Conversion surgery after response to zolbetuximab-based chemotherapy in Claudin 18.2-positive gastric cancer: a case report.

Authors

Shinya Ohno, Tomonari Suetsugu, Hironobu Takeuchi, Sho Miyazaki, Tatsuki Kawahara, Kazuo Yamamoto, Shunya Kiriyama, Kakeru Tawada, Yoshinori Iwata, Shuji Komori, Chihiro Tanaka, Narutoshi Nagao, Masahiko Kawai

Published in

Journal of surgical case reports. Volume 2026. Issue 6. Pages rjag495. Epub Jun 23, 2026.

Abstract

Zolbetuximab, a monoclonal antibody targeting Claudin (CLDN)18.2, has demonstrated clinical benefit in advanced gastric cancer, although reports of conversion surgery remain limited. A 59-year-old man with CLDN18.2-positive stage IV gastric cancer and suspected peritoneal dissemination received zolbetuximab with capecitabine and oxaliplatin. After six courses, imaging showed marked tumor regression. Staging laparoscopy revealed no peritoneal metastasis, and laparoscopic distal gastrectomy achieved R0 resection. Histopathology demonstrated a grade 2b response, and the final stage was ypStage IB. The patient remains recurrence-free at 12 months. Although conversion surgery was feasible, significant intraoperative bleeding occurred, likely due to treatment-related fibrosis and tissue fragility. This case suggests that zolbetuximab-based chemotherapy may enable conversion surgery in selected patients. Careful perioperative management is essential, and further studies are needed.

PMID:
42344864
Bibliographic data and abstract were imported from PubMed on 25 Jun 2026.

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