasis. The patient received modified FOLFOX6 plus zolbetuximab because genetic testing revealed HER2-negative and claudin 18.2-positive. He experienced grade 2 nausea, which improved with the administration of antiemetic agents. Computed tomography performed at month 5 showed resolution of peritoneal dissemination. Endoscopic examination during the same period showed the disappearance of the primary gastric tumor with scarring. Biopsy of the scar area revealed only inflammatory cells; therefore, the primary lesion was defined as an eCR. To the best of our knowledge, this is the first report of eCR to zolbetuximab and chemotherapy in a patient with GC and claudin 18.2 positive. This case report suggested that chemotherapy combined with zolbetuximab may offer greater therapeutic benefit than chemotherapy combined with immune checkpoint inhibitors in patients with undifferentiated GC. Further analysis is expected to enable the identification of patients with claudin 18.2-positive GC in whom zolbetuximab treatment is effective.
最近,zolbetuximab联合化疗已被批准作为晚期胃癌(GC)的一线治疗方案。然而,迄今为止,尚未有内镜图像显示对zolbetuximab加化疗出现内镜完全缓解(eCR)的报道。在此,我们报告一例80岁男性患者,其因上腹部疼痛和食欲不振就诊,被诊断为未分化GC和腹膜转移。由于基因检测显示HER2阴性且claudin 18.2阳性,该患者接受了改良FOLFOX6联合zolbetuximab治疗。他出现了2级恶心,使用止吐药后有所改善。第5个月进行的计算机断层扫描显示腹膜播散消失。同期的内镜检查显示原发性胃肿瘤消失并伴有瘢痕形成。瘢痕区域活检仅发现炎性细胞;因此,原发性病变被定义为eCR。据我们所知,这是首例关于GC且claudin 18.2阳性患者对zolbetuximab和化疗出现eCR的报道。该病例报告表明,对于未分化GC患者,zolbetuximab联合化疗可能比免疫检查点抑制剂联合化疗提供更大的治疗益处。预计进一步分析将能够识别出zolbetuximab治疗有效的claudin 18.2阳性GC患者。