Would you offer zolbetuximab + chemotherapy in a presumed metastatic duodenal bulb adenocarcinoma with 80% Claudin18.2 expression?

I would not. Cancers of the duodenum are different and such patients were not represented in GLOW or SPOTLIGHT. In addition, zolbe is not very easy in terms of nausea and vomiting, especially in the first cycle. Would not expect more "debulking" effect from it given the absence of significant ORR be...

I agree with Dr. @Dr. First Last. These patients were not included in the reported studies, so they would be exposing patients to the risks (infusion reactions, GI upset as noted by Dr. Sonbol) without evidence of benefit. I would, however, favor participation in a clinical trial as mentioned.