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Hua T, Fan R, Fan Y, Chen F. Immune response of COVID-19 vaccines in solid cancer patients: A meta-analysis. Hum Vaccin Immunother 2024; 20:2357424. [PMID: 38785118 PMCID: PMC11135846 DOI: 10.1080/21645515.2024.2357424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Solid cancer patients, compared to their healthy counterparts, are at a greater risk of contracting and suffering from severe complications and poorer prognosis after COVID-19 infections. They also have different immune responses after doses of COVID-19 vaccination, but limited evidence is available to reveal the effectiveness and help to guide immunization programs for this subpopulation; MEDLINE, Embase, Web of Science, Cochrane Library databases, and clinicaltrials.gov were used to search literature. The pooled seroconversion rate was calculated using a random-effects model and reported with a 95% confidence interval (CI); The review includes 66 studies containing serological responses after COVID-19 vaccination in 13,050 solid cancer patients and 8550 healthy controls. The pooled seropositive rates after the first dose in patients with solid cancer and healthy controls are 55.2% (95% CI 45.9%-64.5% N = 18) and 90.2% (95% CI 80.9%-96.6% N = 13), respectively. The seropositive rates after the second dose in patients with solid cancer and healthy controls are 87.6% (95% CI 84.1%-90.7% N = 50) and 98.9% (95% CI 97.6%-99.7% N = 35), respectively. The seropositive rates after the third dose in patients with solid cancer and healthy controls are 91.4% (95% CI 85.4%-95.9% N = 21) and 99.8% (95% CI 98.1%-100.0% N = 4), respectively. Subgroup analysis finds that study sample size, timing of antibody testing, and vaccine type have influence on the results; Seroconversion rates after COVID-19 vaccination are significantly lower in patients with solid malignancies, especially after the first dose, then shrinking gradually after the following two vaccinations, indicating that subsequent doses or a booster dose should be considered for the effectiveness of this subpopulation.
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Affiliation(s)
- Tiantian Hua
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Ru Fan
- Medical Statistics and Analysis Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Fan
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Feng Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
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2
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Cavic G, Almonte AA, Hicks SM, Neeman T, Wang JW, Brew S, Choi PY, Cockburn I, Gardiner EE, Yip D, Fahrer AM, Kanjanapan Y. Response to COVID-19 vaccination in patients on cancer therapy: Analysis in a SARS-CoV-2-naïve population. Asia Pac J Clin Oncol 2024. [PMID: 38221764 DOI: 10.1111/ajco.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/02/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Cancer patients have increased morbidity and mortality from COVID-19, but may respond poorly to vaccination. The Evaluation of COVID-19 Vaccination Efficacy and Rare Events in Solid Tumors (EVEREST) study, comparing seropositivity between cancer patients and healthy controls in a low SARS-CoV-2 community-transmission setting, allows determination of vaccine response with minimal interference from infection. METHODS Solid tumor patients from The Canberra Hospital, Canberra, Australia, and healthy controls who received COVID-19 vaccination between March 2021 and January 2022 were included. Blood samples were collected at baseline, pre-second vaccine dose and at 1, 3 (primary endpoint), and 6 months post-second dose. SARS-CoV-2 anti-spike-RBD (S-RBD) and anti-nucleocapsid IgG antibodies were measured. RESULTS Ninety-six solid tumor patients and 20 healthy controls were enrolled, with median age 62 years, and 60% were female. Participants received either AZD1222 (65%) or BNT162b2 (35%) COVID-19 vaccines. Seropositivity 3 months post vaccination was 87% (76/87) in patients and 100% (20/20) in controls (p = .12). Seropositivity was observed in 84% of patients on chemotherapy, 80% on immunotherapy, and 96% on targeted therapy (differences not satistically significant). Seropositivity in cancer patients increased from 40% (6/15) after first dose, to 95% (35/37) 1 month after second dose, then dropped to 87% (76/87) 3 months after second dose. CONCLUSION Most patients and all controls became seropositive after two vaccine doses. Antibody concentrations and seropositivity showed a decrease between 1 and 3 months post vaccination, highlighting need for booster vaccinations. SARS-CoV-2 infection amplifies S-RBD antibody responses; however, cannot be adequately identified using nucleocapsid serology. This underlines the value of our COVID-naïve population in studying vaccine immunogenicity.
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Affiliation(s)
- George Cavic
- Research School of Biology, Australian National University, Canberra, Australia
| | - Andrew A Almonte
- Research School of Biology, Australian National University, Canberra, Australia
| | - Sarah M Hicks
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Teresa Neeman
- Biological Data Science Institute, Australian National University, Canberra, Australia
| | - Jo-Wai Wang
- Research School of Biology, Australian National University, Canberra, Australia
| | - Sue Brew
- Medical Oncology Clinical Trials Unit, The Canberra Hospital, Canberra, Australia
| | - Philip Y Choi
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
- Department of Medical Oncology, The Canberra Hospital, Canberra, Australia
| | - Ian Cockburn
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Elizabeth E Gardiner
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
- Department of Haematology, The Canberra Hospital, Canberra, Australia
| | - Aude M Fahrer
- Research School of Biology, Australian National University, Canberra, Australia
- Faculty of Science and Technology, University of Canberra, Canberra, Australia
| | - Yada Kanjanapan
- Department of Medical Oncology, The Canberra Hospital, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
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Provencio M, Estival A, Franco F, López-Vivanco G, Saigí M, Arasanz H, Diz P, Carcereny E, García J, Aguado C, Mosquera J, Iruarrizaga E, Majem M, Bosch-Barrera J, Mielgo-Rubio X, Guirado M, Juan-Vidal Ó, Blasco A, Lucía Gozálvez C, Del Barrio A, De Portugal T, López-Martín A, Serrano G, Campos B, Rubio J, Catot S, Esteban B, Martí-Ciriquian JL, Del Barco E, Calvo V. Immunogenicity of COVID-19 vaccines in lung cancer patients. Lung Cancer 2023; 184:107323. [PMID: 37639820 DOI: 10.1016/j.lungcan.2023.107323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Patients with lung cancer are at increased risk of SARS-CoV-2 infection and severe complications from COVID-19, but information on the efficacy of anti-SARS-CoV-2 vaccine in these patients is scarce. We aimed at evaluating the safety and immunogenicity of COVID-19 vaccines in this population. PATIENTS AND METHODS The prospective, nationwide SOLID substudy, enrolled adults with lung cancer who were fully vaccinated against COVID-19. Serum anti-SARS-CoV-2 IgG antibody levels were quantitatively assessed two weeks and six months after receipt of the last dose using a chemiluminescent microparticle immunoassay. Multivariate odds ratios for the association between demographic and clinical factors and seronegativity after vaccination were estimated. RESULTS 1973 lung cancer patients were enrolled. Most patients had stage IV disease (66%) and were receiving active cancer treatment (82.7%). No significant differences were found in the probability of being seronegative for anti-SARS-CoV-2 IgG antibodies after full vaccination between patients who were receiving active cancer treatment and those who were not (p = 0.396). The administration of immunotherapy or oral targeted therapy and immunization with mRNA-1273 COVID-19 vaccine were factors independently associated with increased odds of being seropositive after vaccination. From all patients, 1405 received the second dose of vaccine and high levels of antibody titers were observed in 93.6% of patients two weeks after second dose. At six months, multivariate logistic regression analysis showed that performance status ≥ 2 was independently associated with a higher probability of being seronegative after full vaccination with an OR 4.15. On the other hand, received chemotherapy or oral target therapy and vaccination with mRNA-1273 were a factor independently associated with lower odds of being seronegative after full vaccination with an OR 0.52, 0.37 and 0.34, respectively. CONCLUSIONS Lung cancer patients can safely achieve a strong immune response against SARS-CoV-2 after full vaccination, regardless of the cancer treatment received. TRIAL REGISTRATION NCT04407143.
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Affiliation(s)
- Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
| | - Anna Estival
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
| | - Fernando Franco
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - María Saigí
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
| | - Hugo Arasanz
- Medical Oncology Department, Hospital Universitario de Navarra - Oncoimmunology, Navarrabiomed, Pamplona, Spain
| | - Pilar Diz
- Medical Oncology Department, Complejo Asistencial Universitario de León, León, Spain
| | - Enric Carcereny
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
| | - Javier García
- Medical Oncology Department, Hospital Universitari Son LLàtzer, Palma de Mallorca, Spain
| | - Carlos Aguado
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Joaquín Mosquera
- Medical Oncology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Eluska Iruarrizaga
- Medical Oncology Department, Hospital Universitario Cruces, Barakaldo, Spain
| | - Margarita Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Xavier Mielgo-Rubio
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - María Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Óscar Juan-Vidal
- Medical Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Blasco
- Medical Oncology Department, Hospital General Universitario de Valencia, CIBERONC, Valencia, Spain
| | - Clara Lucía Gozálvez
- Medical Oncology Department, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Anabel Del Barrio
- Medical Oncology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Teresa De Portugal
- Medical Oncology Department, Complejo Hospitalario de Zamora, Zamora, Spain
| | - Ana López-Martín
- Medical Oncology Department, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Gloria Serrano
- Medical Oncology Department, Hospital Universiario Infanta Leonor, Madrid, Spain
| | - Begoña Campos
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Judit Rubio
- Medical Oncology Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Silvia Catot
- Medical Oncology Department, Althaia, Xarxa Assistencial Universitària Manresa, Barcelona, Spain
| | - Beatriz Esteban
- Medical Oncology Department, Hospital General Universitario de Segovia, Segovia, Spain
| | | | - Edel Del Barco
- Medical Oncology Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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Pietroluongo E, De Placido P, Tortora M, Martinelli C, Viggiano A, Saponaro MR, Caltavituro A, Buonaiuto R, Morra R, Ottaviano M, Del Deo V, Cernera G, Gelzo M, Malfitano AM, Di Tolla MF, De Angelis C, Arpino G, Terracciano D, Bianco R, Veneziani BM, Formisano P, Castaldo G, Palmieri G, De Placido S, Giuliano M. Impaired Seroconversion After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA Vaccine in Patients With Thymic Epithelial Tumors. J Thorac Oncol 2023; 18:1399-1407. [PMID: 37390981 PMCID: PMC10303630 DOI: 10.1016/j.jtho.2023.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/29/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Thymic epithelial tumors (TETs) are rare malignancies associated with dysregulation of the immune system and humoral- and cell-mediated immunity abnormalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine is effective in preventing coronavirus disease 2019 morbidity and mortality. The aim of this study was to evaluate the seroconversion in patients with TET after two doses of mRNA vaccine. METHODS This is a prospective study in which consecutive patients with TET were enrolled before receiving the first dose of SARS-CoV-2 mRNA vaccine (BNT162b2 by Pfizer-BioNTech). SARS-CoV-2 spike-binding immunoglobulin (Ig)G antibody serologic levels were analyzed at different time points, including before first vaccine dose (T0), 1 month after the second dose (T2), and 3 months after the second dose (T3). RESULTS Overall, 39 patients were included in the analysis. All patients had negative antibody titer results at T0. There were 19 patients (48.7%) in the follow-up with no residual tumor lesion/s (referred as no evidence of disease), and 20 (51.3%) had evidence of disease (ED) and were receiving systemic treatment. Dysregulations of the immune system were diagnosed in 29 patients (74.4%) with Good syndrome (GS) being the most frequent immune disorder (48.7%). At univariate analysis, lack of seroconversion at T2 was significantly associated with ED (p < 0.001) and with GS (p = 0.043). A significant association with impaired seroconversion was confirmed at multivariate analysis for ED (p = 0.00101) but not for GS (p = 0.625). CONCLUSIONS Our data revealed that patients with TET with ED had substantially higher probability of impaired seroconversion after SARS-CoV-2 mRNA vaccine as compared with patients with no evidence of disease.
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Affiliation(s)
- Erica Pietroluongo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Marianna Tortora
- Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
| | - Claudia Martinelli
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Angela Viggiano
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | | | - Aldo Caltavituro
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberto Buonaiuto
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Rocco Morra
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Margaret Ottaviano
- Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy; Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Italian National Cancer Institute- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Pascale Foundation, Naples, Italy
| | - Vitantonio Del Deo
- Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
| | - Gustavo Cernera
- CEINGE, Biotecnologie Avanzate, Naples, Italy; Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Monica Gelzo
- CEINGE, Biotecnologie Avanzate, Naples, Italy; Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Anna Maria Malfitano
- Department of Translational Medical Sciences, University "Federico II," Naples, Italy
| | | | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University "Federico II," Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Bianca Maria Veneziani
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II," Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, University "Federico II," Naples, Italy
| | - Giuseppe Castaldo
- CEINGE, Biotecnologie Avanzate, Naples, Italy; Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | | | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy; Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy; Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
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Li HJ, Yang QC, Yao YY, Huang CY, Yin FQ, Xian-Yu CY, Zhang C, Chen SJ. COVID-19 vaccination effectiveness and safety in vulnerable populations: a meta-analysis of 33 observational studies. Front Pharmacol 2023; 14:1144824. [PMID: 37426814 PMCID: PMC10326898 DOI: 10.3389/fphar.2023.1144824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
Background: Even 3 years into the COVID-19 pandemic, questions remain about how to safely and effectively vaccinate vulnerable populations. A systematic analysis of the safety and efficacy of the COVID-19 vaccine in at-risk groups has not been conducted to date. Methods: This study involved a comprehensive search of PubMed, EMBASE, and Cochrane Central Controlled Trial Registry data through 12 July 2022. Post-vaccination outcomes included the number of humoral and cellular immune responders in vulnerable and healthy populations, antibody levels in humoral immune responders, and adverse events. Results: A total of 23 articles assessing 32 studies, were included. The levels of IgG (SMD = -1.82, 95% CI [-2.28, -1.35]), IgA (SMD = -0.37, 95% CI [-0.70, -0.03]), IgM (SMD = -0.94, 95% CI [-1.38, -0.51]), neutralizing antibodies (SMD = -1.37, 95% CI [-2.62, -0.11]), and T cells (SMD = -1.98, 95% CI [-3.44, -0.53]) were significantly lower in vulnerable than in healthy populations. The positive detection rates of IgG (OR = 0.05, 95% CI [0.02, 0.14]) and IgA (OR = 0.03, 95% CI [0.01, 0.11]) antibodies and the cellular immune response rates (OR = 0.20, 95% CI [0.09, 0.45]) were also lower in the vulnerable populations. There were no statistically significant differences in fever (OR = 2.53, 95% CI [0.11, 60.86]), chills (OR = 2.03, 95% CI [0.08, 53.85]), myalgia (OR = 10.31, 95% CI [0.56, 191.08]), local pain at the injection site (OR = 17.83, 95% CI [0.32, 989.06]), headache (OR = 53.57, 95% CI [3.21, 892.79]), tenderness (OR = 2.68, 95% CI [0.49, 14.73]), and fatigue (OR = 22.89, 95% CI [0.45, 1164.22]) between the vulnerable and healthy populations. Conclusion: Seroconversion rates after COVID-19 vaccination were generally worse in the vulnerable than healthy populations, but there was no difference in adverse events. Patients with hematological cancers had the lowest IgG antibody levels of all the vulnerable populations, so closer attention to these patients is recommended. Subjects who received the combined vaccine had higher antibody levels than those who received the single vaccine.
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Affiliation(s)
- Hui-Jun Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Qi-Chao Yang
- Department of Emergency, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yang-Yang Yao
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Cheng-Yang Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Fu-Qiang Yin
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Chen-Yang Xian-Yu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Shao-Juan Chen
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Brisotto G, Montico M, Turetta M, Zanussi S, Cozzi MR, Vettori R, Boschian Boschin R, Vinante L, Matrone F, Revelant A, Palazzari E, Innocente R, Fanetti G, Gerratana L, Garutti M, Lisanti C, Bolzonello S, Nicoloso MS, Steffan A, Muraro E. Integration of Cellular and Humoral Immune Responses as an Immunomonitoring Tool for SARS-CoV-2 Vaccination in Healthy and Fragile Subjects. Viruses 2023; 15:1276. [PMID: 37376576 DOI: 10.3390/v15061276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
Cellular and humoral immunity are both required for SARS-CoV-2 infection recovery and vaccine efficacy. The factors affecting mRNA vaccination-induced immune responses, in healthy and fragile subjects, are still under investigation. Thus, we monitored the vaccine-induced cellular and humoral immunity in healthy subjects and cancer patients after vaccination to define whether a different antibody titer reflected similar rates of cellular immune responses and if cancer has an impact on vaccination efficacy. We found that higher titers of antibodies were associated with a higher probability of positive cellular immunity and that this greater immune response was correlated with an increased number of vaccination side effects. Moreover, active T-cell immunity after vaccination was associated with reduced antibody decay. The vaccine-induced cellular immunity appeared more likely in healthy subjects rather than in cancer patients. Lastly, after boosting, we observed a cellular immune conversion in 20% of subjects, and a strong correlation between pre- and post-boosting IFN-γ levels, while antibody levels did not display a similar association. Finally, our data suggested that integrating humoral and cellular immune responses could allow the identification of SARS-CoV-2 vaccine responders and that T-cell responses seem more stable over time compared to antibodies, especially in cancer patients.
