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Lasagna A, Cassaniti I, Arena F, Bergami F, Percivalle E, Comolli G, Sarasini A, Ferrari A, Cicognini D, Schiavo R, Lo Cascio G, Pedrazzoli P, Baldanti F. Persistence of Immune Response Elicited by Three Doses of mRNA Vaccine against SARS-CoV-2 in a Cohort of Patients with Solid Tumors: A One-Year Follow-Up. Int J Mol Sci 2023; 24:ijms24076731. [PMID: 37047704 PMCID: PMC10095115 DOI: 10.3390/ijms24076731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
The role and durability of the immunogenicity of the BNT162b2 mRNA vaccine against severe acute respiratory virus 2 (SARS-CoV-2), in cancer patients one year after receiving the third dose have to be elucidated. We have prospectively evaluated the long-term immunogenicity of the third dose of the SARS-CoV-2 BNT162b2 mRNA vaccine in 55 patients undergoing active treatment. Neutralizing antibody (NT Ab) titers against Omicron variants and total anti-trimeric S IgG levels were measured one year after the third dose. Heparinized whole-blood samples were used for the assessment of the SARS-CoV-2 interferon-γ release assay (IGRA). Thirty-seven patients (67.3%) showed positive total anti-trimeric S IgG one year after the third dose. Looking at the T-cell response against the spike protein, the frequency of responder patients did not decrease significantly between six and twelve months after the third dose. Finally, less than 20% of cancer patients showed an undetectable NT Ab titer against BA.1 and BA.5 variants of concern (VOCs). Underlying therapies seem to not affect the magnitude or frequency of the immune response. Our work underlines the persistence of humoral and cellular immune responses against BNT162b2 in a cohort of cancer patients one year after receiving the third dose, regardless of the type of underlying therapy.
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Affiliation(s)
- Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Irene Cassaniti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesca Arena
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Federica Bergami
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Elena Percivalle
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giuditta Comolli
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Antonella Sarasini
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alessandro Ferrari
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Daniela Cicognini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Roberta Schiavo
- Microbiology Unit, Hospital Guglielmo da Saliceto, 29121 Piacenza, Italy
| | - Giuliana Lo Cascio
- Microbiology Unit, Hospital Guglielmo da Saliceto, 29121 Piacenza, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Fausto Baldanti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Filippi AR, Agustoni F, Arcangeli S, Cortinovis D, Ferrari A, Cicognini D, Saddi J, Klersy C, Pedrazzoli P, Malapelle U, Grossi F. Rationale and Design of a Single-Arm, Phase 2, Multi-Center Study of Chemo-Immunotherapy Followed by Hypo-Fractionated RT and Maintenance Immunotherapy in Patients With Unresectable Stage III NSCLC: The DEDALUS Trial. Clin Lung Cancer 2023; 24:e122-e125. [PMID: 36759266 DOI: 10.1016/j.cllc.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION/BACKGROUND This single-arm, phase 2, multi-center, study aims to assess the safety and efficacy of a regimen of induction chemo-immunotherapy followed by de-intensified, hypo-fractionated thoracic radiotherapy (RT) given concurrently with durvalumab and maintenance durvalumab in patients with unresectable, stage III NSCLC. MATERIAL AND METHODS we will enroll 45 patients with unresectable stage III NSCLC, any PD-L1, deemed ineligible for concurrent CRT by a thoracic oncology multidisciplinary team, and candidate to sequential chemoradiation followed by durvalumab. RESULTS Primary endpoint is safety, defined by the incidence of grade 3 and 4 possibly related adverse events (PRAEs) within 6 months from the initiation of treatment. The secondary objectives are PFS and OS (median and 12 months). Ancillary endpoints are molecular response evaluated by cfDNA isolation baseline, after chemo-immuno RT and at progression, and radiomics analysis on CT scans at baseline and before maintenance. CONCLUSION DEDALUS phase 2 trial explores the safety and efficacy of a novel sequence of chemo-radiation (with de-intensified RT) plus the anti-PD-L1 agent durvalumab in patients with stage III unresectable NSCLC who are candidates to sequential chemoradiation plus maintenance immunotherapy.
