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Cancers & treatments·Sequencing

Claudin 18.2-positive gastric cancer: lines of therapy

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3 standard-of-care settings across 3 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersHER2
Advanced, first line·1
Second line1·
Other settings1·

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
HER2Advanced, first lineZolbetuximab 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 & GLOWZolbetuximabFOLFOX (5-FU, leucovorin, oxaliplatin)CAPOX (capecitabine, oxaliplatin)Claudin 18.2NivolumabPembrolizumab
98

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersSecond lineRamucirumab with paclitaxel; claudin 18.2 antibody-drug conjugates and CAR-T in trials.
RamucirumabPaclitaxel / nab-paclitaxelSonesitatug vedotinSatricabtagene autoleucelCLDN18.2 antibody first line → CLDN18.2 ADC or CAR-T on progression
85

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersToxicity managementAntiemetic prophylaxis and slowed infusion for the nausea and vomiting of the first cycles.
Zolbetuximab
83

Sequence and caution pairings

SequenceApproved
CLDN18.2 antibody first line → CLDN18.2 ADC or CAR-T on progression

Hit Claudin 18.2 twice: first with a plain antibody plus chemotherapy, then with an ADC or engineered cells when the cancer comes back.

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.