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Affiliation(s)
- Giulia Brisotto
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Marcella Montico
- Clinical Trial Office, Scientific Direction, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Matteo Turetta
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Stefania Zanussi
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Maria Rita Cozzi
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Roberto Vettori
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Romina Boschian Boschin
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Lorenzo Vinante
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Fabio Matrone
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Alberto Revelant
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Elisa Palazzari
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Roberto Innocente
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Giuseppe Fanetti
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Lorenzo Gerratana
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Mattia Garutti
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Camilla Lisanti
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Silvia Bolzonello
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Milena Sabrina Nicoloso
- Molecular Oncology Unit, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Elena Muraro
- Immunopathology and Cancer Biomarkers Units, Department of Cancer Research and Advanced Diagnostics, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
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Liatsou E, Ntanasis-Stathopoulos I, Lykos S, Ntanasis-Stathopoulos A, Gavriatopoulou M, Psaltopoulou T, Sergentanis TN, Terpos E. Adult Patients with Cancer Have Impaired Humoral Responses to Complete and Booster COVID-19 Vaccination, Especially Those with Hematologic Cancer on Active Treatment: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15082266. [PMID: 37190194 DOI: 10.3390/cancers15082266] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
The exclusion of patients with cancer in clinical trials evaluating COVID-19 vaccine efficacy and safety, in combination with the high rate of severe infections, highlights the need for optimizing vaccination strategies. The aim of this study was to perform a systematic review and meta-analysis of the published available data from prospective and retrospective cohort studies that included patients with either solid or hematological malignancies according to the PRISMA Guidelines. A literature search was performed in the following databases: Medline (Pubmed), Scopus, Clinicaltrials.gov, EMBASE, CENTRAL and Google Scholar. Overall, 70 studies were included for the first and second vaccine dose and 60 studies for the third dose. The Effect Size (ES) of the seroconversion rate after the first dose was 0.41 (95%CI: 0.33-0.50) for hematological malignancies and 0.56 (95%CI: 0.47-0.64) for solid tumors. The seroconversion rates after the second dose were 0.62 (95%CI: 0.57-0.67) for hematological malignancies and 0.88 (95%CI: 0.82-0.93) for solid tumors. After the third dose, the ES for seroconversion was estimated at 0.63 (95%CI: 0.54-0.72) for hematological cancer and 0.88 (95%CI: 0.75-0.97) for solid tumors. A subgroup analysis was performed to evaluate potential factors affecting immune response. Production of anti-SARS-CoV-2 antibodies was found to be more affected in patients with hematological malignancies, which was attributed to the type of malignancy and treatment with monoclonal antibodies according to the subgroup analyses. Overall, this study highlights that patients with cancer present suboptimal humoral responses after COVID-19 vaccination. Several factors including timing of vaccination in relevance with active therapy, type of therapy, and type of cancer should be considered throughout the immunization process.
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Affiliation(s)
- Efstathia Liatsou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Stavros Lykos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodoros N Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 12243 Aigaleo, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
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8
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Saavedra C, Vallejo A, Longo F, Serrano JJ, Fernández M, Gion M, López-Miranda E, Martínez-Jáñez N, Guerra E, Chamorro J, Rosero D, Velasco H, Martín A, Carrato A, Casado JL, Cortés A. Discordant Humoral and T-Cell Response to mRNA SARS-CoV-2 Vaccine and the Risk of Breakthrough Infections in Women with Breast Cancer, Receiving Cyclin-Dependent Kinase 4 and 6 Inhibitors. Cancers (Basel) 2023; 15:cancers15072000. [PMID: 37046661 PMCID: PMC10093435 DOI: 10.3390/cancers15072000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/09/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Few data are available about the immune response to mRNA SARS-CoV-2 vaccines in patients with breast cancer receiving cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). We conducted a prospective, single-center study of patients with breast cancer treated with CDK4/6i who received mRNA-1273 vaccination, as well as a comparative group of healthcare workers. The primary endpoint was to compare the rate and magnitude of humoral and T-cell response after full vaccination. A better neutralizing antibody and anti-S IgG level was observed after vaccination in the subgroup of women receiving CDK4/6i, but a trend toward a reduced CD4 and CD8 T-cell response in the CDK4/6i group was not statistically significant. There were no differences in the rate of COVID-19 after vaccination (19% vs. 12%), but breakthrough infections were observed in those with lower levels of anti-S IgG and neutralizing antibodies after the first dose. A lower rate of CD4 T-cell response was also found in those individuals with breakthrough infections, although a non-significant and similar level of CD8 T-cell response was also observed, regardless of breakthrough infections. The rate of adverse events was higher in patients treated with CDK4/6i, without serious adverse events. In conclusion, there was a robust humoral response, but a blunted T-cell response to mRNA vaccine in women receiving CDK4/6i, suggesting a reduced trend of the adaptative immune response.
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Affiliation(s)
- Cristina Saavedra
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Alejandro Vallejo
- Laboratory of Immunovirology, Department of Infectious Diseases, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Federico Longo
- CIBERONC, Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, Alcalá University, 28034 Madrid, Spain
| | - Juan José Serrano
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - María Fernández
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - María Gion
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Elena López-Miranda
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Noelia Martínez-Jáñez
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Eva Guerra
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Jesús Chamorro
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Diana Rosero
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Héctor Velasco
- CiberInfect, Infectious Disease Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Adrián Martín
- CiberInfect, Infectious Disease Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Alfredo Carrato
- CIBERONC, Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, Alcalá University, 28034 Madrid, Spain
| | - José Luis Casado
- CiberInfect, Infectious Disease Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
- Correspondence: (J.L.C.); (A.C.)
| | - Alfonso Cortés
- Medical Oncology Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- Correspondence: (J.L.C.); (A.C.)
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9
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Purshouse K, Thomson JP, Vallet M, Alexander L, Bonisteel I, Brennan M, Cameron DA, Figueroa JD, Furrie E, Haig P, Heck M, McCaughan H, Mitchell P, McVicars H, Primrose L, Silva I, Templeton K, Wilson N, Hall PS. The Scottish COVID Cancer Immunity Prevalence Study: A Longitudinal Study of SARS-CoV-2 Immune Response in Patients Receiving Anti-Cancer Treatment. Oncologist 2023; 28:e145-e155. [PMID: 36719033 PMCID: PMC10020811 DOI: 10.1093/oncolo/oyac257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/27/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cancer and anti-cancer treatment (ACT) may be risk factors for severe SARS-CoV-2 infection and limited vaccine efficacy. Long-term longitudinal studies are needed to evaluate these risks. The Scottish COVID cancer immunity prevalence (SCCAMP) study characterizes the incidence and outcomes of SARS-CoV-2 infection and vaccination in patients with solid tumors undergoing ACT. This preliminary analysis includes 766 patients recruited since May 2020. METHODS Patients with solid-organ cancers attending secondary care for active ACT consented to the collection of routine electronic health record data and serial blood samples over 12 months. Blood samples were tested for total SARS-CoV-2 antibody. RESULTS A total of 766 participants were recruited between May 28, 2020 and October 31, 2021. Most received cytotoxic chemotherapy (79%). Among the participants, 48 (6.3%) were tested positive for SARS-CoV-2 by PCR. Infection rates were unaffected by ACT, largely aligning with the local population. Mortality proportion was not higher with a recent positive SARS-CoV-2 PCR (10.4% vs 10.6%). Multivariate analysis revealed lower infection rates in vaccinated patients regardless of chemotherapy (HR 0.307 [95% CI, 0.144-0.6548]) or immunotherapy (HR 0.314 [95% CI, 0.041-2.367]) treatment. A total of 96.3% of patients successfully raised SARS-CoV-2 antibodies after >2 vaccines. This was independent of the treatment type. CONCLUSION This is the largest on-going longitudinal real-world dataset of patients undergoing ACT during the early stages of the COVID-19 pandemic. This preliminary analysis demonstrates that patients with solid tumors undergoing ACT have high protection from SARS-CoV-2 infection following COVID-19 vaccination. The SCCAMP study will evaluate long-term COVID-19 antibody trends, focusing on specific ACTs and patient subgroups.
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Affiliation(s)
| | | | | | - Lorna Alexander
- Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, UK
| | - Isaac Bonisteel
- The University of Edinburgh Medical School, The University of Edinburgh, Chancellor’s Building, Edinburgh BioQuarter, Edinburgh, UK
| | - Maree Brennan
- Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, UK
| | - David A Cameron
- Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Jonine D Figueroa
- Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh, UK
- Usher Institute, Centre for Population Health Sciences, Old Medical School, Teviot Place, Edinburgh, UK
| | - Elizabeth Furrie
- Department of Immunology, Ninewells Hospital and Dundee Medical School, Dundee, UK
| | - Pamela Haig
- Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Mattea Heck
- The University of Edinburgh Medical School, The University of Edinburgh, Chancellor’s Building, Edinburgh BioQuarter, Edinburgh, UK
| | - Hugh McCaughan
- Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Paul Mitchell
- Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Heather McVicars
- Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, UK
| | | | - Ines Silva
- Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Kate Templeton
- Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Natalie Wilson
- Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Peter S Hall
- Corresponding author: Peter S. Hall, PhD, Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh Cancer Centre, NHS Lothian, Crewe Road South, Edinburgh, EH4 2XU, UK.
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10
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Retnakumar SV, Chauvin C, Bayry J. The implication of anti-PD-1 therapy in cancer patients for the vaccination against viral and other infectious diseases. Pharmacol Ther 2023; 245:108399. [PMID: 37001736 DOI: 10.1016/j.pharmthera.2023.108399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
The phenomenon of 'T cell exhaustion', a state of T cell dysfunction observed during chronic infections and cancers, has been a major obstacle in mounting appropriate immune responses against infectious agents or tumor antigens. The exhausted T cells are characterized by poor effector functions mainly due to the overexpression of inhibitory receptors such as programmed cell death protein 1 (PD-1), cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), T cell immunoglobulin and mucin-domain containing 3 (TIM3), lymphocyte activation gene 3 (LAG3), and T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), commonly referred to as immune checkpoint (ICP) molecules. ICP blockade, especially of PD-1 that can potentially reverse T cell exhaustion and thereby re-stimulate the impaired immune system, is widely used in clinics as a promising therapeutic strategy for various cancers and is more recently being investigated in infectious diseases as well. In fact, cancer patients represent a population of immunocompromised individuals who are more susceptible to infections and associated complications, and thus the need for protective vaccinations against these diseases is of prime importance in this category. When it comes to vaccinating anti-PD-1-treated cancer patients against infectious diseases including COVID-19 and influenza, a special focus should be brought on the revived immune cells, which could be dynamically affected by the antigenic stimulation. However, since cancer patients are not generally included in clinical trials for designing vaccines against infectious diseases, the possible interaction between vaccine immune responses and ICP therapy is largely unexplored. Mechanistically, the reversal of T cell exhaustion by ICP in an otherwise immunocompromised population could be beneficial for the vaccine's efficacy, helping the immune system to mount a robust immune response. Nevertheless, patients with cancer undergoing anti-PD-1 blockade are known to experience immune-related adverse effects (irAEs). The risk of increasing the irAEs due to the overstimulation of the immune system during vaccination is a major concern. Therefore, while routine vaccination is indispensable for the protection of cancer patients, the impact of PD-1 blockade on vaccine responses against infectious agents requires careful consideration to avoid undesirable adverse effects that could impair the efficacy of anti-cancer treatment.
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11
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Lee K, Park IH, Oh SC, Seo JH, Jeon MJ, Yu ES, Kim DS, Choi CW, Lim A, Hyun MH, Kim JW, Kim JH, Choi YJ, Lee S, Park KH, Kim YH, Choi JY, Kim JS, Lee SR, Sung HJ, Kang EJ. Perception and safety analysis of COVID-19 vaccination in cancer patients: A multicenter, real-world study. Cancer Med 2023; 12:5558-5568. [PMID: 36373165 PMCID: PMC9877582 DOI: 10.1002/cam4.5400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although various coronavirus disease 2019 (COVID-19) vaccines have been delivered to the public worldwide, data on cancer populations are limited. Vaccine hesitancy related to safety concerns is observed among cancer patients. We report the perception of COVID-19 vaccines and their safety profile after vaccination among cancer patients. MATERIALS AND METHODS Between April and November 2021, a multicenter survey was conducted on 318 patients treated in any hemato-oncology outpatient clinic among three hospitals under the Korea University Medical Center. The medical records of the patients were reviewed to obtain detailed clinical and hematological toxicity data. RESULTS A perception survey was conducted among 293 patients. Among them, 53.9% were concerned about developing vaccine-related adverse events (VRAEs) and 23.5%, about negative effects on cancer treatment. During the study period, 255 and 186 patients participated in a safety survey after the first and second doses, respectively. After the first dose, 62% of patients reported VRAEs (2.4%, grade 3), whereas 48.9% reported VRAEs (2.7%, grade 3) after the second dose. For both doses, injection-site pain and sore arm pain were the most common VRAEs, followed by myalgia, fatigue, and headache. No grade 4/5 VRAEs were observed, and there were no differences in complete blood count after vaccination. Multivariate analysis revealed female sex, active cancer treatment, and mRNA vaccines as independent risk factors for VRAE development in cancer patients. CONCLUSION Despite high levels of concern, COVID-19 vaccines were well tolerated by cancer patients, with a safety profile consistent with that of the general population.
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Affiliation(s)
- Kyoungmin Lee
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - In Hae Park
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - Sang Cheul Oh
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - Jae Hong Seo
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - Min Ji Jeon
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - Eun Sang Yu
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - Dae Sik Kim
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - Chul Won Choi
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
| | - Ah‐reum Lim
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Myung Han Hyun
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Ju Won Kim
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Jwa Hoon Kim
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Yoon Ji Choi
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Soohyeon Lee
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Kyong Hwa Park
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Yeul Hong Kim
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Anam HospitalSeoulRepublic of Korea
| | - Jung Yoon Choi
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Ansan HospitalAnsanRepublic of Korea
| | - Jung Sun Kim
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Ansan HospitalAnsanRepublic of Korea
| | - Se Ryeon Lee
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Ansan HospitalAnsanRepublic of Korea
| | - Hwa Jung Sung
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Ansan HospitalAnsanRepublic of Korea
| | - Eun Joo Kang
- Division of Hemato‐Oncology, Department of Internal Medicine, Korea University College of MedicineKorea University Guro HospitalSeoulRepublic of Korea
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12
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Kakkassery H, Carpenter E, Patten PEM, Irshad S. Immunogenicity of SARS-CoV-2 vaccines in patients with cancer. Trends Mol Med 2022; 28:1082-1099. [PMID: 35999131 PMCID: PMC9345889 DOI: 10.1016/j.molmed.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 01/21/2023]
Abstract
Transmission of the SARS-CoV-2 virus and its corresponding disease (COVID-19) has been shown to impose a higher burden on cancer patients than on the general population. Approved vaccines for use include new technology mRNA vaccines such as BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna), and nonreplicating viral vector vaccines such as Ad26.COV2.S (Johnson & Johnson) and AZD1222 (AstraZeneca). Impaired or delayed humoral and diminished T-cell responses are evident in patients with cancer, especially in patients with haematological cancers or those under active chemotherapy. Herein we review the current data on vaccine immunogenicity in cancer patients, including recommendations for current practice and future research.