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Affiliation(s)
- Andrea Riccardo Filippi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Agustoni
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
| | - Stefano Arcangeli
- Radiation Oncology, San Gerardo Hospital, Monza, and University of Milano Bicocca, Milano, Italy
| | | | - Alessandra Ferrari
- Oncology Clinical Trials Office, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Cicognini
- Oncology Clinical Trials Office, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jessica Saddi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Radiation Oncology, San Gerardo Hospital, Monza, and University of Milano Bicocca, Milano, Italy
| | - Catherine Klersy
- Epidemiology and Biostatistics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Grossi
- Medical Oncology, University of Insubria, ASST dei Settelaghi, Varese, Italy
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Saddi J, Agustoni F, Arcangeli S, Cortinovis D, Ferrari A, Cicognini D, Klersy C, Pedrazzoli P, Malapelle U, Grossi F, Filippi A. 198TiP DEDALUS trial: A single-arm, phase II, multi-center study of chemo-immunotherapy followed by hypo-fractionated RT and maintenance immunotherapy in patients with unresectable stage III NSCLC. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lasagna A, Bergami F, Lilleri D, Percivalle E, Quaccini M, Comolli G, Sarasini A, Sammartino JC, Ferrari A, Arena F, Cicognini D, Schiavo R, Lo Cascio G, Baldanti F, Pedrazzoli P, Cassaniti I. Humoral and Cellular Response before and after the Fourth BNT162b2 Vaccine Dose in patients with solid tumors on active treatment. Ann Oncol 2022; 33:1207-1208. [PMID: 35926815 PMCID: PMC9341169 DOI: 10.1016/j.annonc.2022.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- A Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - F Bergami
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Lilleri
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Percivalle
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Quaccini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Comolli
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Sarasini
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - J C Sammartino
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Ferrari
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Arena
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Cicognini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Schiavo
- Microbiology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - G Lo Cascio
- Microbiology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - F Baldanti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Dept. of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - P Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Dept. of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - I Cassaniti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Lasagna A, Bergami F, Lilleri D, Percivalle E, Quaccini M, Serra F, Comolli G, Sarasini A, Sammartino JC, Ferrari A, Arena F, Secondino S, Cicognini D, Schiavo R, Lo Cascio G, Cavanna L, Baldanti F, Pedrazzoli P, Cassaniti I. Six-month humoral and cellular immune response to the third dose of BNT162b2 anti-SARS-CoV-2 vaccine in the patients with solid tumors: a longitudinal cohort study with a focus on the variants of concern. ESMO Open 2022; 7:100574. [PMID: 36029652 PMCID: PMC9353611 DOI: 10.1016/j.esmoop.2022.100574] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
Background The role and the durability of the immunogenicity of the third dose of vaccine against COVID-19 variants of concern in cancer patients have to be elucidated. Patients and methods We have prospectively evaluated the immunogenicity of the third dose of the SARS-CoV-2 BNT162b2 messenger RNA vaccine in triggering both humoral and cell-mediated immune response in patients with solid tumors undergoing active treatment 6 months after the booster. Neutralizing antibody (NT Ab) titers and total anti-spike immunoglobulin G concentrations were measured in serum. Heparinized whole blood samples were used for the SARS-CoV-2 interferon-γ release assay (IGRA). Results Six months after the third dose only two patients (2.4%) showed negative spike-specific immunoglobulin G antibody levels (<33.8 BAU/ml). The median level of SARS-CoV-2 NT Abs decreased and only 39/83 (47%) subjects showed maximum levels of NT Abs. T-cellular positive response was observed in 38/61 (62.3%) patients; the highest median level of response was observed 21 days after the third dose (354 mIU/ml, interquartile range 83.3-846.3 mIU/ml). The lowest median level of NT Ab response was observed against the Omicron variant (1 : 10, interquartile range 1 : 10-1 : 40) with a significant reduced rate of responder subjects with respect to the wild-type strain (77.5% versus 95%; P = 0.0022) and Delta variant (77.5% versus 93.7%; P = 0.0053). During the follow-up period, seven patients (8%) had a confirmed post-vaccination infection, but none of them required hospitalization or oxygen therapy. Conclusions Our work highlights a significant humoral and cellular immune response among patients with solid tumors 6 months after the third BNT162b2 vaccine dose, although a reduction in neutralizing activity against Omicron was observed. Only two patients (2.4%) showed negative spike-specific IgG antibody levels (<33.8 BAU/ml) Only 39/83 (47%) subjects showed maximum level of neutralizing antibodies (NT Abs). T-cellular positive response was observed in 38/61 (62.3%) analyzed patients. The lowest median level of NT Ab response was observed against the Omicron variant. Seven patients (8%) had a post-vaccination infection; none of them required hospitalization or oxygen therapy.
