What is the greatest possible harm caused by Zotuximab/Veloximab?

Zolbetuximab (zolbetuximab) is an innovative monoclonal antibody targeting Claudin18.2. Its clinical value is mainly reflected in the precise identification of gastric cancer cells with specific expression types and targeted elimination through antibody-dependent immune mechanisms. Although its treatment concept is advanced, it also brings different risk characteristics from traditional chemotherapy. To understand the greatest harm it may cause, we need to start with the target itself.

Claudin18.2 has limited expression in healthy tissues and is mainly located in the tight junction structure of the gastric mucosa. While drugs target tumor cells, they may also have certain effects on normal gastric mucosa. Reactions associated with this mechanism often manifest as gastrointestinal irritation, and some patients may experience gastrointestinal discomfort such as persistent nausea or vomiting, which is one of the most concerning risks at present. The data also points out that such side effects are mostly related to the targeting mechanism itself rather than drug quality issues. Therefore, patients usually need to assess their gastric function and take preventive treatment before treatment.

Another potential hazard comes from immune activation effects. Zotuximab relies on the immune system to clear tumor cells, so some patients may experience systemic discomfort related to the immune response, such as fatigue or mild inflammatory reaction. Although most of them are manageable, if the patient has immune system abnormalities or underlying diseases, the risk of adverse reactions may be amplified. Therefore, international guidelines recommend health status assessment before treatment and close monitoring in the early stages of treatment.

Generally speaking, the hazards of zotuximab that deserve attention are mainly the adverse reactions in the gastrointestinal system and the risk of systemic reactions caused by immune activation. Most risks can be controlled through standardized administration routes, pretreatment measures, monitoring and timely adjustment of plans. Therefore, under the premise of accurately screening Claudin18.2-positive patients and strictly following the guidelines, the benefits of this drug still outweigh the risks in most cases.

Reference materials:https://www.astellas.com/en/news/29401