Claudin 18.2: a new therapeutic target: What are the implications for cytopathologists?
May 2025—Claudin 18.2 (CLDN18.2), an isoform of claudin-18, is a transmembrane tight junction protein essential for maintaining barrier function and cell polarity in normal gastric and pancreatic epithelium. In malignant epithelial cells, the loss of polarity exposes the CLDN18.2 epitope, leading to its increased expression in gastric and pancreatic adenocarcinomas. CLDN18.2 has drawn attention as a therapeutic target, particularly with the development of the monoclonal IgG antibody zolbetuximab (Vyloy, Astellas Pharma). Zolbetuximab exerts its antitumor effects via both antibody-dependent and complement-mediated cytotoxicity and has demonstrated significantly improved progression-free and overall survival when combined with standard chemotherapy in two pivotal phase three clinical trials (SPOTLIGHT and GLOW). These data validated CLDN18.2 as a promising target in advanced, HER2-negative gastric and gastroesophageal junction (GEJ) adenocarcinoma.