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Affiliation(s)
- Helen Kakkassery
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Esme Carpenter
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Piers E M Patten
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Haematological Medicine, King's College Hospital, London, UK
| | - Sheeba Irshad
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Breast Cancer Now Research Unit, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
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13
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Fu L, Wu S, Wang B, Zheng W, Sun Y, Tian T, Zhang X, Xu L, Sun Y, Zhan J, Peng Z, Chen Y, Zou H. COVID-19 vaccination perception and uptake among cancer patients in Guangzhou, China. Hum Vaccin Immunother 2022; 18:2102329. [PMID: 35976684 DOI: 10.1080/21645515.2022.2102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with cancer are considered at high risk of COVID-19 related complications with higher mortality rates than healthy individuals. This study investigated the perception, acceptance, and influencing factors of COVID-19 vaccination among cancer patients in Guangzhou, China. A cross-sectional survey was conducted in Guangzhou, China from August to November 2021 in two tertiary medical centers. Outpatients were recruited through hospital posters to complete a questionnaire including demographics, medical history, knowledge, and attitude toward COVID-19 vaccines and COVID-19 vaccination status. Chi-square tests and multivariable logistic regression were used to analyze predictors for acceptance of COVID-19 vaccination. In total, only 75 out of 343 patients (21.87%) had received at least one dose of COVID-19 vaccine. Twenty-one patients (6.12%) had received a recommendation about COVID-19 vaccination from their physicians. Patients who were recommended by physicians to get vaccinated (aOR = 11.71 95% CI: 2.71-50.66), with a monthly income of more than CNY 5000 (aOR = 3.94, 95% CI: 1.88-8.26) were more likely to have received COVID-19 vaccination. Cancer patients who had been diagnosed for more than one year (aOR = 0.21, 95% CI: 0.09-0.51), had received multiple cancer treatment strategies (aOR = 0.34, 95% CI: 0.16-0.74), worried about the safety of COVID-19 vaccines (aOR = 0.21, 95% CI: 0.11-0.40), were less likely to have received COVID-19 vaccination. COVID-19 vaccination uptake among cancer patients was insufficient. The proportion of cancer patients receiving vaccination recommendations from physicians remains inadequate. Physicians are expected to play an essential role in patients' knowledge of the safety and effectiveness of COVID-19 vaccines.
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Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Shuang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Tian Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xiaoyue Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lingrui Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yukun Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Zhan
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhenwei Peng
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Institute of Precision Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
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14
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Nakashima K, Ishida M, Matsui H, Yoshida C, Nagai T, Shiraga M, Nakaoka H, Otsuka Y, Nakagama Y, Kaku N, Nitahara Y, Kido Y, Hirota Y. Immunogenicity and safety of COVID-19 vaccine in lung cancer patients receiving anticancer treatment: A prospective multicenter cohort study. Hum Vaccin Immunother 2022; 18:2140549. [PMID: 36369871 DOI: 10.1080/21645515.2022.2140549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study assessed the immunogenicity and safety of the BNT162b2 mRNA vaccine in lung cancer patients receiving anticancer treatment. We enrolled lung cancer patients receiving anticancer treatment and non-cancer patients; all participants were fully vaccinated with the BNT162b2 vaccine. Blood samples were collected before the first and second vaccinations and 4 ± 1 weeks after the second vaccination. Anti-severe respiratory syndrome coronavirus-2 (SARS-CoV-2) spike protein S1 subunit receptor-binding domain antibody titers were measured using the Architect SARS-CoV-2 IgG II Quant and Elecsys Anti-SARS-CoV-2 S assays. Fifty-five lung cancer patients and 38 non-cancer patients were included in the immunogenicity analysis. Lung cancer patients showed significant increase in the geometric mean antibody concentration, which was significantly lower than that in the non-cancer patients after the first (30 vs. 121 AU/mL, p < .001 on Architect; 4.0 vs 1.2 U/mL, p < .001 on Elecsys) and second vaccinations (1632 vs. 3472 AU/mL, p = .005 on Architect; 213 vs 573 A/mL, p = .002 on Elecsys). The adjusted odds ratio (aOR) for seroprotection was significantly lower (p < .05) in lung cancer patients than that in non-cancer patients. Analysis of the anticancer treatment types showed that the aOR for seroprotection was significantly lower (p < .05) in lung cancer patients receiving cytotoxic agents. They showed no increase in adverse reactions. BNT162b2 vaccination in lung cancer patients undergoing anticancer treatment significantly increased (p < .05) antibody titers and showed acceptable safety. Immunogenicity in these patients could be inadequate compared with that in non-cancer patients.
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Affiliation(s)
- Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | | | - Hiroki Matsui
- Clinical Research Support Office, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Chihiro Yoshida
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Tatsuya Nagai
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Minoru Shiraga
- Department of Pulmonology, Chikamori Hospital, Kochi, Japan
| | | | - Yoshihito Otsuka
- Department of Laboratory medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yu Nakagama
- Department of Virology & Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Natsuko Kaku
- Department of Virology & Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yuko Nitahara
- Department of Virology & Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yasutoshi Kido
- Department of Virology & Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, SOUSEIKAI Medical Group (Medical Co. LTA), Fukuoka, Japan
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15
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Teeyapun N, Luangdilok S, Pakvisal N, Sainamthip P, Mingmalairak S, Poovorawan N, Sitthideatphaiboon P, Parinyanitikul N, Sriuranpong V, Namkanisorn T, Inthasuwan P, Angspatt P, Wongchanapat P, Bamrungnam A, Leeleakpai N, Uttha S, Jaichum S, Kongkaew P, Suksanong C, Veranitinun R, Prasomphol A, Sartsuk C, Patcharajutanon C, Preaprang S, Choengsamor H, Phongwan R, Preeyasaksa C, Phaibulvatanapong E, Suntronwong N, Yorsaeng R, Vichaiwattana P, Wanlapakorn N, Kerr SJ, Poovorawan Y, Wanchaijiraboon P, Tanasanvimon S. Immunogenicity of ChAdOx1-nCoV-19 vaccine in solid malignancy patients by treatment regimen versus healthy controls: A prospective, multicenter observational study. EClinicalMedicine 2022; 52:101608. [PMID: 35971500 PMCID: PMC9366110 DOI: 10.1016/j.eclinm.2022.101608] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Limited data exists regarding the efficacy of ChAdOx1-nCoV-19 vaccine against Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) in solid cancer patients. We aimed to assess the immunogenicity of the ChAdOx1-nCoV-19 vaccine and the impact of different anticancer therapies for solid malignancies on immune response. METHODS This prospective, longitudinal observational study of immunogenicity following ChAdOx1-nCoV-19 vaccination among 385 solid cancer patients on active cancer treatment was conducted in two oncology centers. Participants received the first dose between June 18 and July 27, 2021 and the second dose at 8-10 weeks later. Blood samples were evaluated for total immunoglobulins against the receptor-binding of SARS-CoV-2 spike protein (anti-RBD total-Ig) before, and 4-week after the first- and second-doses. The primary endpoint was the geometric mean titers (GMT) of antibody among solid cancer patients compared to healthy controls and the impact of different cancer treatment types. FINDINGS Among solid cancer patients, the antibody level increased more slowly to significantly lower levels than achieved in healthy controls. The GMT at 4-weeks post-vaccination in cancer vs. healthy were 224.5 U/ml (95%CI 176.4-285.6) vs. 877.1 U/ml (95%CI 763.5-1008), p<0.0001), respectively. For different types of cancer treatments, chemotherapy agents, especially anthracyclines (GMR 0.004; 95%CI 0.002-0.008), paclitaxel (GMR 0.268; 95%CI 0.123-0.581), oxaliplatin (GMR 0.340; 95%CI 0.165-0.484), and immunotherapy (GMR 0.203; 95%CI 0.109-0.381) showed significantly lower antibody response. Anti-HER2, endocrine therapy and 5-fluouracil or gemcitabine, however, had less impact on the immune response. INTERPRETATION Suboptimal and heterogeneous immunologic responses were observed in cancer patients being treated with different systemic treatments. Immunotherapy or chemotherapy significantly suppressed the antibody response. FUNDING Quality Improvement Fund, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Center of Excellence in Clinical Virology at Chulalongkorn University and Chulalongkorn Medical Oncology Research Fund.
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Affiliation(s)
- Nattaya Teeyapun
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Sutima Luangdilok
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Nussara Pakvisal
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Panot Sainamthip
- Department of Pharmacology, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Siyamol Mingmalairak
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Nattaya Poovorawan
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Piyada Sitthideatphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Napa Parinyanitikul
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Virote Sriuranpong
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Teerayuth Namkanisorn
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Pratchaya Inthasuwan
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Pattama Angspatt
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Ploytuangporn Wongchanapat
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Akradach Bamrungnam
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Nutchanok Leeleakpai
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Sutheera Uttha
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Supaporn Jaichum
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Peerawich Kongkaew
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Chayanin Suksanong
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Rattiya Veranitinun
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Ampai Prasomphol
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Chada Sartsuk
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Cheeraporn Patcharajutanon
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Supreeya Preaprang
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Hathairat Choengsamor
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Rungthong Phongwan
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Charoenpit Preeyasaksa
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | | | - Nungruthai Suntronwong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Ritthideach Yorsaeng
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Preeyaporn Vichaiwattana
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Stephen J. Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Passakorn Wanchaijiraboon
- Phrapokklao Cancer Center of Excellence, Phrapokklao Clinical Research center, Phrapokklao Genomic Laboratories, Phrapokklao Hospital, Mueang District, Chantaburi 22000, Thailand
| | - Suebpong Tanasanvimon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Corresponding author at: Faculty of Medicine, Chulalongkorn University and The King Chulalongkorn Memorial Hospital 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
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Echaide M, Labiano I, Delgado M, Fernández de Lascoiti A, Ochoa P, Garnica M, Ramos P, Chocarro L, Fernández L, Arasanz H, Bocanegra A, Blanco E, Piñeiro-Hermida S, Morente P, Vera R, Alsina M, Escors D, Kochan G. Immune Profiling Uncovers Memory T-Cell Responses with a Th17 Signature in Cancer Patients with Previous SARS CoV-2 Infection Followed by mRNA Vaccination. Cancers (Basel) 2022; 14:cancers14184464. [PMID: 36139625 PMCID: PMC9496802 DOI: 10.3390/cancers14184464] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Cancer patients are considered a high-risk group for infectious diseases including COVID-19. The protective effects of vaccination are unclear in oncologic patients, as well as their duration. In this study antibody, T-cell and myeloid cell immunity were evaluated in three cohorts of healthy donors and oncologic patients, including those infected with SARS-CoV-2, BNT162b2-vaccinated (mRNA vaccine), and with previous COVID-19 and subsequently vaccinated. We concluded that vaccination was a poor inductor of cellular immunity towards the S protein. Memory T-cells were only detected in patients and healthy donors with COVID-19 previous to vaccination but with an accentuated Th17 inflammatory profile, together with elevated numbers of circulating neutrophils. Abstract It is unclear whether patients with cancer present inherently impaired responses to COVID-19 and vaccination due to their treatments, neoplastic diseases or both. To address this question, immune profiling was performed in three cohorts of healthy donors and oncologic patients: infected with SARS-CoV-2, BNT162b2-vaccinated, and with previous COVID-19 disease and subsequently vaccinated. Cancer patients showed good antibody responses to vaccination, but poor induction of T-cell responses towards the S protein when compared to infection. Following natural infection, the major targets for T-cells were the SARS-CoV-2 structural proteins M and S, but not the N protein. Similar to antibody titers, the T-cell responses quickly decayed after six months post-vaccination. Significant memory T-cell expansion was observed in vaccinated donors only if previously diagnosed with COVID-19 before undergoing vaccination. Oncologic patients with previous COVID-19 followed by vaccination exhibited potent IL-17+ CD4 and CD8 T-cell responses and elevated numbers of circulating neutrophils in peripheral blood.
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Affiliation(s)
- Miriam Echaide
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Ibone Labiano
- Oncobiona Group-Navarrabiomed-UPNA-IdiSNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Marina Delgado
- Oncobiona Group-Navarrabiomed-UPNA-IdiSNA, Irunlarrea 3, 31008 Pamplona, Spain
- Department of Medical Oncology, Hospital Universitario de Navarra-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Angela Fernández de Lascoiti
- Oncobiona Group-Navarrabiomed-UPNA-IdiSNA, Irunlarrea 3, 31008 Pamplona, Spain
- Department of Medical Oncology, Hospital Universitario de Navarra-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Patricia Ochoa
- Department of Medical Oncology, Hospital Universitario de Navarra-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Maider Garnica
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Pablo Ramos
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Luisa Chocarro
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Leticia Fernández
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Hugo Arasanz
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
- Department of Medical Oncology, Hospital Universitario de Navarra-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Ana Bocanegra
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Ester Blanco
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Sergio Piñeiro-Hermida
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Pilar Morente
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Ruth Vera
- Oncobiona Group-Navarrabiomed-UPNA-IdiSNA, Irunlarrea 3, 31008 Pamplona, Spain
- Department of Medical Oncology, Hospital Universitario de Navarra-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - Maria Alsina
- Oncobiona Group-Navarrabiomed-UPNA-IdiSNA, Irunlarrea 3, 31008 Pamplona, Spain
- Department of Medical Oncology, Hospital Universitario de Navarra-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
| | - David Escors
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
- Correspondence: (D.E.); (G.K.)
| | - Grazyna Kochan
- Oncoimmunology Group, Navarrabiomed, Fundación Miguel Servet-Hospital Universitario de Navarra-UPNA-IdISNA, Irunlarrea 3, 31008 Pamplona, Spain
- Correspondence: (D.E.); (G.K.)
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Abraham S, Manohar SA, Patel R, Saji AM, Dani SS, Ganatra S. Strategies for Cardio-Oncology Care During the COVID-19 Pandemic. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022; 24:137-153. [PMID: 36090762 PMCID: PMC9446588 DOI: 10.1007/s11936-022-00965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
Abstract
Purpose of review The COVID-19 pandemic has disrupted healthcare and has disproportionately affected the marginalized populations. Patients with cancer and cardiovascular disease (cardio-oncology population) are uniquely affected. In this review, we explore the current data on COVID-19 vulnerability and outcomes in these patients and discuss strategies for cardio-oncology care with a focus on healthcare innovation, health equity, and inclusion. Recent findings The growing evidence suggest increased morbidity and mortality from COVID-19 in patients with comorbid cancer and cardiovascular disease. Additionally, de novo cardiovascular complications such as myocarditis, myocardial infarction, arrhythmia, heart failure, and thromboembolic events have increasingly emerged, possibly due to an accentuated host immune response and cytokine release syndrome. Summary Patient-centric policies are helpful for cardio-oncology surveillance like remote monitoring, increased use of biomarker-based surveillance, imaging modalities like CT scan, and point-of-care ultrasound to minimize the exposure for high-risk patients. Abundant prior experience in cancer therapy scaffolded the repurposed use of corticosteroids, IL-6 inhibitors, and Janus kinase inhibitors in the treatment of COVID-19 infection. COVID-19 vaccine timing and dose frequency present a challenge due to overlapping toxicities and immune cell depletion in patients receiving cancer therapies. The SARS-CoV-2 pandemic laid bare social and ethnic disparities in healthcare but also steered in innovation to combat problems of patient outreach, particularly with virtual care. In the recovery phase, the backlog in cardio-oncology care, interplay of cancer therapy-related side effects, and long COVID-19 syndrome are crucial issues to address.
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Affiliation(s)
- Sonu Abraham
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | | | - Rushin Patel
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | - Anu Mariam Saji
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA USA
| | - Sourbha S. Dani
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | - Sarju Ganatra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
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Mehrabi Nejad MM, Shobeiri P, Dehghanbanadaki H, Tabary M, Aryannejad A, Haji Ghadery A, Shabani M, Moosaie F, SeyedAlinaghi S, Rezaei N. Seroconversion following the first, second, and third dose of SARS-CoV-2 vaccines in immunocompromised population: a systematic review and meta-analysis. Virol J 2022; 19:132. [PMID: 35941646 PMCID: PMC9358061 DOI: 10.1186/s12985-022-01858-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/18/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Immunocompromised (IC) patients are at higher risk of more severe COVID-19 infections than the general population. Special considerations should be dedicated to such patients. We aimed to investigate the efficacy of COVID-19 vaccines based on the vaccine type and etiology as well as the necessity of booster dose in this high-risk population. MATERIALS AND METHODS We searched PubMed, Web of Science, and Scopus databases for observational studies published between June 1st, 2020, and September 1st, 2021, which investigated the seroconversion after COVID-19 vaccine administration in adult patients with IC conditions. For investigation of sources of heterogeneity, subgroup analysis and sensitivity analysis were conducted. Statistical analysis was performed using R software. RESULTS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we included 81 articles in the meta-analysis. The overall crude prevalence of seroconversion after the first (n: 7460), second (n: 13,181), and third (n: 909, all population were transplant patients with mRNA vaccine administration) dose administration was 26.17% (95% CI 19.01%, 33.99%, I2 = 97.1%), 57.11% (95% CI: 49.22%, 64.83%, I2 = 98.4%), and 48.65% (95% CI: 34.63%, 62.79%, I2 = 94.4%). Despite the relatively same immunogenicity of mRNA and vector-based vaccines after the first dose, the mRNA vaccines induced higher immunity after the second dose. Regarding the etiologic factor, transplant patients were less likely to develop immunity after both first and second dose rather than patients with malignancy (17.0% vs 37.0% after first dose, P = 0.02; 38.3% vs 72.1% after second dose, P < 0.001) or autoimmune disease (17.0% vs 36.4%, P = 0.04; 38.3% vs 80.2%, P < 0.001). To evaluate the efficacy of the third dose, we observed an increasing trend in transplant patients after the first (17.0%), second (38.3%), and third (48.6%) dose. CONCLUSION The rising pattern of seroconversion after boosting tends to be promising. In this case, more attention should be devoted to transplant patients who possess the lowest response rate.
