Fitting Zolbetuximab into the Gastric/GEJ Cancer Treatment Paradigm

Samuel Klempner, MD, gastrointestinal medical oncologist, Oncology, Massachusetts General Hospital and faculty, Medicine, Harvard Medical School, discusses zolbetuximab for patients with claudin 18.2 (CLDN18.2)-positive, HER2-negative, locally advanced unresectable or metastatic gastric or gastroesophageal junction (GEJ) cancer.

TRANSCRIPT:

0:08 | The landscape of stomach and esophagus cancer is rapidly evolving, and that's a good thing for patients. Even in the past couple of years, we've had approvals for new HER2 agents like trastuzumab deruxtecan [Enhertu]. We've had immunotherapy added to the frontline. We've had neoadjuvant immunotherapy for MSI-high patients where these are all great things for patients.

0:30 | The area that's the most complex is that in patients that have expression of multiple biomarkers, how we're going to manage or choose which is approach. Let's say a patient walks into your clinic 9 months from now, and they're PD-L1 positive and they're CLDN18.2-positive, how do we decide between giving them chemotherapy with immunotherapy or chemotherapy with zolbetuximab. Right now, we don't have head-to-head comparison to pick that. So, we have to look at the patient factors, we have to look at the side effects of the drugs we have to have shared decision-making and discussions with the patients. And then we need to look at the relative benefit in the areas that we do have data. For example, someone who is PD-L1-low, but claudin and that's someone that I envision using a claudin antibody in the front-line setting. For someone who's had very high PD-L1 expression, perhaps you might use immunotherapy, or you could do both, but you could choose immunotherapy plus zolbetuximab plus chemotherapy. There are some ongoing trials to test that to see if it's safe and active.

1:48 | So, someday, we may be using triplet combinations of targeted plus immunotherapy plus chemotherapy. But right now, we’re really trying to tease apart the data and decide what we think is best for our patients.