Global prevalence of CLDN18.2 in patients with locally advanced (LA) unresectable or metastatic gastric or gastroesophageal junction (mG/GEJ) adenocarcinoma: Biomarker analysis of two zolbetuximab phase 3 studies (SPOTLIGHT and GLOW).

Authors

Kohei Shitara

Kohei Shitara

Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan

Kohei Shitara , Rui-Hua Xu , Diarmuid Martin Moran , Abraham Guerrero , Ran Li , Janet Pavese , Maria Matsangou , Pranob P. Bhattacharya , Jaffer A. Ajani , Manish A. Shah

Organizations

Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China, Astellas Pharma Global Development, Inc., Northbrook, IL, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, Weill Cornell Medical College, New York, NY

Research Funding

Pharmaceutical/Biotech Company
Astellas Pharma Global Development, Inc

Background: There is an unmet need for additional therapies to treat patients (pts) with locally advanced (LA) unresectable or metastatic gastric or gastroesophageal junction (mG/GEJ) adenocarcinoma. Claudin-18.2 (CLDN18.2), a new validated target in these pts, is expressed in normal gastric mucosa cells and often retained in G/GEJ tumor cells. There are limited data on the global prevalence of CLDN18.2 in tumors of pts with LA unresectable or mG/GEJ adenocarcinoma. The SPOTLIGHT (NCT03504397) and GLOW (NCT03653507) phase 3 studies demonstrated clinically meaningful and statistically significant improvement in PFS and OS with the CLDN18.2-targeted antibody zolbetuximab + chemotherapy (mFOLFOX6 or CAPOX, respectively) vs placebo + chemotherapy as 1L therapy in pts with CLDN18.2+/HER2− disease. We report the biomarker analysis of these studies. Methods: Pts with LA unresectable or mG/GEJ adenocarcinoma were screened for CLDN18.2 status by IHC before enrollment. Tumors were defined as CLDN18.2+ if they had ≥75% of tumor cells with moderate-to-strong membranous CLDN18 staining per the investigational VENTANA CLDN18 (43-14A) RxDx Assay. HER2 status was evaluated per central or local assessment. Ad hoc PD-L1 IHC was performed via the Dako PD-L1 IHC 28-8 pharmDx assay for a subgroup of enrolled pts. Results exclude pts from mainland China and pts missing data for disease type, Lauren classification, or tumor collection site. Results: Across SPOTLIGHT and GLOW, 3576 pts had valid CLDN18 IHC results; 1399 (39.1%) had CLDN18.2+ tumors. CLDN18.2 prevalence was 43.7% (513/1175) in female pts and 36.9% (886/2401) in male pts. CLDN18.2 prevalence was 44.0% (671/1524) in pts in Europe/Middle East, 37.7% (183/485) in pts in N. America, and 36.5% (479/1314) in pts in Asia Pacific. CLDN18.2 prevalence was 41.0% (1056/2576) in pts with gastric adenocarcinoma and 37.3% (302/809) in pts with GEJ adenocarcinoma. CLDN18.2 prevalence trended higher in pts with diffuse (48.9%, 479/980) vs intestinal (38.9%, 265/682) disease. CLDN18.2 prevalence was 41.1% (175/426) in tumors collected from metastatic sites and 38.6% (1195/3094) in tumors collected from primary sites. CLDN18.2 prevalence was similar across other clinical and histopathological characteristics. Of 2908 HER2− pts with valid CLDN18 IHC results, 1264 (43.5%) had CLDN18.2+ tumors. Of 599 enrolled pts tested for PD-L1 expression, 104 (17.4%) had a PD-L1 CPS ≥5. Conclusions: The SPOTLIGHT and GLOW phase 3 studies are the largest data sources to date for determining global CLDN18.2 prevalence. CLDN18.2 is a high prevalence biomarker, with high tumor expression in ~35–40% of pts with LA unresectable or mG/GEJ adenocarcinoma, for whom zolbetuximab + chemotherapy represents a potential 1L therapy. Clinical trial information: NCT03504397, NCT03653507.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Esophageal or Gastric Cancer - Advanced/Metastatic Disease

Clinical Trial Registration Number

NCT03504397, NCT03653507

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 4035)

DOI

10.1200/JCO.2023.41.16_suppl.4035

Abstract #

4035

Poster Bd #

356

Abstract Disclosures