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Affiliation(s)
- Mohammad-Mehdi Mehrabi Nejad
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hojat Dehghanbanadaki
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tabary
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Armin Aryannejad
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolkarim Haji Ghadery
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahya Shabani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran.
| | - Nima Rezaei
- Department of Immunology, Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran. .,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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19
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Tang K, Wei Z, Wu X. Impaired serological response to COVID-19 vaccination following anti-cancer therapy: a systematic review and meta-analysis. J Med Virol 2022; 94:4860-4868. [PMID: 35750492 PMCID: PMC9349696 DOI: 10.1002/jmv.27956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
Owing to the high coronavirus disease 2019 (COVID‐19)‐related morbidity and fatality rate among patients with cancer, the introduction of COVID‐19 vaccines is of profound significance in this fragile population. Accumulating data suggested that oncologic patients, especially those with anticancer therapy have an impaired immune response to COVID‐19 vaccination. However, the exact effect of anticancer treatments on postvaccination response has not been elucidated yet. We, therefore, conducted a meta‐analysis to evaluate the impact of treatments on response to COVID‐19 vaccination in patients with cancer. A total of 39 studies were finally included comprising 11 075 oncologic patients. Overall, we found the humoral response was significantly decreased in patients undergoing anticancer treatments (odds ratio [OR] = 2.55, 95% confidence interval [CI]: 2.04–3.18) compared with those without active treatment. The seroconversion rates were significantly lower in patients with chemotherapy (OR = 3.04, 95% CI: 2.28–4.05), targeted therapy (OR = 4.72, 95% CI: 3.18–7.01) and steroid usage (OR = 2.19, 95% CI: 1.57–3.07), while there was no significant association between immunotherapy or hormonal therapy and seroconversion after vaccination. Subgroup analyses showed therapies with anti‐CD20 antibody (OR = 11.28, 95% CI: 6.40–19.90), B‐cell lymphoma 2 inhibitor (OR = 5.76, 95% CI: 3.64–9.10), and Bruton tyrosine kinase inhibitor (OR = 6.86, 95% CI: 4.23–11.15) were significantly correlated with the risk of negative humoral response to vaccination. In conclusion, our results demonstrated that specific oncologic therapies may significantly affect serological response to COVID‐19 vaccines in patients with cancer. Thus, an adapted vaccination strategy taking the influence of active treatment into account is in need, and further research on the effect of the third dose of vaccine and the role of postvaccination cellular response in oncologic patients is also needed.
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Affiliation(s)
- Kefu Tang
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200051, China
| | - Zhiying Wei
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, PR China
| | - Xi Wu
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University,, Shanghai, 200030, China
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Effectiveness and Safety of ANTI SARS-CoV-2 Vaccination in Transplant Patients Treated with Immunosuppressants: A Real-World Pilot Study with a 1-Year Follow-Up. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
SARS-CoV-2 is a betacoronavirus, which induced a severe pandemic infectious disease around the world. Even if several drugs have been suggested for its treatment, to date, the only strategy to reduce the severity of disease is represented by the use of vaccine. However, the lack of pre-marketing evidence in frail patients suggests the necessity of the real-world study of a vaccine benefit–risk profile. In this study, we evaluated the efficacy and the safety of SARS-CoV-2 vaccination in a cohort of 33 patients treated with an immunosuppressant after solid organ transplant. Both CLIA and LS/MS analysis were used to evaluate the levels of immunoglobulin (Ig)G anti SARS-CoV-2 and the therapeutic drug monitoring of immunosuppressant drugs. We documented that SARS-CoV-2 vaccination induced a dose- and gender-related serological response. In particular, in 63.6% of the enrolled patients, we documented a significant serological response at T2, and after a time related decrease, the booster dose induced a serological response in 72.7% of enrolled patients. In conclusion, the vaccine anti SARS-CoV-2 is immunogenic in patients under immunosuppression, and is not related to the development of ADRs. We also suggest that the booster dose could be used to increase the efficacy of the vaccination, particularly in women.
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21
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Janzic U, Bidovec-Stojkovic U, Mohorcic K, Mrak L, Dovnik NF, Ivanovic M, Ravnik M, Caks M, Skof E, Debeljak J, Korosec P, Rijavec M. Solid cancer patients achieve adequate immunogenicity and low rate of severe adverse events after SARS-CoV-2 vaccination. Future Oncol 2022; 18:2537-2550. [PMID: 35678621 PMCID: PMC9245563 DOI: 10.2217/fon-2022-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: SARS-CoV-2 vaccination in cancer patients is crucial to prevent severe COVID-19 disease course. Methods: This study assessed immunogenicity of cancer patients on active treatment receiving mRNA-based SARS-CoV-2 vaccine by detection of anti-SARS-CoV-2 S1 IgG antibodies in serum, before, after the first and second doses and 3 months after a complete primary course of vaccination. Results were compared with healthy controls. Results: Of 112 patients, the seroconversion rate was 96%. A significant reduction in antibody levels was observed 3 months after vaccination in patients receiving immune checkpoint inhibitors versus control participants (p < 0.001). Adverse events were mostly mild. Conclusion: Immunogenicity after mRNA-based vaccine in cancer patients is adequate but influenced by the type of anticancer therapy. Antibody levels decline after 3 months, and thus a third vaccination is warranted.
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Affiliation(s)
- Urska Janzic
- Department of Medical Oncology, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia.,University of Ljubljana, Ljubljana, 1000, Slovenia
| | - Urska Bidovec-Stojkovic
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Katja Mohorcic
- Department of Medical Oncology, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Loredana Mrak
- Department of Medical Oncology, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Nina Fokter Dovnik
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Marija Ivanovic
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Maja Ravnik
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Marina Caks
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Erik Skof
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, 1000, Slovenia.,Medical Faculty Ljubljana, University of Ljubljana, Ljubljana, 1000, Slovenia
| | - Jerneja Debeljak
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Peter Korosec
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, 1000, Slovenia
| | - Matija Rijavec
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia.,Biotechnical Faculty, University of Ljubljana, Ljubljana, 1000, Slovenia
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22
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Nguyen HNT, Kawahara M, Vuong CK, Fukushige M, Yamashita T, Ohneda O. SARS-CoV-2 M Protein Facilitates Malignant Transformation of Breast Cancer Cells. Front Oncol 2022; 12:923467. [PMID: 35747796 PMCID: PMC9209714 DOI: 10.3389/fonc.2022.923467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has spread faster due to the emergence of SARS-CoV-2 variants, which carry an increased risk of infecting patients with comorbidities, such as breast cancer. However, there are still few reports on the effects of SARS-CoV-2 infection on the progression of breast cancer, as well as the factors and mechanisms involved. In the present study, we investigated the impact of SARS-CoV-2 proteins on breast cancer cells (BCC). The results suggested that SARS-CoV-2 M protein induced the mobility, proliferation, stemness and in vivo metastasis of a triple-negative breast cancer (TNBC) cell line, MDA-MB-231, which are involved in the upregulation of NFκB and STAT3 pathways. In addition, compared to MDA-MB-231 cells, the hormone-dependent breast cancer cell line MCF-7 showed a less response to M protein, with the protein showing no effects of promoting proliferation, stemness, and in vivo metastasis. Of note, coculture with M protein-treated MDA-MB-231 cells significantly induced the migration, proliferation, and stemness of MCF-7 cells, which are involved in the upregulation of genes related to EMT and inflammatory cytokines. Therefore, SARS-CoV-2 infection might promote the ability of aggressive BCC to induce the malignant phenotypes of the other non-aggressive BCC. Taken together, these findings suggested an increased risk of poor outcomes in TNBC patients with a history of SARS-CoV-2 infection, which required a long-term follow-up. In addition, the inhibition of NFκB and STAT3 signaling pathways is considered as a promising candidate for the treatment of worsen clinical outcomes in TNBC patients with COVID-19.
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23
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Napuri NI, Curcio D, Swerdlow DL, Srivastava A. Immune Response to COVID-19 and mRNA Vaccination in Immunocompromised Individuals: A Narrative Review. Infect Dis Ther 2022; 11:1391-1414. [PMID: 35614299 PMCID: PMC9132351 DOI: 10.1007/s40121-022-00648-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/21/2022] [Indexed: 01/04/2023] Open
Abstract
Immunocompromised individuals are at high risk of poor coronavirus disease 2019 (COVID-19) outcomes and demonstrate a lower immune response to COVID-19 vaccines, including to the novel mRNA vaccines that have been shown to elicit high neutralizing antibody levels. This review synthesized available data on the immune response to COVID-19 and critically assessed mRNA COVID-19 vaccine immunogenicity in this vulnerable subpopulation. Patients with various immunocompromising conditions exhibit diverse responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 severity and mortality, and available vaccines elicit lower immune responses, particularly in solid organ transplant recipients. Strategies to improve vaccine responses in immunocompromised individuals are being implemented in vaccine recommendations, including the use of a third and fourth vaccine dose beyond the two-dose series. Additional doses may enhance vaccine effectiveness and help provide broad coverage against emerging SARS-CoV-2 variants. Continued investigation of vaccines and dosing regimens will help refine approaches to help protect this vulnerable subpopulation from COVID-19.
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Affiliation(s)
| | | | | | - Amit Srivastava
- Vaccines, Medical Development, Scientific and Clinical Affairs, Pfizer Inc, 300 Technology Square, 3rd Floor, Cambridge, MA, 02139, USA.
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24
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Li M, Wang H, Tian L, Pang Z, Yang Q, Huang T, Fan J, Song L, Tong Y, Fan H. COVID-19 vaccine development: milestones, lessons and prospects. Signal Transduct Target Ther 2022; 7:146. [PMID: 35504917 PMCID: PMC9062866 DOI: 10.1038/s41392-022-00996-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/15/2022] Open
Abstract
With the constantly mutating of SARS-CoV-2 and the emergence of Variants of Concern (VOC), the implementation of vaccination is critically important. Existing SARS-CoV-2 vaccines mainly include inactivated, live attenuated, viral vector, protein subunit, RNA, DNA, and virus-like particle (VLP) vaccines. Viral vector vaccines, protein subunit vaccines, and mRNA vaccines may induce additional cellular or humoral immune regulations, including Th cell responses and germinal center responses, and form relevant memory cells, greatly improving their efficiency. However, some viral vector or mRNA vaccines may be associated with complications like thrombocytopenia and myocarditis, raising concerns about the safety of these COVID-19 vaccines. Here, we systemically assess the safety and efficacy of COVID-19 vaccines, including the possible complications and different effects on pregnant women, the elderly, people with immune diseases and acquired immunodeficiency syndrome (AIDS), transplant recipients, and cancer patients. Based on the current analysis, governments and relevant agencies are recommended to continue to advance the vaccine immunization process. Simultaneously, special attention should be paid to the health status of the vaccines, timely treatment of complications, vaccine development, and ensuring the lives and health of patients. In addition, available measures such as mix-and-match vaccination, developing new vaccines like nanoparticle vaccines, and optimizing immune adjuvant to improve vaccine safety and efficacy could be considered.
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Affiliation(s)
- Maochen Li
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Han Wang
- Laboratory for Clinical Immunology, Harbin Children's Hospital, Harbin, China
| | - Lili Tian
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Zehan Pang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Qingkun Yang
- College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Tianqi Huang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Junfen Fan
- Institute of Cerebrovascular Disease Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Lihua Song
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China.
| | - Yigang Tong
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China. .,Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, China.
| | - Huahao Fan
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China.
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25
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Milano E, Ricciardi A, Casciaro R, Pallara E, De Vita E, Bavaro DF, Larocca AMV, Stefanizzi P, Tafuri S, Saracino A. Immunogenicity and safety of the BNT162b2 COVID-19 mRNA vaccine in PLWH: A monocentric study in Bari, Italy. J Med Virol 2022; 94:2230-2236. [PMID: 35106771 PMCID: PMC9015486 DOI: 10.1002/jmv.27629] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/06/2022]
Abstract
In March, people living with HIV infection (PLWH) were included in the risk category of fragile people for severe COVID-19 receiving priority access to vaccination with BNT162b2 vaccine. The aim of the study was to evaluate the immunogenicity and safety of the two doses regimen. The antibodies titer for severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) was evaluated after 21 days since the first administration (Time 1), 1 (Time 2), and 3 (Time 3) months post-vaccination. Information regarding virological and immunological conditions at baseline, previous SARS-CoV-2 state of infection, other immunodeficiencies, current antiretroviral therapy (ART), comorbidities, and severe adverse events (SAE) to vaccination was collected. Six hundred and ninety-seven patients were tested for quantitative anti-spike antibodies at Time 1, 577 patients had a second detection at Time 2, and 491 patients had the third detection. Baseline characteristics of the study population are reported in Table 1. At the time of vaccine administration, all patients were on ART (except one long-term nonprogressor); 632 (90.7%) patients had undetectable HIV-RNA; 12 (1.7%) patients were immunosuppressed due to chemotherapy or other immunosuppressive drugs; 345 (49.5%) patients had at least one COVID-19 related comorbidity and 155 (22.2%) had two or more comorbidities. No SAEs were reported. Final serological results are available for 694 patients after the first dose, 577 and 491 after the second and third ones, respectively; positive titer (values ≥ 50 AU/ml) was demonstrated in 653 (94.1%), 576 (99.8%), 484 (98.6%) patients, respectively. Only one patient was a nonresponder after completing vaccination, who was a newly diagnosed one for HIV infection. All vaccinations were well tolerated, with no SAEs. BNT162b2 mRNA vaccine was immunogenic and safe in PLWH.
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Affiliation(s)
- Eugenio Milano
- Clinic of Infectious DiseasesUniversity of BariBariItaly
| | | | | | | | - Elda De Vita
- Clinic of Infectious DiseasesUniversity of BariBariItaly
| | | | | | - Pasquale Stefanizzi
- Department of Biomedical Science, Human Oncology‐Hygiene SectionUniversity of BariBariItaly
| | - Silvio Tafuri
- Department of Biomedical Science, Human Oncology‐Hygiene SectionUniversity of BariBariItaly
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26
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Connors JM, Iba T. Vaccine-induced immune thrombotic thrombocytopenia and patients with cancer. Thromb Res 2022; 213 Suppl 1:S77-S83. [PMID: 36210565 PMCID: PMC9133965 DOI: 10.1016/j.thromres.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 01/17/2023]
Abstract
Vaccines to combat SARS-CoV-2 infection and the COVID-19 pandemic were quickly developed due to significant and combined efforts by the scientific community, government agencies, and private sector pharmaceutical and biotechnology companies. Following vaccine development, which took less than a year to accomplish, randomized placebo controlled clinical trials enrolled almost 100,000 people, demonstrating efficacy and no major safety signals. Vaccination programs were started, but shortly thereafter a small number of patients with a constellation of findings including thrombosis in unusual locations, thrombocytopenia, elevated D-dimer and often low fibrinogen led another intense and concentrated scientific effort to understand this syndrome. It was recognized that this occurred within a short time following administration of adenoviral vector SARS-CoV-2 vaccines. Critical to the rapid understanding of this syndrome was prompt communication among clinicians and scientists and exchange of knowledge. Now known as vaccine-induced immune thrombotic thrombocytopenia syndrome (VITT), progress has been made in understanding the pathophysiology of the syndrome, with the development of diagnostic criteria, and most importantly therapeutic strategies needed to effectively treat this rare complication of adenoviral vector vaccination. This review will focus on the current understanding of the pathophysiology of VITT, the findings that affected patients present with, and the rational for therapies, including for patients with cancer, as prompt recognition, diagnosis, and treatment of this syndrome has resulted in a dramatic decrease in associated mortality.