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Affiliation(s)
- A Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - F Bergami
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Lilleri
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Percivalle
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Quaccini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Serra
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Comolli
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Sarasini
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - J C Sammartino
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Ferrari
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Arena
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Secondino
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Cicognini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Schiavo
- Microbiology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - G Lo Cascio
- Microbiology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - L Cavanna
- Oncology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - F Baldanti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Departments of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pavia, Italy
| | - P Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - I Cassaniti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Zuccarini A, Cicognini D, Tancredi R, Ferrari A, Rizzo G, Lasagna A, Caccialanza R, Cavanna L, Orlandi E, Biasini C, Molinaro P, Garigliano D, Costantino A, Moroni M, Perrone L, Alessio NL, Rovati B, Ferretti VV, Klersy C, Pedrazzoli P. Randomized trial of sucrosomial iron supplementation in patients with chemotherapy-related anemia treated with ESA. Support Care Cancer 2022; 30:7645-7653. [PMID: 35678882 DOI: 10.1007/s00520-022-07184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Iron supplementation improves the erythropoiesis-stimulating agents' (ESAs) response in chemotherapy-related anemia. The primary aim of our study is to assess the efficacy of sucrosomial iron, a new oral iron formulation, in cancer patients with chemotherapy-induced anemia treated with ESAs. The secondary objectives included the efficacy into two subgroups of patients (iron replete and functional iron deficiency) between the two study arms, safety and the effect on transfusion need. METHODS In this randomized, multicentre, open-label, phase III clinical trial, 60 cancer patients were enrolled. Each patient was randomly assigned (1:1) to receive 12 weeks of oral sucrosomial iron at the dose of 30 mg daily in combination with ESAs or no supplementation to ESA treatment. The endpoint considered for efficacy was the proportion of patients achieving complete hematological response at 12 weeks (increase in Hb > 2 g/dL from baseline, without RBC transfusions in the previous 28 days or achieving Hb ≥ 12 g/dL). RESULTS There was a statistically significant association between oral sucrosomial iron supplementation in combination with ESAs and the achievement of a complete hematological response. This response was achieved within 12 weeks by 31% of patients in the control group and by 52% of patients supplemented with oral sucrosomial iron. A trend of greater response in sucrosomial iron arm was found in both subgroups. No difference was observed about safety and transfusion need. CONCLUSIONS Sucrosomial iron is well tolerated and its combination with ESAs improves the hematological response in cancer patients with chemotherapy-related anemia. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION This study has been reviewed by the Institutional Ethics Committee of the IRCCS Policlinico San Matteo Foundation, Pavia, Italy (28/04/2015; prot. N. 20,150,002,059), and by the Institutional Ethics Committee of the other Italian oncological centers involved in this study.
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Affiliation(s)
- Andrea Zuccarini
- Oncology Clinical Trial Office, Oncology Unit IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Daniela Cicognini
- Oncology Clinical Trial Office, Oncology Unit IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Richard Tancredi
- Medical Oncology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alessandra Ferrari
- Oncology Clinical Trial Office, Oncology Unit IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Gianpiero Rizzo
- Medical Oncology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Angioletta Lasagna
- Medical Oncology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Riccardo Caccialanza
- Nutrition and Dietetics Service, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Luigi Cavanna
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza, Italy
| | - Elena Orlandi
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza, Italy
| | - Claudia Biasini
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza, Italy
| | - Peppina Molinaro
- Oncology Unit Hospital "Giovanni Paolo II", Lamezia Terme, CZ, Italy
| | - Danula Garigliano
- Oncology Unit Hospital "Giovanni Paolo II", Lamezia Terme, CZ, Italy
| | - Angela Costantino
- Oncology Unit Hospital "Giovanni Paolo II", Lamezia Terme, CZ, Italy
| | - Mauro Moroni
- Oncology Division, San Carlo Borromeo Hospital, ASST Santi Paolo E Carlo, Milan, Italy
| | - Lorenzo Perrone
- Medical Oncology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Bianca Rovati
- Oncology Clinical Trial Office, Oncology Unit IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Catherine Klersy
- Clinical Epidemiology and Biometry Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. .,Univerisity of Pavia, Pavia, Italy.
