COVID-19 Vaccination Efficient in Patients with Cancer Who Receive Active Anticancer Treatment

Prof. Jean-Yves Blay of the Department of Medical Oncology, Centre Léon Bérard, Université Claude Bérard in Lyon, France and colleagues reported on 2 August 2021 in the Annals of Oncology findings from an analysis of the clinical efficacy of COVID-19 vaccination in a series of 1503 patients with cancer under active treatment for cancer. All patients in the series received one or two doses of COVID-19 vaccine in the Centre Léon Bérard and the study team observed reduced SARS-CoV-2 infection and death in those who received two doses of COVID-19 vaccine. However, documented COVID-19 and death rate were higher in patients with cancer who received only one dose of COVID-19 vaccine and in patients with haematological malignancies.

From 4th January to 6th April 2021, 1503 patients with cancer without previously documented SARS-CoV-2 infection were included in the analysis. There was slightly less female patients (n = 735, 48.9%) and median age was 64.8 years (range, 16.7-95.4). Less than 10% of patients refused the COVID-19 vaccination.

In total, 1127 patients (74.9%) received BNT162b2, 317 patients (21.1%) received mRNA-1273, and 59 patients (4%) received ChAdOx1 vaccine, depending on availability. Of those, 1203 patients (80%) had a solid tumour and 300 patients (20%) had haematological malignancy, including 72 patients with chronic lymphocytic leukaemia. In total, 1081 patients (71.9%) had metastatic disease. In terms of type of anticancer treatment, 1003 patients (66.7%) received cytotoxic chemotherapy, 60 patients (3.9%) received anti-CD20, 245 patients (16.3%) received radiotherapy and 189 patients (12.5%) have been treated by surgery in the last 3 months.

In total, 1091 patients (72.6 %) received two doses of COVID-19 vaccine, and 412 patients (27.4 %) received only one dose. Median follow-up was 44 days (range, 1-130) for the whole group of 1503 patients. During that period, 24 of the 1503 patients (1.5%) developed COVID-19 symptoms with documented SARS-CoV-2 on RT-PCR; 4 of 1091 patients (0.4%) who received two doses of vaccine versus 20 of 412 patients (5%) who received only one vaccine dose (p < 0.0001). At 21 days after first COVID-19 vaccine dose, these numbers were 4 of 1001 patients (0.4%) versus 5 of 283 patients (1.7%) among those who received two versus one dose of vaccine (p = 0.016). The same differences were observed when mRNA vaccines were selected.

RT-PCR documented SARS-CoV-2 infection was not correlated with age, co-morbidities (for example diabetes, renal failure, obesity), solid or haematological malignancies.

In total, 3 of the 24 patients (12.5%) with positive RT-PCR died of COVID-19; of those 2 among 5 patients (40%) with hematological malignancy versus 1 of 19 patients (5%) with solid tumours (p = 0.036). An overall mortality rate was 0.7% and 0.08% in these two groups. The overall survival within 2 months from the date of the first vaccine dose was inferior in patients vaccinated with one dose versus in patients who received two vaccine doses (log rank p=0.015) in the overall population, and also at 21 days analysis (p = 0.032).

In total, 96 of the 1503 patients (6%) were tested for antispike antibody after vaccination at a median time of 55 days after the first vaccine dose. Of those 96 patients, 61 (63%) had detectable antispike antibody. Among these, 4 of the 8 (50%) patients who presented later a documented SARS-CoV-2 bv RT-PCR had a detectable antispike antibody. Among the 96 tested patients, 4 of the 5 patients (80%) who died had undetectable antispike antibody after vaccination versus 31 of 91 (34%) of the remaining patients (p = 0.038). Two of the 5 patients who died had a RT-PCR documented SARS-CoV-2 infection.

The authors concluded that according their experience, COVID-19 vaccination is efficient in patients with cancer. Documented COVID-19 was more frequent in patients who received only one dose of vaccine. In this large series, overall death rate in a period of 2 months following the first vaccine dose was significantly higher in patients who received only one dose of COVID-19 vaccine and in patients with haematological malignancies.

Reference

Heudel P, Favier B, Assaad S, et al. Reduced SARS-CoV-2 infection and death after two doses of COVID-19 vaccines in a series of 1503 patients. Annals of Oncology; Published online 2 August 2021. DOI: https://doi.org/10.1016/j.annonc.2021.07.012

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