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Affiliation(s)
- Jean M. Connors
- Hematology Division, Brigham and Women's Hospital, Dana Farber Cancer institute, 75 Francis Street, Boston, MA 02115, United States of America,Corresponding author
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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27
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Ladoire S, Rederstorff E, Goussot V, Parnalland S, Briot N, Ballot E, Truntzer C, Ayati S, Bengrine-Lefevre L, Bremaud N, Coudert B, Desmoulins I, Favier L, Fraisse C, Fumet JD, Hennequin A, Hervieu A, Ilie S, Kaderbhai C, Lagrange A, Martin N, Mazilu I, Mayeur D, Palmier R, Simonet-Lamm AL, Vincent J, Zanetta S, Arnould L, Coutant C, Bertaut A, Ghiringhelli F. Parallel evolution and differences in seroprevalence of SARS-CoV-2 antibody between patients with cancer and health care workers in a tertiary cancer centre during the first and second wave of COVID-19 pandemic: canSEROcov-II cross-sectional study. Eur J Cancer 2022; 165:13-24. [PMID: 35189537 PMCID: PMC8806022 DOI: 10.1016/j.ejca.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
Abstract
Background Patients with cancer are a population at high risk of severe infection from SARS-CoV-2. Patients with cancer regularly attend specialised healthcare centres for management and treatment, where they are in contact with healthcare workers (HCWs). Numerous recommendations target both patients with cancer and HCWs to minimise the spread of SARS-CoV-2 during these interactions. Objective To investigate the parallel evolution of the COVID-19 epidemic in these 2 populations over time, we studied the seroprevalence of anti-SARS-CoV-2 antibodies after both the first and second waves of the pandemic, and in both cancer patients and HCWs from a single specialised anti-cancer centre. Factors associated with seropositivity were identified in both populations. Methods We conducted a cross-sectional study after the second wave of the COVID pandemic in France. All participants were invited to undergo serological testing for SARS-CoV-2 and complete a questionnaire collecting data about their working conditions (for HCWs) or medical management (for patients) during this period. Results after the second wave were compared to those of a previous study among 1011 patients with cancer and 663 HCWs performed in the same centre after the first wave, using the same evaluations. Findings We included 502 HCWs and 507 patients with cancer. Seroprevalence of anti-SARS-CoV-2 antibodies was higher after the second wave than after the first wave in both HCWs (15.1% versus 1.8%; p < 0.001), and patients (4.1% versus 1.7%; p = 0.038). By multivariate analysis, the factors found to be associated with seropositivity after the second wave for HCWs were: working in direct patient care (p = 0.050); having worked in a dedicated COVID-19 unit (p = 0.0036); contact with a person with COVID-19-positive in the workplace (p = 0.0118) or outside of the workplace (p = 0.0297). Among patients with cancer, only a contact with someone who tested positive for COVID-19 was found to be significantly associated with positive serology. The proportion of reported contacts with individuals with COVID-19-positive was significantly lower among patients with cancer than among HCWs (7.6% versus 40.7%, respectively; p < 0.0001) Interpretation Between the first and second waves of the epidemic in France, the seroprevalence of anti-SARS-CoV-2 antibodies increased to a lesser extent among patients with cancer than among their HCWs, possibly due to better self-protection, notably social distancing. The risk factors for infection identified among HCWs plead in favour of numerous intra-hospital contaminations, especially for HCWs in contact with high-risk patients. This underlines the compelling need to pursue efforts to implement strict hygiene and personal protection measures (including vaccination) to protect HCWs and patients with cancer.
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Affiliation(s)
- Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France.
| | - Emilie Rederstorff
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Vincent Goussot
- Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Sophie Parnalland
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Nathalie Briot
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - Elise Ballot
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges-François Leclerc Cancer Center, Dijon, France
| | - Caroline Truntzer
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges-François Leclerc Cancer Center, Dijon, France
| | - Siavoshe Ayati
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Nathalie Bremaud
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Bruno Coudert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laure Favier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Cléa Fraisse
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Jean-David Fumet
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Audrey Hennequin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Silvia Ilie
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Courèche Kaderbhai
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Nils Martin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Irina Mazilu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Didier Mayeur
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Rémi Palmier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Julie Vincent
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Sylvie Zanetta
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laurent Arnould
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Charles Coutant
- University of Burgundy-Franche Comté, France; Department of Oncologic Surgery, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France
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28
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Seneviratne SL, Yasawardene P, Wijerathne W, Somawardana B. COVID-19 vaccination in cancer patients: a narrative review. J Int Med Res 2022; 50:3000605221086155. [PMID: 35313761 PMCID: PMC8943636 DOI: 10.1177/03000605221086155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), has affected over 220 million individuals worldwide,
and has been shown to cause increased disease severity and mortality in patients
with active cancer versus healthy individuals. Vaccination is important in
reducing COVID-19-associated morbidity and mortality. Thus, the aim of this
article was to review the existing knowledge on effectiveness, immunogenicity
and safety of COVID-19 vaccines in patients with cancer. Fifty-four articles
were included following a search of PubMed and Google Scholar databases for
studies published between January 2020 and September 2021 that investigated
humoral and cell-mediated immune responses following COVID-19 vaccination in
patients with cancer. Immunogenicity of vaccines was found to be lower in
patients with cancer versus healthy individuals, and humoral immune responses
were inferior in those with haematological versus solid cancers. Patient-,
disease-, and treatment-related factors associated with poorer vaccine responses
should be identified and corrected or mitigated when possible. Consideration
should be given to offering patients with cancer second doses of COVID vaccine
at shorter intervals than in healthy individuals. Patients with cancer warrant a
third vaccine dose and must be prioritized in vaccination schedules. Vaccine
adverse effect profiles are comparable between patients with cancer and healthy
individuals.
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Affiliation(s)
- Suranjith L Seneviratne
- Department of Clinical Immunology and Allergy, Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
| | - Pamodh Yasawardene
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Buddhika Somawardana
- Department of Haemato-Oncology, National Cancer Institute, Maharagama, Sri Lanka
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29
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Vanderpool RC, Gaysynsky A, Chou WYS, Tonorezos ES. Using Behavioral Science to Address COVID-19 Vaccine Hesitancy Among Cancer Survivors: Communication Strategies and Research Opportunities. J Behav Med 2022; 46:366-376. [PMID: 35305205 PMCID: PMC8933612 DOI: 10.1007/s10865-022-00304-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
Due to cancer survivors’ increased vulnerability to complications from COVID-19, addressing vaccine hesitancy and improving vaccine uptake among this population is a public health priority. However, several factors may complicate efforts to increase vaccine confidence in this population, including the underrepresentation of cancer patients in COVID-19 vaccine trials and distinct recommendations for vaccine administration and timing for certain subgroups of survivors. Evidence suggests vaccine communication efforts targeting survivors could benefit from strategies that consider factors such as social norms, risk perceptions, and trust. However, additional behavioral research is needed to help the clinical and public health community better understand, and more effectively respond to, drivers of vaccine hesitancy among survivors and ensure optimal protection against COVID-19 for this at-risk population. Knowledge generated by this research could also have an impact beyond the current COVID-19 pandemic by informing future vaccination efforts and communication with cancer survivors more broadly.
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Affiliation(s)
- Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA.
| | - Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA.,ICF Next, Rockville, MD, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 20850, Rockville, MD, USA
| | - Emily S Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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30
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Lee ARYB, Wong SY, Chai LYA, Lee SC, Lee MX, Muthiah MD, Tay SH, Teo CB, Tan BKJ, Chan YH, Sundar R, Soon YY. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis. BMJ 2022; 376:e068632. [PMID: 35236664 PMCID: PMC8889026 DOI: 10.1136/bmj-2021-068632] [Citation(s) in RCA: 203] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the efficacy of covid-19 vaccines between immunocompromised and immunocompetent people. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Central Register of Controlled Trials, COVID-19 Open Research Dataset Challenge (CORD-19), and WHO covid-19 databases for studies published between 1 December 2020 and 5 November 2021. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched in November 2021 to identify registered but as yet unpublished or ongoing studies. STUDY SELECTION Prospective observational studies comparing the efficacy of covid-19 vaccination in immunocompromised and immunocompetent participants. METHODS A frequentist random effects meta-analysis was used to separately pool relative and absolute risks of seroconversion after the first and second doses of a covid-19 vaccine. Systematic review without meta-analysis of SARS-CoV-2 antibody titre levels was performed after first, second, and third vaccine doses and the seroconversion rate after a third dose. Risk of bias and certainty of evidence were assessed. RESULTS 82 studies were included in the meta-analysis. Of these studies, 77 (94%) used mRNA vaccines, 16 (20%) viral vector vaccines, and 4 (5%) inactivated whole virus vaccines. 63 studies were assessed to be at low risk of bias and 19 at moderate risk of bias. After one vaccine dose, seroconversion was about half as likely in patients with haematological cancers (risk ratio 0.40, 95% confidence interval 0.32 to 0.50, I2=80%; absolute risk 0.29, 95% confidence interval 0.20 to 0.40, I2=89%), immune mediated inflammatory disorders (0.53, 0.39 to 0.71, I2=89%; 0.29, 0.11 to 0.58, I2=97%), and solid cancers (0.55, 0.46 to 0.65, I2=78%; 0.44, 0.36 to 0.53, I2=84%) compared with immunocompetent controls, whereas organ transplant recipients were 16 times less likely to seroconvert (0.06, 0.04 to 0.09, I2=0%; 0.06, 0.04 to 0.08, I2=0%). After a second dose, seroconversion remained least likely in transplant recipients (0.39, 0.32 to 0.46, I2=92%; 0.35, 0.26 to 0.46), with only a third achieving seroconversion. Seroconversion was increasingly likely in patients with haematological cancers (0.63, 0.57 to 0.69, I2=88%; 0.62, 0.54 to 0.70, I2=90%), immune mediated inflammatory disorders (0.75, 0.69 to 0.82, I2=92%; 0.77, 0.66 to 0.85, I2=93%), and solid cancers (0.90, 0.88 to 0.93, I2=51%; 0.89, 0.86 to 0.91, I2=49%). Seroconversion was similar between people with HIV and immunocompetent controls (1.00, 0.98 to 1.01, I2=0%; 0.97, 0.83 to 1.00, I2=89%). Systematic review of 11 studies showed that a third dose of a covid-19 mRNA vaccine was associated with seroconversion among vaccine non-responders with solid cancers, haematological cancers, and immune mediated inflammatory disorders, although response was variable in transplant recipients and inadequately studied in people with HIV and those receiving non-mRNA vaccines. CONCLUSION Seroconversion rates after covid-19 vaccination were significantly lower in immunocompromised patients, especially organ transplant recipients. A second dose was associated with consistently improved seroconversion across all patient groups, albeit at a lower magnitude for organ transplant recipients. Targeted interventions for immunocompromised patients, including a third (booster) dose, should be performed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021272088.
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Affiliation(s)
| | - Shi Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Synthetic Biology for Clinical and Technological Innovation, National University of Singapore, Singapore
- National University Cancer Institute, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, 119228, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Matilda Xinwei Lee
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, 119228, Singapore
| | - Mark Dhinesh Muthiah
- Department of Gastroenterology and Hepatology, National University Health System, Singapore
- National University Centre for Organ Transplantation, Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Chong Boon Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raghav Sundar
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, 119228, Singapore
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore
- Singapore Gastric Cancer Consortium, Singapore
| | - Yu Yang Soon
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Radiation Oncology, National University Cancer Institute, Singapore
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Latif MB, Shukla S, Del Rio Estrada PM, Ribeiro SP, Sekaly RP, Sharma AA. Immune mechanisms in cancer patients that lead to poor outcomes of SARS-CoV-2 infection. Transl Res 2022; 241:83-95. [PMID: 34871809 PMCID: PMC8641406 DOI: 10.1016/j.trsl.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/09/2023]
Abstract
Patients with cancers have been severely affected by the COVID-19 pandemic. This is highlighted by the adverse outcomes in cancer patients with COVID-19 as well as by the impact of the COVID-19 pandemic on cancer care. Patients with cancer constitute a heterogeneous population that exhibits distinct mechanisms of immune dysfunction, associated with distinct systemic features of hot (T-cell-inflamed/infiltrated) and cold (Non-T-cell-inflamed and/or infiltrated) tumors. The former show hyper immune activated cells and a highly inflammatory environment while, contrastingly, the latter show the profile of a senescent and/or quiescent immune system. Thus, the evolution of SARS-CoV-2 infection in different types of cancers can show distinct trajectories which could lead to a variety of clinical and pathophysiological outcomes. The altered immunological environment including cytokines that characterizes hot and cold tumors will lead to different mechanisms of immune dysfunction, which will result in downstream effects on the course of SARS-CoV-2 infection. This review will focus on defining the known contributions of soluble pro- and anti-inflammatory mediators on immune function including altered T-cells and B-cells responses and as well on how these factors modulate the expression of SARS-CoV-2 receptor ACE2, TMPRSS2 expression, and lymph node fibrosis in cancer patients. We will propose immune mechanisms that underlie the distinct courses of SARS-CoV-2 infection in cancer patients and impact on the success of immune based therapies that have significantly improved cancer outcomes. Better understanding of the immune mechanisms prevalent in cancer patients that are associated to the outcomes of SARS-CoV-2 infection will help to identify the high-risk cancer patients and develop immune-based approaches to prevent significant adverse outcomes by targeting these pathways.
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Affiliation(s)
- Muhammad Bilal Latif
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Sudhanshu Shukla
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Perla Mariana Del Rio Estrada
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Susan Pereira Ribeiro
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Rafick Pierre Sekaly
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia.
| | - Ashish Arunkumar Sharma
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
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32
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Doherty J, O Morain N, Stack R, Girod P, Tosetto M, Inzitiari R, Sheridan J, Cullen G, Mc Dermott E, Buckley M, Horgan G, Mulcahy H, Ryan EJ, Daghfal D, Doran P, O Morain C, Doherty GA. Reduced Serological Response to COVID-19 Vaccines in Patients with IBD is Further Diminished by TNF Inhibitor Therapy; Early Results of the VARIATION study [VAriability in Response in IBD Against SARS-COV-2 ImmunisatiON]. J Crohns Colitis 2022; 16:1354-1362. [PMID: 35176770 PMCID: PMC8903431 DOI: 10.1093/ecco-jcc/jjac029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Evidence suggests patients with inflammatory bowel disease [IBD] receiving TNF antagonists have attenuated response to vaccination against COVID-19. We sought to determine the impact of IBD and of various medications for treatment of IBD on antibody responses to vaccination against COVID-19. METHODS Patients with IBD [n = 270] and healthy controls [HC, n = 116] were recruited prospectively, and quantitative antibody responses were assessed following COVID-19 vaccination. The impact of IBD and of medications for treatment of IBD on vaccine response rates was investigated. RESULTS Of HC, 100% seroconverted following complete vaccination with two vaccine doses; 2% of patients with IBD failed to seroconvert. Median anti-spike protein [SP] immunoglobulin [Ig]G levels following complete vaccination in our IBD cohort was significantly lower than among HC [2613 AU/mL versus 6871 AU/mL, p ≤0.001]. A diagnosis of IBD was independently associated with lower anti-SP IgG levels [β coefficient -0.2, p = 0.001]. Use of mRNA vaccines was independently associated with higher anti-SP IgG levels [β coefficient 0.25, p ≤0.001]. Patients with IBD receiving TNF inhibitors had significantly lower anti-SP IgG levels [2445 AU/mL] than IBD patients not receiving TNF inhibitors [3868 AU/mL, p ≤0.001]. Patients with IBD not receiving TNF inhibitors still showed attenuated responses compared with HC [3868 AU/mL versus 8747 AU/mL, p = 0.001]. CONCLUSIONS Patients with IBD have attenuated serological responses to SARS-CoV-2 vaccination. Use of anti-TNF therapy negatively affects anti-SP IgG levels further. Patients who do not seroconvert following vaccination are a particularly vulnerable cohort. Impaired responses to vaccination in our study highlight the importance of booster vaccination programmes for patients with IBD.
