What are the side effects of zotuximab? How to alleviate adverse reactions?

VYLOY (Zolbetuximab) is a new type of monoclonal antibody mainly used to treat patients with HER2-negative, CLDN18.2-positive advanced gastric cancer and gastroesophageal junction cancer (GEJ cancer). The drug specifically binds to and inhibits the cell junction protein CLDN18.2, thereby preventing the proliferation of tumor cells and activating the anti-tumor response of the immune system. The efficacy of zotuximab in clinical treatment is gradually recognized, but like all therapeutic drugs, certain adverse reactions may occur during use. Understanding these side effects and how to mitigate them is critical to improving patients' treatment compliance and quality of life.

Common side effects

1.Allergic reaction

As a monoclonal antibody, zotuximab may cause allergic reactions, especially when administered for the first time. Symptoms of an allergic reaction include rash, fever, chills, difficulty breathing, and swelling of the face or throat. When an allergic reaction occurs, patients may need to stop taking the drug immediately and receive medical treatment. Severe allergic reactions may require intervention with medications such as antihistamines, corticosteroids, and epinephrine.

Mitigation methods: To reduce the risk of anaphylaxis, a slow infusion is usually given during the first infusion and the patient is given prophylactic medications (such as antihistamines and corticosteroids). If allergic reactions occur, timely treatment and discontinuation of medication are necessary, and treatment should be adjusted according to the guidance of a doctor.

2.Gastrointestinal reactions

One of the common side effects of zotuximab is gastrointestinal effects, specifically nausea, vomiting, diarrhea, and decreased appetite. These symptoms usually occur early in treatment and resolve as the medication is gradually tolerated. Gastrointestinal reactions, although common, are controllable in most cases.

Relief methods: For nausea and vomiting, antiemetic drugs such as clozapine or omeprazole can be used to help reduce symptoms. In case of diarrhea, antidiarrheal drugs such as loperamide can be used, and patients are advised to adopt easy-to-digest, low-irritation foods in their diet, such as porridge, bread, and soup. If symptoms are severe, patients should communicate with their doctor to adjust their treatment plan.

3.Abnormal liver function

Zotuximab may cause changes in liver function, manifested as increases in liver enzymes (such as ALT, AST increases). Although liver function abnormalities are mild and reversible in most patients, liver function needs to be monitored regularly during treatment.

Relief methods: Regular blood tests to monitor liver function, especiallyALT, ASTand total bilirubin and other indicators. If liver enzymes are significantly elevated, treatment may need to be suspended or the drug dose adjusted as recommended by your doctor. In some cases, the use of hepatoprotective or other medications can help improve liver function.

4.Fatigue and fatigue

Fatigue is a common side effect of many cancer treatments, and patients may feel exhausted, weak, and sleepy during zotuximab treatment. Although the symptoms are usually more noticeable early in treatment, they may improve as treatment continues.

Relief methods: Arrange your work and rest time reasonably, try to avoid overexertion, and maintain adequate rest and sleep. Adding low-intensity activities, such as walking, can also help relieve fatigue. The doctor may recommend some drugs or nutritional supplements based on the patient's specific situation to improve the patient's energy and physical strength.

5.Anemia

Zotuximab may cause anemia, manifested by a decrease in hemoglobin levels. Symptoms of anemia include fatigue, dizziness, palpitations, etc. Especially in patients with gastric cancer, anemia occurs more frequently due to malnutrition and blood loss that may be caused by the cancer itself.

Relief methods: For mild anemia, patients can improve the anemia by supplementing iron, vitaminsB12 or folic acid. For more severe anemia, blood transfusions or erythropoietin (EPO) drugs may be needed. Regular blood tests can help monitor the degree of anemia and take appropriate measures in a timely manner.

6.Other potential side effects and mitigation methods

In addition to the common side effects mentioned above, zotuximab may also cause other rare side effects, such as headache, insomnia, weight loss, immune system-related reactions (such as immune pneumonitis, hepatitis, etc.) and skin reactions (such as rash, hair loss). For these side effects, patients should closely monitor physical changes and report to their doctors in a timely manner.

For immune-related adverse reactions, patients may require treatment with immunosuppressants (such as steroids). For skin reactions, anti-allergic medications or topical medications can be used to relieve them.

Although zotuximab has shown significant efficacy in the treatment of advanced gastric cancer and gastroesophageal junction cancer, like all drug treatments, it is also associated with certain adverse effects. Understanding and monitoring these side effects can help to take appropriate mitigation measures in a timely manner. Allergic reactions, gastrointestinal reactions, liver function abnormalities, fatigue and anemia are common side effects, which can usually be effectively alleviated through medication adjustment, reasonable rest and symptomatic treatment. Patients should undergo treatment under the guidance of a doctor and undergo regular examinations to ensure the safety and efficacy of the treatment.

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