ArticleCancer chemotherapy and pharmacology2026
Zolbetuximab-induced gastric mucosal injury and hypoalbuminemia: a mechanism-informed clinical analysis.
Article in Cancer chemotherapy and pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeZolbetuximab plus chemotherapy is standard first-line therapy for HER2-negative, CLDN18.2-positive advanced gastric or gastroesophageal junction cancer (GC/GEJC), but the incidence, course, and clinical correlations of zolbetuximab-related gastric mucosal injury and hypoalbuminemia remain unclear. We thus evaluated these relationships and the clinical course in real-world practice.
methodsWe retrospectively analyzed 38 patients with HER2-negative, CLDN18.2-positive, advanced GC/GEJC treated with zolbetuximab plus chemotherapy at a single center. Associations between endoscopic findings and albumin changes from baseline were analyzed.
resultsMedian albumin decreased from 3.7 to 2.6 g/dL. The median albumin decline was greater in patients without gastrectomy (- 1.0 g/dL) or with partial gastrectomy (- 1.1 g/dL) than in those with total gastrectomy (- 0.3 g/dL; P = 0.009 and 0.007). Albumin levels fell rapidly at weeks 1-3 and recovered toward baseline by weeks 19-27. Upper gastrointestinal endoscopies were performed in patients with a remaining stomach, showing peak abnormalities within 7-12 weeks; no cases with grade ≥ 2 gastric mucosal injury were observed after week 25. White exudate was associated with albumin decline (- 0.9 vs. -0.4 g/dL, P = 0.023).
conclusionsThe presence of white exudate demonstrated a significant association with a marked decrease in serum albumin levels. The risk of hypoalbuminemia appeared to be lower in patients after total gastrectomy. Serum albumin levels decreased after treatment initiation and subsequently showed a tendency to recover over time. Gastric mucosal abnormalities were most frequently observed during the early phase of treatment and were less common in examinations performed after week 25.
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