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Affiliation(s)
- Jayne Doherty
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,INITIative IBD research network,Corresponding author: Dr Jayne Doherty Centre for Colorectal Disease St Vincent’s University Hospital Elm Park Dublin 4 00353876419786
| | - Neil O Morain
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin
| | - Roisin Stack
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin
| | - Parker Girod
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin
| | | | | | - Juliette Sheridan
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin
| | - Garret Cullen
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin,INITIative IBD research network
| | - Edel Mc Dermott
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,St Vincent’s Private Hospital, Dublin
| | - Maire Buckley
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,St Vincent’s Private Hospital, Dublin,St Michaels Hospital, Dun Laoghaire, Co Dublin
| | - Gareth Horgan
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,St Vincent’s Private Hospital, Dublin,St Columcille’s Hospital, Loughlinstown, Co Dublin
| | - Hugh Mulcahy
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin
| | - Elizabeth J Ryan
- Department of Biological Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - David Daghfal
- Abbott Laboratories, Abbott Diagnostics, Lake Forest, IL
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin
| | - Colm O Morain
- Beacon Hospital, Sandyford, Co. Dublin and Trinity College Dublin,INITIative IBD research network
| | - Glen A Doherty
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin,INITIative IBD research network
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Gounant V, Ferré VM, Soussi G, Charpentier C, Flament H, Fidouh N, Collin G, Namour C, Assoun S, Bizot A, Brouk Z, Vicaut E, Teixeira L, Descamps D, Zalcman G. Efficacy of Severe Acute Respiratory Syndrome Coronavirus-2 Vaccine in Patients With Thoracic Cancer: A Prospective Study Supporting a Third Dose in Patients With Minimal Serologic Response After Two Vaccine Doses. J Thorac Oncol 2022; 17:239-251. [PMID: 34798306 PMCID: PMC8593625 DOI: 10.1016/j.jtho.2021.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 resulted in a 30% mortality rate in patients with thoracic cancer. Given that patients with cancer were excluded from serum antisevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine registration trials, it is still unknown whether they would develop a protective antispike antibody response after vaccination. This prospective vaccine monitoring study primarily aimed to assess humoral responses to the SARS-CoV-2 vaccine in patients with thoracic cancer. METHODS SARS-CoV-2-spike antibodies were measured using the Abbot Architect SARS-CoV-2 immunoglobulin G immunoassay before the first injection of BNT162b2 mRNA vaccine, at week 4, and 2 to 16 weeks after the second vaccine dose administration. The factors associated with antibody response were analyzed. RESULTS Overall, 306 patients, with a median age of 67.0 years (interquartile range: 58-74), were vaccinated. Of these, 283 patients received two vaccine doses at 28-day intervals. After a 6.7-month median follow-up, eight patients (2.6%) contracted proven symptomatic SARS-CoV-2 infection, with rapid favorable evolution. Of the 269 serologic results available beyond day 14 after the second vaccine dose administration, 17 patients (6.3%) were still negative (<50 arbitrary units/mL, whereas 34 (11%) were less than 300 arbitrary units/mL (12.5th percentile). In multivariate analysis, only age (p < 0.01) and long-term corticosteroid treatment (p = 0.01) were significantly associated with a lack of immunization. A total of 30 patients received a third vaccine dose, with only three patients showing persistently negative serology thereafter, whereas the others exhibited clear seroconversion. CONCLUSIONS SARS-CoV2 vaccines were found to be efficient in patients with thoracic cancer, most of them being immunized after two doses. A third shot given to 1% of patients with persistent low antibody titers resulted in an 88% immunization rate.
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Affiliation(s)
- Valérie Gounant
- Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Valentine Marie Ferré
- Virology Department, Université de Paris, INSERM Unité Mixte de Recherche (UMR) 1137 Infection, Antimicrobials, Modelling, Evolution, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Ghassen Soussi
- Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Charlotte Charpentier
- Virology Department, Université de Paris, INSERM Unité Mixte de Recherche (UMR) 1137 Infection, Antimicrobials, Modelling, Evolution, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Héloïse Flament
- Hematology, and Immunology Department, Université de Paris, INSERM-U1149, Research Center on Inflammation (CRI) Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Nadhira Fidouh
- Virology Department, Université de Paris, INSERM Unité Mixte de Recherche (UMR) 1137 Infection, Antimicrobials, Modelling, Evolution, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Gilles Collin
- Virology Department, Université de Paris, INSERM Unité Mixte de Recherche (UMR) 1137 Infection, Antimicrobials, Modelling, Evolution, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Céline Namour
- Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Sandra Assoun
- Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Alexandra Bizot
- Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Zohra Brouk
- Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Eric Vicaut
- Biostatistics and Clinical Research Department, Université de Paris, Lariboisière Hospital (AP-HP.Nord), Paris, France
| | - Luis Teixeira
- Breast Diseases Centre, North-Paris Cancer University Institute, Université de Paris, INSERM U976 Human Immunology, Pathophysiology, Immunotherapy (HIPI) (Pathophysiology of Breast Cancer Team), Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Diane Descamps
- Virology Department, Université de Paris, INSERM Unité Mixte de Recherche (UMR) 1137 Infection, Antimicrobials, Modelling, Evolution, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France
| | - Gérard Zalcman
- Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; INSERM U830 Cancer, Heterogeneity Plasticity, Curie Institute Research Centre, Paris, France.
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Barrière J, Carles M, Audigier-Valette C, Re D, Adjtoutah Z, Seitz-Polski B, Gounant V, Descamps D, Zalcman G. Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position article. Eur J Cancer 2022; 162:182-193. [PMID: 35016032 PMCID: PMC8674546 DOI: 10.1016/j.ejca.2021.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022]
Abstract
Taking into account higher risk of severe coronavirus disease 2019 or death among patients with cancer, as well as impaired immunogenicity after anti-SARS-CoV-2 vaccines, in addition to waning immunity, booster dosing appears mandatory in this patient population. This review sought to provide reasonable evidence so as to assist oncologists in their daily practice, helping them decide when an anti-SARS-Cov2 antibody (Ab) dosage should be scheduled after a full two-dose vaccination and, if necessary, propose an early third dose (D3). Such D3 could apply to non-responder patients with anti-Spike (S) Abs titres <40 binding Ab unit (BAU)/mL. For lowresponder patients with anti-S Ab titres between 40 BAU/mL and 100/260 BAU/mL (suggested area of uncertainty), an early D3 may similarly be proposed. Nevertheless, this D3 could be administered in a less urgent manner, taking into account associated comorbidities and regional epidemic incidence rates. This latter strategy may comprise a monthly dosage of anti-S titres so as to better assess the kinetics of waning immunity. For responder patients with anti-S titres above 260 BAU/mL, we suggest to follow the recommendations outlined for the general population. Given this context, patients with anti-S titres above 1000 BAU/mL should be given the possibility to undergo anti-S titre control after three months, designed to assess rapid humoral waning immunity. We strongly recommend that patients with cancer be included into observational serological monitoring studies or clinical trials that are dedicated to severe immunocompromised patients without any humoral seroconversion after D3.
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Affiliation(s)
- Jérôme Barrière
- Medical Oncology Department, Polyclinique Saint-Jean, 92 Avenue Dr Donat, FR-06800, Cagnes-sur-Mer, France.
| | - Michel Carles
- Infectious Diseases Department, Côte D'Azur University, CHU de Nice, Hôpital Archet 1, FR-06000, Nice, France.
| | - Clarisse Audigier-Valette
- Pulmonology and Oncology Department, Centre Hospitalier Toulon Sainte-Musse, 54 rue Henri-Sainte-Claire-Deville, FR-83056 Toulon, France.
| | - Daniel Re
- Department of Hematology and Medical Oncology, Centre Hospitalier Antibes Juan-les-Pins, 107 Route de Nice, FR-06600 Antibes, France.
| | - Zoubir Adjtoutah
- Medical Biology Laboratory, Cerballiance Côte D'Azur, 52 Avenue des Alpes FR-06800, Cagnes-sur-Mer, France.
| | - Barbara Seitz-Polski
- Department of Immunology & UR2CA, Côte D'Azur University, CHU Nice, 151 Route Saint-Antoine de Ginestière FR-06200 Nice, France.
| | - Valérie Gounant
- Thoracic Oncology Department & INSERM Centre D'Investigation Clinique 1425, Université de Paris, University Institute of Cancer AP-HP North, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), 46 Rue Henri Huchard, Paris, France.
| | - Diane Descamps
- Department of Virology and INSERM UMR 1137, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), 46 Rue Henri Huchard, Paris, France.
| | - Gérard Zalcman
- Thoracic Oncology Department & INSERM Centre D'Investigation Clinique 1425, Université de Paris, University Institute of Cancer AP-HP North, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), 46 Rue Henri Huchard, Paris, France.
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Rüthrich MM, Giesen N, Mellinghoff SC, Rieger CT, von Lilienfeld-Toal M. Cellular Immune Response after Vaccination in Patients with Cancer—Review on Past and Present Experiences. Vaccines (Basel) 2022; 10:vaccines10020182. [PMID: 35214642 PMCID: PMC8875094 DOI: 10.3390/vaccines10020182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 01/27/2023] Open
Abstract
Patients with cancer are at particular risk for infection but also have diminished vaccine responses, usually quantified by the level of specific antibodies. Nonetheless, vaccines are specifically recommended in this vulnerable patient group. Here, we discuss the cellular part of the vaccine response in patients with cancer. We summarize the experience with vaccines prior to and during the SARS-CoV-2 pandemic in different subgroups, and we discuss why, especially in patients with cancer, T cells may be the more reliable correlate of protection. Finally, we provide a brief outlook on options to improve the cellular response to vaccines.
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Affiliation(s)
- Maria Madeleine Rüthrich
- Department of Internal Medicine II, Hematology and Medical Oncology, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institut, Adolf-Reichwein-Straße 23, 07745 Jena, Germany
| | - Nicola Giesen
- Department of Haematology and Oncology, Internal Medicine V, University Hospital Heidelberg, 69115 Heidelberg, Germany;
| | - Sibylle C. Mellinghoff
- Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, University of Cologne, 50923 Cologne, Germany;
| | - Christina T. Rieger
- Hemato-Oncology Germering & Interdisciplinary Tumorcenter, Ludwig-Maximilians-University Munich, 81377 Munich, Germany;
| | - Marie von Lilienfeld-Toal
- Department of Internal Medicine II, Hematology and Medical Oncology, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institut, Adolf-Reichwein-Straße 23, 07745 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9324210
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Body A, Ahern E, Lal L, Gillett K, Abdulla H, Opat S, O'Brien T, Downie P, Turville S, Munier CML, Smith C, MacIntyre CR, Segelov E. Protocol for SARS-CoV-2 post-vaccine surveillance study in Australian adults and children with cancer: an observational study of safety and serological and immunological response to SARS-CoV-2 vaccination (SerOzNET). BMC Infect Dis 2022; 22:70. [PMID: 35057745 PMCID: PMC8771167 DOI: 10.1186/s12879-021-07019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is associated with excess morbidity and mortality from coronavirus disease 2019 (COVID-19) following infection by the novel pandemic coronavirus SARS-CoV-2. Vaccinations against SARS-CoV-2 have been rapidly developed and proved highly effective in reducing the incidence of severe COVID-19 in clinical trials of healthy populations. However, patients with cancer were excluded from pivotal clinical trials. Early data suggest that vaccine response is less robust in patients with immunosuppressive conditions or treatments, while toxicity and acceptability of COVID-19 vaccines in the cancer population is unknown. Unanswered questions remain about the impact of various cancer characteristics (such as treatment modality and degree of immunosuppression) on serological response to and safety of COVID-19 vaccinations. Furthermore, as the virus and disease manifestations evolve, ongoing data is required to address the impact of new variants. METHODS SerOzNET is a prospective observational study of adults and children with cancer undergoing routine SARS-CoV-2 vaccination in Australia. Peripheral blood will be collected and processed at five timepoints (one pre-vaccination and four post-vaccination) for analysis of serologic responses to vaccine and exploration of T-cell immune correlates. Cohorts include: solid organ cancer (SOC) or haematological malignancy (HM) patients currently receiving (1) chemotherapy, (2) immune checkpoint inhibitors (3) hormonal or targeted therapy; (4) patients who completed chemotherapy within 6-12 months of vaccination; (5) HM patients with conditions associated with hypogammaglobulinaemia or immunocompromise; (6) SOC or HM patients with allergy to PEG or polysorbate 80. Data from healthy controls already enrolled on several parallel studies with comparable time points will be used for comparison. For children, patients with current or prior cancer who have not received recent systemic therapy will act as controls. Standardised scales for quality-of-life assessment, patient-reported toxicity and vaccine hesitancy will be obtained. DISCUSSION The SerOzNET study was commenced in June 2021 to prospectively study immune correlates of vaccination in specific cancer cohorts. The high proportion of the Australian population naïve to COVID-19 infection and vaccination at study commencement has allowed a unique window of opportunity to study vaccine-related immunity. Quality of life and patient-reported adverse events have not yet been reported in detail post-vaccination for cancer patients. Trial registration This trial is registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001004853. Submitted for registration 25 June 2021. Registered 30 July 2021 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382281&isReview=true.
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Affiliation(s)
- Amy Body
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia.
- Monash University, Clayton, Melbourne, VIC, 3168, Australia.
| | - Elizabeth Ahern
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Luxi Lal
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Karen Gillett
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Hesham Abdulla
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stephen Opat
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Tracey O'Brien
- Kids Cancer Centre, Sydney Children's Hospital', Randwick, NSW, 2031, Australia
- School of Women's & Children's Health, Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Peter Downie
- Children's Cancer Centre, Monash Children's Hospital, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stuart Turville
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - C Mee Ling Munier
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Corey Smith
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Translational and Human Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - C Raina MacIntyre
- The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Eva Segelov
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
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Nelli F, Fabbri A, Onorato A, Giannarelli D, Silvestri M, Giron Berrios J, Virtuoso A, Marrucci E, Signorelli C, Chilelli M, Primi F, Schirripa M, Mazzotta M, Ruggeri E. Effects of active cancer treatment on safety and immunogenicity of COVID-19 mRNA-BNT162b2 vaccine: preliminary results from the prospective observational Vax-On study. Ann Oncol 2022; 33:107-108. [PMID: 34555502 PMCID: PMC8452134 DOI: 10.1016/j.annonc.2021.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- F. Nelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - A. Fabbri
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - A. Onorato
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - D. Giannarelli
- Clinical Trial Center, Biostatistics and Bioinformatics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M.A. Silvestri
- Department of Oncology and Hematology, Microbiology and Virology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - J.R. Giron Berrios
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - A. Virtuoso
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - E. Marrucci
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - C. Signorelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - M.G. Chilelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - F. Primi
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - M. Schirripa
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - M. Mazzotta
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - E.M. Ruggeri
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
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Mair MJ, Berger JM, Berghoff AS, Starzer AM, Ortmayr G, Puhr HC, Steindl A, Perkmann T, Haslacher H, Strassl R, Tobudic S, Lamm WW, Raderer M, Mitterer M, Fuereder T, Fong D, Preusser M. Humoral Immune Response in Hematooncological Patients and Health Care Workers Who Received SARS-CoV-2 Vaccinations. JAMA Oncol 2022; 8:106-113. [PMID: 34591965 PMCID: PMC8485209 DOI: 10.1001/jamaoncol.2021.5437] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/24/2021] [Indexed: 12/14/2022]
Abstract
Importance To our knowledge, little is known about antibody development after SARS-CoV-2 vaccination in immunocompromised individuals, such as patients with cancer. Objective To determine whether hematooncological patients develop anti-SARS-CoV-2 antibodies after vaccination. Design, Setting, and Participants This retrospective cohort study included 2 independent cohorts of patients who were treated for hematological and solid malignant tumors between October 2020 and May 2021, comprising 901 samples from 595 patients and 58 health care workers (HCWs). Serum samples were collected from patients who were treated at an academic center and a community hospital in a rural area and a control group of HCWs, all of whom received SARS-CoV-2 vaccination. Main Outcomes and Measures Total anti-SARS-CoV-2 nucleocapsid (anti-NC) and antispike protein (anti-S) antibodies were measured retrospectively. Results In total, 595 patients (320 women [53.8%] and 275 men [46.2%]; median [range] age, 67 [19-96] years) and 58 HCWs (40 women [69.0%] and 18 men [31.0%]; median [range] age, 42 [24-60] years) were included. Previous SARS-CoV-2 infection was documented in 43 of 595 (7.2%), while anti-NC antibodies that suggested previous infections were observed in 49 of 573 evaluable patients (8.6%). In both cohorts, anti-S antibody levels were higher in fully vaccinated patients compared with patients who received 1 dose. After the first vaccination, patients with hematological cancer who received B cell-targeting agents had lower anti-S levels (median, 1.6 AU/mL; range: 0-17 244 AU/mL) than patients who received other therapies (median, 191.6 AU/mL; range, 0-40 000; P < .001) or patients with solid tumors (median, 246.4 AU/mL; range, 0-40 000 AU/mL; P < .001). Anti-S levels after the first vaccination differed according to ongoing antineoplastic treatment modalities, with the lowest median levels in patients who received chemotherapy alone (157.7 AU/mL; range, 0-40 000 AU/mL) or in combination with immunotherapy (118.7 AU/mL; range, 14.1-38 727 AU/mL) and the highest levels in patients with no ongoing antineoplastic treatment (median, 634.3 AU/mL; range, 0-40 000 AU/mL; P = .01). Antibody levels after full immunization were higher in HCWs (median, 2500 U/mL; range, 485-2500 U/mL) than in patients with cancer (median, 117.0 U/mL; range, 0-2500 U/mL; P < .001). Conclusions and Relevance In this cohort study of patients with hematooncological diseases and a control group of HCWs, anti-SARS-CoV-2 antibodies after vaccination could be detected in patients with cancer. Lower antibody levels compared with HCWs and differences in seroconversion in specific subgroups underscore the need for further studies on SARS-CoV-2 vaccination in patients with hematooncological disease.
