COVID-19 Vaccination Is Protective, Well Tolerated in Cancer Patients
Key findings
- This study analyzed prospective data on 762 adult cancer patients who completed their primary COVID-19 vaccination series and had immunogenicity and reactogenicity evaluated seven or more days later
- Antibody concentrations and neutralization titers were greatest with the Moderna vaccine, followed by the Pfizer vaccine, and were likely to be sufficient to protect against severe disease, although lower than in healthy controls
- Receipt of chemotherapy within the past 12 months or current receipt of corticosteroids was associated with significantly lower antibody concentrations
- Most side effects were mild or moderate, and systemic side effects correlated with higher antibody concentrations and neutralization titers
- Whenever possible, patients with cancer being vaccinated against COVID-19 should receive an mRNA vaccine, and patients who received the Johnson & Johnson vaccine should be considered for additional doses
The initial trials of COVID-19 vaccines did not specifically include patients with a history of cancer or active cancer. Based on data from a large prospective cohort study, Vivek Naranbhai, MBchB, PhD, DPhil, of the Mass General Cancer Center, and colleagues say the vaccines are well tolerated in patients with cancer, and most recipients achieve responses likely to protect them against severe disease.
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They reported their findings in the Journal of Clinical Oncology.
Methods
The analysis included 762 patients from CANVAX, a study of adults at the Cancer Center who underwent testing of SARS-CoV-2 spike protein antibodies and neutralization seven or more days after completing their primary vaccine series. Testing occurred between April 21 and September 20, 2021.
For comparison, the researchers examined antibody test data on 418 adults without cancer and neutralization assay results in 1,220 pre-pandemic controls.
Effects of Vaccine Type
Geometric mean antibody concentrations (GMC) and neutralization titers (GMT) in cancer patients were:
- Moderna vaccine—2.9 and 2.3 log10 units, respectively
- Pfizer vaccine—2.4 and 1.9
- Johnson & Johnson vaccine—1.5 and 1.4
Seroconversion rates followed the same pattern.
Regardless of age, vaccine type, or time of sampling, GMC was lower in patients with cancer than healthy controls (−0.6; P<0.001), as was GMT (−0.35; P<0.001).
Effects of Therapy and Cancer Type
Chemotherapy in the preceding 12 months was associated with modestly but significantly lower GMC (−0.29; P<0.001) and GMT (−0.21; P<0.001). Current receipt of corticosteroids was associated with significantly lower antibody concentrations.
There were no significant differences in immunogenicity among the 545 patients with solid tumors, but responses were lower in the 113 who had undergone bone marrow transplantation and 85 other patients with hematologic malignancies.
Reactogenicity
72% of participants reported at least one local or systemic symptom after vaccination, which were mild or moderate in 89%. The presence of systemic symptoms was significantly correlated with higher immunogenicity.
Recommendations
Whenever possible, mRNA COVID-19 vaccines should be prioritized for patients with cancer. Patients who received the Johnson & Johnson vaccine should be considered for additional doses.
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