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Lasagna A, Cassaniti I, Bergami F, Lilleri D, Percivalle E, Quaccini M, Alessio N, Comolli G, Sarasini A, Camilla J, Ferrari A, Arena F, Secondino S, Cicognini D, Schiavo R, Lo Cascio G, Cavanna L, Baldanti F, Pedrazzoli P. Humoral and cell-mediated immune response to the third dose of BNT162b2 anti-SARS-CoV-2 vaccine in patients with cancer on active treatment: Focus on wild type, Delta and Omicron strains. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13505 Background: Although a full course of COVID-19 vaccine is effective in cancer patients, the duration of the protection and the efficacy of a booster dose against the new variants remain unknown. We prospectively evaluated the immunogenicity of the third dose of the SARS-CoV-2 BNT162b2 mRNA vaccine in cancer patients undergoing active treatment. Methods: Patients with solid cancer, vaccinated with a booster dose during active treatment, were prospectively enrolled in this study. Patients were classified in SARS-CoV-2 naïve (without previous COVID-19 infection) and SARS-CoV-2 experienced (with previous COVID-19 infection). Neutralizing antibody (NT Abs) titer and total anti-Spike IgG concentration were quantified in serum. Heparinized whole blood samples were used for SARS-CoV-2 Interferon Gamma Release Assay (IGRA). The primary endpoint was to assess the increase of IgG antibody level between baseline (T0) and 3 weeks after the booster (T1). Results: 142 consecutive patients were recruited. In SARS-CoV-2 naïve subjects, median level of IgG was 157 BAU/mL (interquartile range (IQR) 62-423) at T0 and reached median of 2080 (IQR 2080-2080) at three weeks after booster administration (T1; p < 0.0001). A median 16-fold increase of SARS-CoV-2 NT Abs titre (IQR 4-32) was observed in naïve subjects (from median 20 IQR 10-40 to median 640 IQR 160-640; p < 0.0001). Median IFN-γ level at T1 was significantly higher than that measured at T0 in SARS-CoV-2 naïve subjects (p = 0.0049) but not in SARS-CoV-2 experienced patients. No difference was observed in terms of median response between patients treated with immunotherapy and chemotherapy (p > 0.05). A stronger correlation between SARS-CoV-2 NT Abs and total IgG level was observed at T0 (r = 0.76; p < 0.0001) compared to T1 (r = 0.27, p = 0.0081). No correlation as regards the number of days was observed from the first to the third vaccination and SARS-CoV-2 NT Abs/total IgG. The median level of SARS-CoV-2 NT Abs was 32-fold lower against Omicron compared to wild type strain (p = 0.0004) and 12-fold lower compared to Delta strain (p = 0.0110). Conclusions: The third dose is able to trigger both the humoral and the cell-mediated immune response in cancer patients on active treatment. Our preliminary data about the neutralization of the SARS-CoV-2 vaccine against variants of concern (VOCs) seem to confirm the vaccine lower activity.