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Affiliation(s)
- Maximilian J. Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Julia M. Berger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S. Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Angelika M. Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gregor Ortmayr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Hannah C. Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ariane Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Selma Tobudic
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Wolfgang W. Lamm
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Manfred Mitterer
- Hemato-Oncological Day Hospital Unit, Franz Tappeiner Hospital, Meran/Merano, Italy
| | - Thorsten Fuereder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Dominic Fong
- Hemato-Oncological Day Hospital Unit, Franz Tappeiner Hospital, Meran/Merano, Italy
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Bosch-Barrera J, Roqué A, Teixidor E, Carmona-Garcia MC, Arbusà A, Brunet J, Martin-Castillo B, Cuyàs E, Verdura S, Menendez JA. Clinical Management of COVID-19 in Cancer Patients with the STAT3 Inhibitor Silibinin. Pharmaceuticals (Basel) 2021; 15:19. [PMID: 35056076 PMCID: PMC8778965 DOI: 10.3390/ph15010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19 pathophysiology is caused by a cascade of respiratory and multiorgan failures arising, at least in part, from the SARS-CoV-2-driven dysregulation of the master transcriptional factor STAT3. Pharmacological correction of STAT3 over-stimulation, which is at the root of acute respiratory distress syndrome (ARDS) and coagulopathy/thrombosis events, should be considered for treatment of severe COVID-19. In this perspective, we first review the current body of knowledge on the role of STAT3 in the pathogenesis of severe COVID-19. We then exemplify the potential clinical value of treating COVID-19 disease with STAT3 inhibitors by presenting the outcomes of two hospitalized patients with active cancer and COVID-19 receiving oral Legalon®-a nutraceutical containing the naturally occurring STAT3 inhibitor silibinin. Both patients, which were recruited to the clinical trial SIL-COVID19 (EudraCT number: 2020-001794-77) had SARS-CoV-2 bilateral interstitial pneumonia and a high COVID-GRAM score, and showed systemic proinflammatory responses in terms of lymphocytopenia and hypoalbuminemia. Both patients were predicted to be at high risk of critical COVID-19 illness in terms of intensive care unit admission, invasive ventilation, or death. In addition to physician's choice of best available therapy or supportive care, patients received 1050 mg/day Legalon® for 10 days without side-effects. Silibinin-treated cancer/COVID-19+ patients required only minimal oxygen support (2-4 L/min) during the episode, exhibited a sharp decline of the STAT3-regulated C-reactive protein, and demonstrated complete resolution of the pulmonary lesions. These findings might inspire future research to advance our knowledge and improve silibinin-based clinical interventions aimed to target STAT3-driven COVID-19 pathophysiology.
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Affiliation(s)
- Joaquim Bosch-Barrera
- Medical Oncology, Catalan Institute of Oncology, Dr. Josep Trueta Hospital of Girona, 17007 Girona, Spain
- Department of Medical Sciences, Medical School, University of Girona, 17003 Girona, Spain
- Girona Biomedical Research Institute (IDIBGI), 17190 Salt, Spain
| | - Ariadna Roqué
- Medical Oncology, Catalan Institute of Oncology, Dr. Josep Trueta Hospital of Girona, 17007 Girona, Spain
| | - Eduard Teixidor
- Medical Oncology, Catalan Institute of Oncology, Dr. Josep Trueta Hospital of Girona, 17007 Girona, Spain
| | | | - Aina Arbusà
- Girona Biomedical Research Institute (IDIBGI), 17190 Salt, Spain
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, 17007 Girona, Spain
| | - Joan Brunet
- Medical Oncology, Catalan Institute of Oncology, Dr. Josep Trueta Hospital of Girona, 17007 Girona, Spain
- Department of Medical Sciences, Medical School, University of Girona, 17003 Girona, Spain
- Catalan Institute of Oncology, IDIBELL, 08908 L'Hospitalet de Llobregat, Spain
| | - Begoña Martin-Castillo
- Girona Biomedical Research Institute (IDIBGI), 17190 Salt, Spain
- Unit of Clinical Research, Catalan Institute of Oncology, 17007 Girona, Spain
| | - Elisabet Cuyàs
- Girona Biomedical Research Institute (IDIBGI), 17190 Salt, Spain
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, 17007 Girona, Spain
| | - Sara Verdura
- Girona Biomedical Research Institute (IDIBGI), 17190 Salt, Spain
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, 17007 Girona, Spain
| | - Javier A Menendez
- Girona Biomedical Research Institute (IDIBGI), 17190 Salt, Spain
- Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism and Cancer Group, Catalan Institute of Oncology, 17007 Girona, Spain
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Efficacy and safety of the BNT162b2 mRNA COVID-19 vaccine in participants with a history of cancer: subgroup analysis of a global phase 3 randomized clinical trial. Vaccine 2021; 40:1483-1492. [PMID: 35131133 PMCID: PMC8702495 DOI: 10.1016/j.vaccine.2021.12.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Abstract
Introduction Individuals with an underlying malignancy have high risk of poor COVID-19 outcomes. In clinical trials, COVID-19 vaccines were safe and efficacious against infection, hospitalization, and death, but most trials excluded participants with cancer. We report results from participants with a history of past or active neoplasm (malignant or benign/unknown) and up to 6 months’ follow-up post-dose 2 from the placebo-controlled, observer-blinded trial of the 2-dose BNT162b2 mRNA COVID-19 vaccine. Patients and methods Between July 2020–January 2021, 46,429 participants aged ≥ 12 years were randomized at 152 sites in 6 countries. Healthy participants with pre-existing stable neoplasm could participate; those receiving immunosuppressive therapy were excluded. Data are reported for participants, aged ≥ 16 years for safety and ≥ 12 years for efficacy, who had any history of neoplasm at baseline (data cut-off: March 13, 2021). Adverse-event (AE) data are controlled for follow-up time before unblinding and reported as incidence rates (IRs) per 100 person-years follow-up. Results At baseline, 3813 participants had a history of neoplasm; most common malignancies were breast (n = 460), prostate (n = 362), and melanoma (n = 223). Four BNT162b2 and 71 placebo recipients developed COVID-19 from 7 days post-dose 2; vaccine efficacy was 94.4% (95% CI: 85.2, 98.5) after up to 6 months’ follow-up post-dose 2. This compares favorably with vaccine efficacy of 91.1% in the overall trial population after the same follow-up. AEs were reported at IRs of 95.4 (BNT162b2) and 48.3 (placebo) per 100 person-years. Most common AEs were reactogenicity events (injection-site pain, fatigue, pyrexia). Three BNT162b2 and 1 placebo recipients withdrew because of vaccine-related AEs. No vaccine-related deaths were reported. Conclusion In participants with past or active neoplasms, BNT162b2 vaccine has a similar efficacy and safety profile as in the overall trial population. These results can inform BNT162b2 use during the COVID-19 pandemic and future trials in participants with cancer. Clinical trial number: NCT04368728.
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Palaia I, Caruso G, Di Donato V, Vestri A, Napoli A, Perniola G, Casinelli M, Alunni Fegatelli D, Campagna R, Tomao F, D’Aniello D, Antonelli G, Muzii L. Pfizer-BioNTech COVID-19 Vaccine in Gynecologic Oncology Patients: A Prospective Cohort Study. Vaccines (Basel) 2021; 10:vaccines10010012. [PMID: 35062673 PMCID: PMC8780883 DOI: 10.3390/vaccines10010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: To evaluate the safety and immunogenicity of the Pfizer-BioNTech COVID-19 vaccine in gynecologic oncology patients under chemotherapy. Methods: A prospective cohort study including gynecologic oncology women who were under chemotherapy or had completed it within 6 months at the time of the study. All patients received a two-dose schedule of the Pfizer-BioNTech COVID-19 vaccine. Results were compared with a control group of healthy women vaccinated in the same period. Results: Overall, 44 oncologic patients with a mean age of 61.3 ± 10.7 years were enrolled: 28 (63.6%) had ovarian cancer, 9 (20.4%) endometrial, and 7 (16%) cervical. The IgG antibody titer after 1 month from vaccination was low in 9 (20.5%) patients, moderate in 21 (47.7%), and high in 14 (31.8%). The 3-month titer was null in 2 (4.5%) patients, low in 26 (59.1%), moderate in 13 (29.5%), and high in 3 (6.8%). Patients ≥ 50 years reported lower 1-month (p = 0.018) and 3-month (p = 0.004) titers compared with <50 years. Patients with BMI < 30 kg/m2 had a higher 1-month titer compared with BMI ≥ 30 kg/m2 (p = 0.016). Compared with healthy women (n = 44), oncologic patients showed a lower 3-month titer (p < 0.001). None of the patients experienced serious adverse effects. Conclusions: The COVID-19 vaccine was safe and immunogenic in gynecologic oncology patients under chemotherapy. Serological monitoring and further vaccine shots should be considered to boost protection.
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Affiliation(s)
- Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
- Correspondence:
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.V.); (D.A.F.)
| | - Anna Napoli
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Matteo Casinelli
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.V.); (D.A.F.)
| | - Roberta Campagna
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Debora D’Aniello
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Guido Antonelli
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
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Amatu A, Pani A, Patelli G, Gagliardi OM, Loparco M, Piscazzi D, Cassingena A, Tosi F, Ghezzi S, Campisi D, Grifantini R, Abrignani S, Siena S, Scaglione F, Sartore-Bianchi A. Impaired seroconversion after SARS-CoV-2 mRNA vaccines in patients with solid tumours receiving anticancer treatment. Eur J Cancer 2021; 163:16-25. [PMID: 35032813 PMCID: PMC8692068 DOI: 10.1016/j.ejca.2021.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/19/2022]
Abstract
Background Patients with solid tumours have high COVID-19 mortality. Limited and heterogeneous data are available regarding the immunogenicity of SARS-CoV-2 mRNA vaccines in this population. Methods and findings This is a prospective, single-centre cohort study aiming at evaluating seroconversion in terms of anti-spike antibodies in a population of patients with solid tumours undergoing cancer therapy within 2 months before the second vaccine dose, as compared with a cohort of controls. Subjects who were not SARS-CoV-2 naïve were excluded, and 171 patients were included in the final study population (150 vaccinated with BNT162b2, 87.7%; 21 with mRNA-1273, 12.3%) and compared with 2406 controls. The median follow-up time from the second dose of vaccination was 30 days (12–42; IQR: 26–34). Most patients had metastatic disease (138, 80.7%). Seroconversion rate was significantly lower in cancer patients than in controls (94.2% versus 99.8%, p < 0.001). At univariate logistic regression analysis, Odds ratio (OR) for seroconversion was also reduced in older individuals (>70 years). A multivariate logistic model confirmed cancer as the only significant variable in impairing seroconversion (OR 0.03, p < 0.001). In the cancer population, a multivariate analysis among clinical variables, including the type of cancer treatment, showed ECOG PS > 2 as the only one of impact (OR 0.07, p = 0.012). Conclusions There is a fraction of 6% of patients with solid tumours undergoing cancer treatment, mainly with poorer performance status, who fail to obtain seroconversion after SARS-CoV-2 mRNA vaccines. These patients should be considered for enhanced vaccination strategies and carefully monitored for SARS-CoV-2 infection during cancer treatment.
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Affiliation(s)
- Alessio Amatu
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Arianna Pani
- SC Analisi Chimico Cliniche e Microbiologia, Dipartimento Medicina di Laboratorio, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy
| | - Giorgio Patelli
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy
| | - Oscar M Gagliardi
- SC Analisi Chimico Cliniche e Microbiologia, Dipartimento Medicina di Laboratorio, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy
| | - Marina Loparco
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy
| | - Daniele Piscazzi
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy
| | - Andrea Cassingena
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Tosi
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Ghezzi
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Campisi
- SC Analisi Chimico Cliniche e Microbiologia, Dipartimento Medicina di Laboratorio, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Renata Grifantini
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy; INGM, Istituto Nazionale Genetica Molecolare 'Romeo Ed Enrica Invernizzi', Milan, Italy
| | - Sergio Abrignani
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy; INGM, Istituto Nazionale Genetica Molecolare 'Romeo Ed Enrica Invernizzi', Milan, Italy
| | - Salvatore Siena
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy
| | - Francesco Scaglione
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy.
| | - Andrea Sartore-Bianchi
- SC Oncologia Falck, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia Ed Emato-Oncologia, Università Degli Studi di Milano (La Statale), Milan, Italy.
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Luxi N, Giovanazzi A, Capuano A, Crisafulli S, Cutroneo PM, Fantini MP, Ferrajolo C, Moretti U, Poluzzi E, Raschi E, Ravaldi C, Reno C, Tuccori M, Vannacci A, Zanoni G, Trifirò G. COVID-19 Vaccination in Pregnancy, Paediatrics, Immunocompromised Patients, and Persons with History of Allergy or Prior SARS-CoV-2 Infection: Overview of Current Recommendations and Pre- and Post-Marketing Evidence for Vaccine Efficacy and Safety. Drug Saf 2021; 44:1247-1269. [PMID: 34739716 PMCID: PMC8569292 DOI: 10.1007/s40264-021-01131-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/24/2022]
Abstract
To date, four vaccines have been authorised for emergency use and under conditional approval by the European Medicines Agency to prevent COVID-19: Comirnaty, COVID-19 Vaccine Janssen, Spikevax (previously COVID-19 Vaccine Moderna) and Vaxzevria (previously COVID-19 Vaccine AstraZeneca). Although the benefit-risk profile of these vaccines was proven to be largely favourable in the general population, evidence in special cohorts initially excluded from the pivotal trials, such as pregnant and breastfeeding women, children/adolescents, immunocompromised people and persons with a history of allergy or previous SARS-CoV-2 infection, is still limited. In this narrative review, we critically overview pre- and post-marketing evidence on the potential benefits and risks of marketed COVID-19 vaccines in the above-mentioned special cohorts. In addition, we summarise the recommendations of the scientific societies and regulatory agencies about COVID-19 primary prevention in the same vaccinee categories.
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Affiliation(s)
- Nicoletta Luxi
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alexia Giovanazzi
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Centre, University Hospital of Messina, Messina, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmen Ferrajolo
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ugo Moretti
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudia Ravaldi
- PeaRL-Perinatal Research Laboratory, NEUROFARBA Department, University of Florence and CiaoLapo Foundation for Perinatal Health, Florence, Italy
| | - Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Tuccori
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Vannacci
- PeaRL-Perinatal Research Laboratory, NEUROFARBA Department, University of Florence and CiaoLapo Foundation for Perinatal Health, Florence, Italy
| | | | - Gianluca Trifirò
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
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Brisotto G, Muraro E, Montico M, Corso C, Evangelista C, Casarotto M, Caffau C, Vettori R, Cozzi MR, Zanussi S, Turetta M, Ronchese F, Steffan A. IgG antibodies against SARS-CoV-2 decay but persist 4 months after vaccination in a cohort of healthcare workers. Clin Chim Acta 2021; 523:476-482. [PMID: 34755649 PMCID: PMC8555109 DOI: 10.1016/j.cca.2021.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Monitoring the immune response against SARS-CoV-2 is pivotal in the evaluation of long-term vaccine efficacy. Immunoglobulin G (IgG) antibodies represent an advisable tool to reach this goal, especially for the still poorly defined antibody trend induced by the new class of mRNA vaccines against SARS-CoV-2. MATERIALS AND METHODS Anti-Spike RBD IgG antibodies were monitored in a cohort of healthcare workers at CRO Aviano, National Cancer Institute, through MAGLUMI® chemiluminescence assay, at 1 and 4 months after full-schedule of BNT162b2 or mRNA-1273 vaccination. RESULTS At 1 month after vaccination, 99.9% of 767 healthcare workers showed a reactive antibody response, which was inversely correlated with age, and positively associated with a previous history of COVID-19, and mRNA-1273 vaccination. Serological response was maintained in 99.6% of the 516 subjects monitored also at follow-up. An antibody decay from 559.8 AU/mL (IQR 359.7-845.7) to 92.7 AU/mL (IQR 65.1-148.6; p < 0.001) was observed, independently from age and sex. CONCLUSION Our data supported the ability of SARS-CoV-2 mRNA vaccines to induce at least a 4 months-lasting IgG response, even outside the rules of clinical trials. The antibody decay observed at follow-up suggested to deepen the immune response characterization to identify subjects with low anti-SARS-CoV-2 immunity possibly requiring a vaccination boost.
