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Pathological Complete Response Following mFOLFOX6 Plus Zolbetuximab and Conversion Surgery in Initially Unresectable
Tamotsu Sagawa1, Shutaro Oiwa2, Masahiro Hirakawa3
1Department of Gastroenterology, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui 4-jo 2-chome, Shiroishi-ku, Sapporo-shi, Hokkaido, 003-0804, Japan. stamotsu@jk9.so-net.ne.jp.
Journal of Gastrointestinal Cancer
|July 25, 2026
Summary
Zolbetuximab combined with chemotherapy achieved a pathological complete response in a patient with advanced gastric cancer, peritoneal dissemination, and malignant ascites. This treatment may enable conversion surgery in selected patients with CLDN18.2-positive tumors.
Area of Science:
- Gastroenterology
- Oncology
- Medical Research
Background:
- Zolbetuximab plus chemotherapy is a first-line option for CLDN18.2-positive, HER2-negative advanced gastric cancer.
- Pathological complete response after zolbetuximab induction and conversion surgery is rarely documented, especially with peritoneal spread and ascites.
Purpose of the Study:
- To report a case of pathological complete response in a patient with initially unresectable advanced gastric cancer with peritoneal dissemination and malignant ascites.
- To evaluate the potential of zolbetuximab-based therapy to achieve deep responses and enable conversion surgery.
Main Methods:
- A patient with unresectable, CLDN18.2-positive, HER2-negative advanced gastric cancer received first-line mFOLFOX6 plus zolbetuximab.
- Treatment involved nine cycles, followed by conversion surgery (total gastrectomy, D2 lymph node dissection).
Main Results:
- The patient achieved marked radiological, endoscopic, and cytological improvements after nine cycles.
- Final pathology confirmed pathological complete response (ypT0N0) and enabled R0 conversion surgery.
Conclusions:
- mFOLFOX6 plus zolbetuximab can induce deep responses in selected patients with CLDN18.2-positive unresectable advanced gastric cancer.
- This regimen may facilitate R0 conversion surgery in patients with peritoneal dissemination and malignant ascites.