Zolbetuximab for untreated HER2-negative, claudin-18.2-positive, unresectable advanced gastric or gastroesophageal junction adenocarcinoma

Published on 06 Feb 2026
Last Updated on 01 Jul 2026

Guidance Recommendations

The Ministry of Health’s Drug Advisory Committee has not recommended zolbetuximab, in combination with chemotherapy, for inclusion on the MOH List of Subsidised Drugs for untreated HER2-negative, claudin-18.2-positive, unresectable advanced gastric or gastroesophageal junction adenocarcinoma. The decision was based on the unfavourable cost effectiveness of zolbetuximab plus chemotherapy compared with alternative treatments, and the unacceptable price-volume agreement proposed by the company.

Clinical indication, subsidy class and MediShield Life claims eligibility for zolbetuximab plus chemotherapy are provided in the Annex.

Guidance_Zolbetuximab for untreated HER2-negative, claudin-18.2-positive, unresectable advanced gastric or gastroesophageal junction adenocarcinoma (Updated 1 Jul 2026) [PDF, 317.29 KB]

Plain English Summary

Gastric cancer occurs when cells grow in the stomach uncontrollably and form a mass (tumour), with adenocarcinoma being the most common type. When it affects the area where the oesophagus meets the stomach, this is known as gastroesophageal junction (GEJ) cancer. Symptoms of gastric or GEJ cancer include difficulty swallowing, feeling full or bloated after eating, loss of appetite, heartburn, and unexplained weight loss. If the cancer cannot be removed by surgery (unresectable) and has spread to nearby areas, this is known as locally advanced disease. When it spreads to other parts of the body, this is known as metastatic disease.

Most gastric or GEJ cancers have normal amounts of the HER2 (human epidermal growth factor 2) protein on the cell surface (HER2-negative). Some gastric or GEJ cancers have high levels of the claudin 18.2 protein on the cell surface (claudin-18.2-positive) and can be targeted with specific treatments.

Zolbetuximab is a biologic medicine (monoclonal antibody) which helps the immune system find and destroy cancer cells with the claudin 18.2 protein on their surface. It is given as a slow drip into a vein (intravenously), in combination with chemotherapy.

Zolbetuximab, in combination with chemotherapy, was not recommended for government subsidy because its benefits do not justify its cost compared with alternative treatments. It can be claimed under MediShield Life, and the claim limits are available here.

There are different treatments available for advanced gastric or GEJ cancer. Your doctor can advise whether zolbetuximab or other treatments may be suitable for you.