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Affiliation(s)
- Giulia Brisotto
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Elena Muraro
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy.
| | - Marcella Montico
- Clinical Trial Office, Scientific Direction, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Chiara Corso
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Chiara Evangelista
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Mariateresa Casarotto
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Cristina Caffau
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Roberto Vettori
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Maria Rita Cozzi
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Stefania Zanussi
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Matteo Turetta
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
| | - Federico Ronchese
- Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, 34100 Trieste, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers Units, Department of Translational Research, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, PN, Italy
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Ruggeri EM, Nelli F, Fabbri A, Onorato A, Giannarelli D, Giron Berrios JR, Virtuoso A, Marrucci E, Mazzotta M, Schirripa M, Panichi V, Pessina G, Signorelli C, Chilelli MG, Primi F, Natoni F, Fazio S, Silvestri MA. Antineoplastic treatment class modulates COVID-19 mRNA-BNT162b2 vaccine immunogenicity in cancer patients: a secondary analysis of the prospective Vax-On study. ESMO Open 2021; 7:100350. [PMID: 34942438 PMCID: PMC8626231 DOI: 10.1016/j.esmoop.2021.100350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Preliminary analysis from the Vax-On study did not find a correlation between cancer treatment type and antibody response to COVID-19 vaccination. We carried out a secondary subgroup analysis to verify the effects of comprehensive cancer treatment classification on vaccine immunogenicity. METHODS The Vax-On study prospectively enrolled patients who started a two-dose messenger RNA-BNT162b2 vaccine schedule from 9 March 2021 to 12 April 2021 (timepoint-1). Those on active treatment within the previous 28 days accounted for the exposed cases. Patients who had discontinued such treatment by at least 28 days or received intravesical therapy represented the control cases. Quantification of immunoglobulin G (IgG) antibodies against the receptor binding domain of the S1 subunit of the SARS-CoV-2 spike protein was carried out before the second dose (timepoint-2) and 8 weeks thereafter (timepoint-3). Seroconversion response was defined at ≥50 arbitrary units/ml IgG titer. Classification of antineoplastic agents was based on their pharmacodynamic properties. RESULTS Three hundred and sixty-six patients were enrolled (86 and 260 as control and exposed cases, respectively). Univariate analysis revealed a significantly lower IgG titer after both doses of vaccine in subgroups treated with tyrosine kinase inhibitors (TKIs), multiple cytotoxic agents, alkylating agents, and topoisomerase inhibitors. At timepoint-3, seroconversion response was significantly impaired in the topoisomerase inhibitors and mechanistic target of rapamycin (mTOR) inhibitors subgroups. After multivariate testing, treatment with alkylating agents and TKIs was significantly associated with a reduced change in IgG titer at timepoint-2. Treatment with mTOR inhibitors resulted in a similar interaction at each timepoint. Cyclin-dependent kinase 4/6 inhibitor treatment was independently correlated with an incremental variation in IgG titer at timepoint-3. Specific subgroups (TKIs, antimetabolites, alkylating agents, and multiple-agent chemotherapy) predicted lack of seroconversion at timepoint-2, but their effect was not retained at timepoint-3. Eastern Cooperative Oncology Group performance status 2, immunosuppressive corticosteroid dosing, and granulocyte colony-stimulating factor use were independently linked to lower IgG titer after either dose of vaccine. CONCLUSIONS Drugs interfering with DNA synthesis, multiple-agent cytotoxic chemotherapy, TKIs, mTOR and cyclin-dependent kinase 4/6 inhibitors differentially modulate humoral response to messenger RNA-BNT162b2 vaccine.
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Affiliation(s)
- E M Ruggeri
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - F Nelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy.
| | - A Fabbri
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - A Onorato
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - D Giannarelli
- Clinical Trial Center, Biostatistics and Bioinformatics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - J R Giron Berrios
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - A Virtuoso
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - E Marrucci
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - M Mazzotta
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - M Schirripa
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - V Panichi
- Department of Oncology and Hematology, Microbiology and Virology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - G Pessina
- Department of Oncology and Hematology, Molecular Biology and Covid Diagnostics, Central Hospital of Belcolle, Viterbo, Italy
| | - C Signorelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - M G Chilelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - F Primi
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - F Natoni
- Department of Oncology and Hematology, Molecular Biology and Covid Diagnostics, Central Hospital of Belcolle, Viterbo, Italy
| | - S Fazio
- Department of Oncology and Hematology, Molecular Biology and Covid Diagnostics, Central Hospital of Belcolle, Viterbo, Italy
| | - M A Silvestri
- Department of Oncology and Hematology, Microbiology and Virology Unit, Central Hospital of Belcolle, Viterbo, Italy
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Predictors of poor seroconversion and adverse events to SARS-CoV-2 mRNA BNT162b2 vaccine in cancer patients on active treatment. Eur J Cancer 2021; 159:105-112. [PMID: 34742157 PMCID: PMC8502731 DOI: 10.1016/j.ejca.2021.09.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022]
Abstract
Purpose Initial findings in patients with cancer suggest a lower seroconversion to SARS-CoV-2 vaccination possibly related to myelo-immunosuppressive therapies. We conducted a prospective study to assess factors predicting poor seroconversion and adverse events following immunisation (AEFI) to the BNT162b2 vaccine in patients on active treatment. Patients and methods Cancer patients, candidates to two doses of BNT162b2 SARS-CoV-2 vaccination, were enrolled. Patients on active surveillance served as controls. The primary endpoint was poor seroconversion (anti S1/S2 IgG < 25 AU/mL) after 21 days from the second dose. Results Between March and July 2021, 320 subjects were recruited, and 291 were assessable. The lack of seroconversion at 21 days from the second dose was 1.6% (95% CI, 0.4–8.7) on active surveillance, 13.9% (8.2–21.6) on chemotherapy, 11.4% (5.1–21.3) on hormone therapy, 21.7% (7.5–43.7) on targeted therapy and 4.8% (0.12–23.8) on immune-checkpoint-inhibitors (ICI). Compared to controls, the risk of no IgG response was greater for chemotherapy (p = 0.033), targeted therapy (0.005) and hormonotherapy (p = 0.051). Lymphocyte count < 1 × 109/L (p = 0.04) and older age (p = 0.03) also significantly predicted poor seroconversion. Overall, 43 patients (14.8%) complained of AEFI, mostly of mild grade. Risk of AEFI was greater in females (p = 0.001) and younger patients (p = 0.009). Conclusion Chemotherapy, targeted therapy, hormone therapy, lymphocyte count < 1 × 109/L, and increasing age predict poor seroconversion after two doses of BNT162b2 in up to 20% of patients, indicating the need for a third dose and long-term serological testing in non-responders. AEFI occur much more frequently in women and younger subjects who may benefit from preventive medications. ClinicalTrials.gov Identifier NCT04932863.
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Guven DC, Sahin TK, Kilickap S, Uckun FM. Antibody Responses to COVID-19 Vaccination in Cancer: A Systematic Review. Front Oncol 2021; 11:759108. [PMID: 34804957 PMCID: PMC8599356 DOI: 10.3389/fonc.2021.759108] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION After the results of phase III vaccine studies became available, the leading oncology societies recommended two doses of COVID-19 vaccination to all patients with cancer with no specific recommendation for tumor type and active treatments. However, the data on the COVID-19 vaccine efficacy in cancer patients is limited due to exclusion of cancer patients from most vaccine clinical trials. Therefore, we systemically reviewed the available evidence evaluating the antibody responses in cancer patients. METHODS We conducted a systematic search from the Pubmed database and calculated risk differences (RD) and 95% confidence intervals (CI) to compare seroconversion rates between cancer patients and controls using the Review Manager software, version 5.3. RESULTS Our systematic search retrieved a total 27 studies and we included 17 studies with control arms in the analyses. Cancer patients had significantly lower seroconversion rates (37.3%) than controls (74.1%) (RD: -0.44, 95% CI: -0.52, -0.35, p<0.001) with first vaccine dose. After two doses, the seroconversion rates were 99.6% in control arm and 78.3% in cancer patients (RD: -0.19, 95% CI: -0.28, -0.10, p<0.001). The difference in seroconversion rates was more pronounced patients with hematologic malignancies (72.6%) (RD: -0.25, 95% CI: -0.27, -0.22, p<0.001) than patients with solid tumors (91.6%) (RD: -0.09, 95% CI: -0.13, -0.04, p<0.003) and patients in remission (RD: -0.10, 95% CI: -0.14, -0.06, p<0.001). CONCLUSION In conclusion, COVID-19 vaccine seroconversion rates were significantly lower in patients with hematological malignancies and patients under active treatment. Further research focusing on the approaches to improve vaccine efficacy and exploration of novel treatment options is urgently needed for these patients.
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Affiliation(s)
- Deniz C. Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Taha K. Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
- Department of Medical Oncology, Istinye University, Istanbul, Turkey
| | - Fatih M. Uckun
- Department of Immunology and Inflammatory Disorders, Reven Pharmaceuticals, Westminster, CO, United States
- Immuno-Oncology Program and COVID-19 Task Force, Ares Pharmaceuticals, St. Paul, MN, United States
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Corti C, Antonarelli G, Scotté F, Spano JP, Barrière J, Michot JM, André F, Curigliano G. Seroconversion rate after vaccination against COVID-19 in cancer patients-a systematic review. Ann Oncol 2021; 33:158-168. [PMID: 34718117 PMCID: PMC8552625 DOI: 10.1016/j.annonc.2021.10.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/03/2021] [Accepted: 10/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has affected >210 million people worldwide. An optimal therapeutic approach for COVID-19 remains uncertain, to date. Since the history of cancer was linked to higher mortality rates due to COVID-19, the establishment of a safe and effective vaccine coverage is crucial in these patients. However, patients with cancer (PsC) were mostly excluded from vaccine candidates' clinical trials. This systematic review aims to investigate the current available evidence about the immunogenicity of COVID-19 vaccines in PsC. Patients and methods All prospective studies that evaluated the safety and efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included, with immunogenicity after the first and the second dose as the primary endpoint, when available. Results Vaccination against COVID-19 for PsC seems overall safe and immunogenic after well-conducted vaccination schedules. Yet the seroconversion rate remains lower, lagged or both compared to the general population. Patients with hematologic malignancies, especially those receiving B-cell-depleting agents in the past 12 months, are the most at risk of poor seroconversion. Conclusion A tailored approach to vaccination may be proposed to PsC, especially on the basis of the type of malignancy and of the specific oncologic treatments received.
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Affiliation(s)
- C Corti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haematology (DIPO), University of Milan, Milan, Italy
| | - G Antonarelli
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haematology (DIPO), University of Milan, Milan, Italy
| | - F Scotté
- Gustave Roussy Cancer Campus, Villejuif, France; Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Villejuif, France
| | - J P Spano
- APHP-Sorbonne Université, Institut Pierre Louis d'Epidemiologie et de Santé Publique INSERM 1136, Paris, France
| | - J Barrière
- Department of Medical Oncology, Clinique Saint-Jean, Cagnes-sur-Mer, France
| | - J M Michot
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - F André
- Predictive biomarkers and novel therapeutic strategies Group, Institut Gustave Roussy, University of Paris Sud, INSERM 981, Université Paris Saclay, Villejuif, France
| | - G Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haematology (DIPO), University of Milan, Milan, Italy.
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Nath SS, Yadav NU, Derkach A, Perez-Johnston R, Tachiki L, Maguire K, Babar A, Maloy MA, Klotz A, Jee J, Taur Y, Chawla S, Babady E, Khaki AR, Madeleine MM, Grivas P, Henning DJ, Aaltonen HL, Lyman GH, Groeger J. Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room. Cancer Invest 2021; 40:17-25. [PMID: 34709102 PMCID: PMC9480619 DOI: 10.1080/07357907.2021.1985134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Our goal was to identify discrete clinical characteristics associated with safe discharge from an emergency department/urgent care for patients with a history of cancer and concurrent COVID-19 infection during the SARS-CoV-2 pandemic and prior to widespread vaccination. Patients and Methods: We retrospectively analyzed 255 adult patients with a history of cancer who presented to Memorial Sloan Kettering Cancer Center (MSKCC) urgent care center (UCC) from March 1, 2020 to May 31, 2020 with concurrent COVID-19 infection. We evaluated associations between patient characteristics and 30-day mortality from initial emergency department (ED) or urgent care center (UCC) visit and the absence of a severe event within 30 days. External validation was performed on a retrospective data from 29 patients followed at Fred Hutchinson Cancer Research Center that presented to the local emergency department. A late cohort of 108 additional patients at MSKCC from June 1, 2020 to January 31, 2021 was utilized for further validation. Results: In the MSKCC cohort, 30-day mortality and severe event rate was 15% and 32% respectively. Using stepwise regression analysis, elevated BUN and glucose, anemia, and tachypnea were selected as the main predictors of 30-day mortality. Conversely, normal albumin, BUN, calcium, and glucose, neutrophil–lymphocyte ratio <3, lack of (severe) hypoxia, lack of bradycardia or tachypnea, and negative imaging were selected as the main predictors of an uneventful course as defined as a Lack Of a Severe Event within Thirty Days (LOSETD). Utilizing this information, we devised a tool to predict 30-day mortality and LOSETD which achieved an area under the operating curve (AUC) of 79% and 74% respectively. Similar estimates of AUC were obtained in an external validation cohort. A late cohort at MSKCC was consistent with the prior, albeit with a lower AUC Conclusion: We identified easily obtainable variables that predict 30-day mortality and the absence of a severe event for patients with a history of cancer and concurrent COVID-19. This has been translated into a bedside tool that the clinician may utilize to assist disposition of this group of patients from the emergency department or urgent care setting.
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Affiliation(s)
- Sandy Simcha Nath
- Urgent Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nandini Umesh Yadav
- Urgent Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rocio Perez-Johnston
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Lisa Tachiki
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kelsey Maguire
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Afia Babar
- Urgent Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Molly A Maloy
- Division of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adam Klotz
- Urgent Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Justin Jee
- Urgent Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying Taur
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Infectious Disease, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sanjay Chawla
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esther Babady
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Margaret M Madeleine
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - H Laura Aaltonen
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Gary H Lyman
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jeffrey Groeger
- Urgent Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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50
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Becerril-Gaitan A, Vaca-Cartagena BF, Ferrigno AS, Mesa-Chavez F, Barrientos-Gutiérrez T, Tagliamento M, Lambertini M, Villarreal-Garza C. Immunogenicity and risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection after Coronavirus Disease 2019 (COVID-19) vaccination in patients with cancer: a systematic review and meta-analysis. Eur J Cancer 2021; 160:243-260. [PMID: 34794855 PMCID: PMC8548030 DOI: 10.1016/j.ejca.2021.10.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022]
Abstract
Background Patients with cancer are considered a priority group for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination given their high risk of contracting severe Coronavirus Disease 2019 (COVID-19). However, limited data exist regarding the efficacy of immunisation in this population. In this study, we assess the immunologic response after COVID-19 vaccination of cancer versus non-cancer population. Methods PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases were searched from 01st March 2020 through 12th August 12 2021. Primary end-points were anti-SARS-CoV-2 spike protein (S) immunoglobulin G (IgG) seroconversion rates, T-cell response, and documented SARS-CoV-2 infection after COVID-19 immunisation. Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Overall effects were pooled using random-effects models. Results This systematic review and meta-analysis included 35 original studies. Overall, 51% (95% confidence interval [CI], 41–62) and 73% (95% CI, 64–81) of patients with cancer developed anti-S IgG above the threshold level after partial and complete immunisation, respectively. Patients with haematologic malignancies had a significantly lower seroconversion rate than those with solid tumours after complete immunisation (65% vs 94%; P < 0.0001). Compared with non-cancer controls, oncological patients were less likely to attain seroconversion after incomplete (risk ratio [RR] 0.45 [95% CI 0.35–0.58]) and complete (RR 0.69 [95% CI 0.56–0.84]) COVID-19 immunisation schemes. Patients with cancer had a higher likelihood of having a documented SARS-CoV-2 infection after partial (RR 3.21; 95% CI 0.35–29.04) and complete (RR 2.04; 95% CI 0.38–11.10) immunisation. Conclusions Patients with cancer have an impaired immune response to COVID-19 vaccination compared with controls. Strategies that endorse the completion of vaccination schemes are warranted. Future studies should aim to evaluate different approaches that enhance oncological patients’ immune response.
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Affiliation(s)
- Andrea Becerril-Gaitan
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Bryan F Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Fernanda Mesa-Chavez
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - Marco Tagliamento
- Department of Medical Oncology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genova, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.
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