Claudin 18.2-positive gastric cancer
Prepared with OnCo (onco.cc/prep/gastric-cldn18-2-positive/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
16 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Claudin 18.2 by immunohistochemistry, HER2, PD-L1 combined positive score, Claudin 18.2 expression in metastases and after prior therapy), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (advanced, first line), which of the standard options do you recommend and why?
- 6.Am I a candidate for Zolbetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin) or related drugs, and what side effects should I expect?
- 7.How do the results of SPOTLIGHT & GLOW apply to someone like me?
- 8.For my situation (second line), which of the standard options do you recommend and why?
- 9.Am I a candidate for Ramucirumab, Paclitaxel / nab-paclitaxel, Sonesitatug vedotin or related drugs, and what side effects should I expect?
- 10.For my situation (toxicity management), which of the standard options do you recommend and why?
- 11.Am I a candidate for Zolbetuximab, and what side effects should I expect?
- 12.Are there clinical trials I could join, for example of Sonesitatug vedotin, Satricabtagene autoleucel, LM-302, ASP2138?
- 13.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 14.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 15.I read that “Whether zolbetuximab or PD-1 blockade should come first when both PD-L1 and claudin 18.2 are positive”. How does that affect my plan?
- 16.I read that “Tumours below the 75 percent threshold have no approved claudin 18.2 therapy”. How does that affect my plan?
Tests and results to bring
Biomarker results to ask for: Claudin 18.2 by immunohistochemistry (VENTANA 43-14A; 75 percent threshold), HER2 (must be negative for zolbetuximab), PD-L1 combined positive score, Claudin 18.2 expression in metastases and after prior therapy.
Scans and tests linked to this cancer: Companion diagnostics.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Advanced, first line: Zolbetuximab with FOLFOX (SPOTLIGHT) or CAPOX (GLOW) in HER2-negative, claudin 18.2-positive disease; nivolumab or pembrolizumab with chemotherapy remains an alternative where PD-L1 is high. (SPOTLIGHT & GLOW, Zolbetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), Claudin 18.2, Nivolumab, Pembrolizumab)
- Toxicity management: Antiemetic prophylaxis and slowed infusion for the nausea and vomiting of the first cycles. (Zolbetuximab)
- Second line: Ramucirumab with paclitaxel; claudin 18.2 antibody-drug conjugates and CAR-T in trials. (Ramucirumab, Paclitaxel / nab-paclitaxel, Sonesitatug vedotin, Satricabtagene autoleucel, CLDN18.2 antibody first line → CLDN18.2 ADC or CAR-T on progression)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.