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Affiliation(s)
| | | | | | | | | | | | | | - Giuditta Comolli
- Microbiology and Virology, Biotechnology Laboratories, IRCCS San Matteo, Pavia, Italy
| | | | - Josè Camilla
- Fondazione Irccs Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | | | | | - Luigi Cavanna
- Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza, Italy
| | | | - Paolo Pedrazzoli
- Medical Oncology Unit, IRCCS Policlinico San Matteo, Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
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Lasagna A, Bergami F, Lilleri D, Percivalle E, Quaccini M, Alessio N, Comolli G, Sarasini A, Sammartino JC, Ferrari A, Arena F, Secondino S, Cicognini D, Schiavo R, Lo Cascio G, Cavanna L, Baldanti F, Pedrazzoli P, Cassaniti I. Immunogenicity and safety after the third dose of BNT162b2 anti-SARS-CoV-2 vaccine in patients with solid tumors on active treatment: a prospective cohort study. ESMO Open 2022; 7:100458. [PMID: 35427842 PMCID: PMC8913298 DOI: 10.1016/j.esmoop.2022.100458] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although a full course of coronavirus disease 2019 (COVID-19) vaccine is effective in cancer patients, the duration of the protection and the efficacy of a booster dose against the new variants remain unknown. We prospectively evaluated the immunogenicity of the third dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 messenger RNA vaccine in cancer patients undergoing active treatment. PATIENTS AND METHODS Patients with solid cancer, vaccinated with a booster dose during active treatment, were enrolled in this study. Patients were classified into SARS-CoV-2 naïve (without previous COVID-19 infection) and SARS-CoV-2 experienced (with previous COVID-19 infection). Neutralizing antibody (NT Ab) titer and total anti-Spike immunoglobulin G (IgG) concentration were quantified in serum. Heparinized whole blood samples were used for SARS-CoV-2 Interferon Gamma Release Assay (IGRA). The primary endpoint was to assess the increase of IgG antibody level between baseline and 3 weeks after the booster. RESULTS One hundred and forty-two consecutive patients were recruited. In SARS-CoV-2-naïve subjects, the median level of IgG was 157 BAU/ml [interquartile range (IQR) 62-423 BAU/ml] at T0 and reached a median of 2080 BAU/ml (IQR 2080-2080 BAU/ml) at 3 weeks after booster administration (T1; P < 0.0001). A median 16-fold increase of SARS-CoV-2 NT Ab titer (IQR 4-32) was observed in naïve subjects (from median 20, IQR 10-40, to median 640, IQR 160-640; P < 0.0001). Median interferon-γ level at T1 was significantly higher than that measured at T0 in SARS-CoV-2-naïve subjects (P = 0.0049) but not in SARS-CoV-2-experienced patients. The median level of SARS-CoV-2 NT Abs was 32-fold lower against Omicron compared to the wild-type strain (P = 0.0004) and 12-fold lower compared to the Delta strain (P = 0.0110). CONCLUSIONS The third dose is able to trigger both the humoral and the cell-mediated immune response in cancer patients on active treatment. Our preliminary data about the neutralization of the SARS-CoV-2 vaccine against variants of concern seem to confirm the lower vaccine activity.
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Affiliation(s)
- A Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Bergami
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Lilleri
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Percivalle
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Quaccini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - N Alessio
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Comolli
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Sarasini
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - J C Sammartino
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Ferrari
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Arena
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Secondino
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Cicognini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Schiavo
- Microbiology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - G Lo Cascio
- Microbiology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - L Cavanna
- Oncology Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - F Baldanti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Departments of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pavia, Italy
| | - P Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
| | - I Cassaniti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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9
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Lasagna A, Muzzana M, Ferretti VV, Klersy C, Pagani A, Cicognini D, Pedrazzoli P, Brugnatelli SG. The Role of Pre-treatment Inflammatory Biomarkers in the Prediction of an Early Response to Panitumumab in Metastatic Colorectal Cancer. Cureus 2022; 14:e24347. [PMID: 35607541 PMCID: PMC9123381 DOI: 10.7759/cureus.24347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 01/17/2023] Open
Abstract
Background Systemic inflammation is a critical component of the development and progression of several types of cancer. Neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) are simple, inexpensive, and reliable predictors of the systemic inflammatory response to the therapy in different malignant tumors, including colorectal cancer. Methods Metastatic colorectal cancer (mCRC) patients treated with panitumumab plus chemotherapy at first-line at the medical oncology unit of Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo di Pavia between January 1st 2016 and February 1st 2021 were retrospectively analyzed. NLR and LMR were divided into two groups (high and low) based on the cut-off points, with the estimation of the prognostic accuracy of NLR for the early treatment response as the primary end-point of this study. Results The receiver operating characteristic (ROC) analysis showed a fair prognostic accuracy of NLR for early treatment response (area under the curve (AUC)=0.76, 95% CI: 0.62-0.89). A slightly lower prognostic accuracy was found for LMR (AUC=0.71, 95% CI: 0.57-0.85). In the univariable proportional hazard Cox model, no effect of NLR on PFS was found (NLRHigh vs. NLRLow HR=1.3; 95% CI: 0.7-2.4, p=0.414). Patients with higher levels of LMR showed a trend towards higher PFS (LMRHigh vs. LMRLow HR=0.4; 95% CI: 0.2-1.1, p=0.066). No association was found between NLR (or LMR) and skin toxicity. Conclusions NLR and LMR may be used as biomarkers of prognostic accuracy for the early treatment response in mCRC patients treated with panitumumab.
