Emerging issues related to COVID-19 vaccination in patients with cancer
Authors: Kamal S. Saini, Diogo Martins-Branco, Marco Tagliamento, Laura Vidal, Navneet Singh, Kevin Punie, Monika Lamba Saini, Isagani Chico, Giuseppe Curigliano, Evandro de Azambuja & Matteo Lambertini
Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths globally. The pandemic has had a severe impact on oncology care and research. Patients with underlying cancer are more vulnerable to contracting COVID-19, and also have a more severe clinical course following the infection. The rollout of COVID-19 vaccines in many parts of the world has raised hopes of controlling the pandemic. In this editorial, the authors outline key characteristics of the currently approved COVID-19 vaccines, provide a brief overview of key emerging issues such as vaccine-induced immune thrombotic thrombocytopenia and SARS-CoV-2 variants of concern, and review the available data related to the efficacy and side effects of vaccinating patients with cancer.
Key Summary Points
Patients with underlying cancer who develop infection with SARS-CoV-2 have a high rate of mortality. They constitute a highly vulnerable population and must receive COVID-19 vaccination on priority.
Multiple vaccines have been approved by regulatory agencies around the world.
Patients with cancer were largely excluded from late-stage vaccine trials, leading to a paucity of data related to this population.
A rare syndrome of thrombosis associated with thrombocytopenia, known variously as thrombosis with thrombocytopenia syndrome (TTS), vaccine-induced immune thrombotic thrombocytopenia (VITT), or vaccine-induced prothrombotic immune thrombocytopenia (VIPIT), has been reported in people, especially younger women, receiving AstraZeneca’s ChAdOx1 nCoV-19 or Janssen’s Ad.26.COV2.S vaccines. Currently, it is believed that the benefits of these vaccines outweigh the risks in the majority of people.
Patients with cancer may show a weaker immune response to COVID-19 vaccines, compared to the general population.
Results from the UK SOAP-02 study show that a prolonged prime-boost interval may leave patients with cancer vulnerable to COVID-19.
Current SARS-CoV-2 variants of concern (VoC) include B.1.1.7 (alpha), B.1.351 (beta), P.1 (gamma), and B.1.617.2 (delta), which were first identified in the UK, South Africa, Brazil, and India, respectively. These VOCs may differ with respect to transmissibility, lethality, and response to vaccine.
“Mix-and-match” studies with heterologous prime-boost combinations and studies with three-dose schedules are ongoing, and results eagerly awaited.