CLDN18.2靶向治疗药物相关恶心、呕吐的预防和管理专家共识(2026年版)OA

Claudin 18.2(CLDN18.2)has emerged as an important therapeutic target in gastrointestinal malignancies,particularly gastric cancer,adenocarcinoma of gastroesophageal junction,and pancreatic cancer.While CLDN18.2-targeted therapies have demonstrated promising antitumor efficacy in both clinical trials and real-world practice,they are also associated with characteristic gastrointestinal toxicities,most notably nausea and vomiting,which may adversely affect patients'quality of life,treatment adherence,and sustained therapeutic efficacy.Increasing preclinical and clinical evidence suggests that these adverse events are primarily attributable to on-target/off-tumor gastric mucosal injury resulting from physiological CLDN18.2 expression in normal gastric mucosa.Consequently,their underlying mechanisms,clinical manifestations,and management strategies differ substantially from those of conventional cancer therapy-induced nausea and vomiting,and therefore should not be managed using standard antiemetic protocols alone.To standardize the risk assessment,prevention,monitoring,and full course management of CLDN18.2-targeted therapy-related nausea and vomiting,the Antitumor Drug Safety Management Professional Committee of Shanghai Anti-Cancer Association convened a multidisciplinary expert panel.Based on a systematic review of the domestic and international evidence and extensive clinical experience,recommendations were developed using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach and a formal consensus methodology.The consensus addresses key aspects of clinical management,including individualized risk assessment,risk-adapted antiemetic prophylaxis,gastric mucosal protection,infusion optimization,management of breakthrough nausea and vomiting,integrative supportive care combining Western and traditional Chinese medicine,patient education and follow-up,as well as multidisciplinary management.Recommendations were formulated to provide practical guidance for the standardized management of this specific toxicity,improvement of treatment adherence,and enhancement of patient benefit.Notably,this is the first expert consensus to propose a comprehensive,multidisciplinary,full-course and full cycle management strategy specifically tailored to the unique pathophysiological characteristics of CLDN18.2-targeted therapy-related nausea and vomiting,which distinguishes it from conventional chemotherapy-induced nausea and vomiting(CINV)management.This consensus is intended to provide practical guidance for the safe clinical application of CLDN18.2-targeted therapies and the standardized management of their associated adverse events.