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Affiliation(s)
- Angioletta Lasagna
- Medical Oncology, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
| | - Marta Muzzana
- Medical Oncology, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
| | - Virginia V Ferretti
- Service of Clinical Epidemiology & Biostatistic, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biostatistic, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
| | - Anna Pagani
- Medical Oncology, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
| | - Daniela Cicognini
- Medical Oncology, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
| | - Paolo Pedrazzoli
- Medical Oncology, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
| | - Silvia G Brugnatelli
- Medical Oncology, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, ITA
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10
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Armani G, Pozzi E, Pagani A, Porta C, Rizzo M, Cicognini D, Rovati B, Moccia F, Pedrazzoli P, Ferraris E. The heterogeneity of cancer endothelium: The relevance of angiogenesis and endothelial progenitor cells in cancer microenvironment. Microvasc Res 2021; 138:104189. [PMID: 34062191 DOI: 10.1016/j.mvr.2021.104189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/02/2023]
Abstract
Tumor-associated vessels constitution is the result of angiogenesis, the hallmark of cancer essential for tumor to develop in dimension and to spread throughout the organism. Tumor endothelium is configured as an active functioning organ capable of determine interaction with the immune response and all the other components of the variegate cancer microenvironment, determining reciprocal influence. Angiogenesis is here analyzed in its molecular and cellular mechanisms, multiple mediators and principal players, represented by Endothelial Cells. It is discussed the striking heterogeneity of cancer endothelium, due to morphological and molecular aberrations that it often presents and its multiple origin. Among the cells that participate to the composition of tumor vasculature, Endothelial Progenitor Cells represent an important source for physical sustain and paracrine signaling in the process of angiogenesis. Treatment options are reviewed, with particular focus on novel therapeutic strategies for overcoming tumor resistance to anti-angiogenic agents.
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Affiliation(s)
- Giovanna Armani
- Division of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy..
| | - Emma Pozzi
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Pagani
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camillo Porta
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Mimma Rizzo
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Daniela Cicognini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bianca Rovati
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Moccia
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Ferraris
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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11
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Pedrazzoli P, Caccialanza R, Stobäus N, Turri A, Klersy C, Caraccia M, Brugnatelli S, Secondino S, Cicognini D, Imarisio I, Filippi AR, Monaco T, Giannoni A, Norman K, Cereda E. Validation of a new prognostic body composition parameter in cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11597 Background: In cancer patients protein-calorie imbalances are responsible for decreased lean body mass and, in turn, for worse clinical outcome. We evaluated the prognostic value of a new body composition parameter (creatinine height index [CHI]) obtained from bioimpedance vectorial analysis-derived body cell mass and its association with nutritional and functional status. Methods: Data from Italian and German cancer patients based on information from previous prospective cohort studies were used. Multivariable models (adjusted for age, gender, hydration status, performance status, and disease stage) were built in both cohorts to assess the association between body composition outcome parameters (low fat-free mass [FFM], <15 [females] and <17 [males] kg/m2; low standardized phase angle [SPA], <-1.65; low CHI, <510 [females] and <660 [males] mg/24h/m) and 1-year all-cause mortality, low body mass index (BMI; <20 [<70 years] and <22 [>/=70 years] kg/m2), clinically significant weight loss (WL; >/=10% in 6 months) and low handgrip strength (HG; <20 [females] and <30 [males] kg). Results: Overall, 1084 cancer patients were included (Italians, N=454; Germans, N=630). Low CHI was independently associated with mortality in both Italian and German cohorts (Table). Low FFMI and low SPA did not predict survival in the German cohort. In patients with low CHI, worse nutritional and functional status were observed in both study populations. Performance of models addressing the study endpoints showed substantial consistency with both cohorts, particularly of those including low CHI. Conclusions: We validated a new prognostic body composition parameter, which is easier to interpret than standard nutritional parameters and may be useful for identifying cancer patients at nutritional risk, requiring early nutritional support. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Teresa Monaco
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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