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In a US and Swiss study, almost all cancer patients developed a good immune response to COVID-19 mRNA vaccines three to four weeks after receiving their second dose, but the fact that a small group of patients did not submitted no response raised questions about how their protection against the virus will be approached in the future.
Among the 131 patients studied, 94% developed antibodies against the coronavirus. Seven high-risk patients did not. “We could not find any antibodies to the virus in these patients,” said Dimpy P. Shah, MD, PhD, of Mays Cancer Center, headquarters of UT Health San Antonio MD Anderson. “This has implications for the future. Should we provide a third dose of vaccine after cancer treatment is completed in some high-risk patients?”
Dr Shah is the corresponding author of the study, published in the high-impact journal Cancer cell. The co-authors are from the Mays Cancer Center and the University of Geneva.
“With other vaccines and infections, cancer patients have been shown to not develop as robust an immune response as the general population,” said study co-author Ruben Mesa, MD, FACP , executive director of the Mays Cancer Center. “It was therefore logical to hypothesize that certain groups of high-risk patients do not have an antibody response to the COVID-19 vaccine. “
“Patients with blood malignancies, such as myeloma and Hodgkin lymphoma, were less likely to respond to vaccination than those with solid tumors,” said Pankil K. Shah, MD, PhD, of the Mays Cancer Center, who was co-lead author of the study with Alfredo Addeo, MD, senior oncologist at Geneva University Hospitals.
Among high-risk groups, patients receiving treatment called Rituximab within six months of vaccination did not develop any antibodies. Rituximab is a monoclonal antibody used in the treatment of hematologic cancers and autoimmune diseases.
Patients receiving cell-toxic chemotherapy developed an antibody response, but this was attenuated compared to the general population. “How this relates to protection against COVID-19, we don’t know yet,” Dr Dimpy Shah said.
The Delta variant and other mutants of the COVID-19 virus were not examined in the study. The team also did not analyze the response of anti-infective T cells and B cells in cancer patients.
The median age of the patients in the study was 63 years. Most patients (106) had solid cancers as opposed to hematologic malignancies (25). The study population consisted of 80% non-Hispanic whites, 18% Hispanics and 2% blacks.
“We recommend that future studies also be conducted in black, Asian and Hispanic patients, to see if there are any differences in the immune response to the vaccination,” said Dr Mesa.
In countries where there is no vaccination, it is said that one dose could provide adequate protection, but this may not be true in the case of cancer patients, Dr Dimpy Shah said.
“We observed a significant difference in response when two doses were given,” said Dr. Shah. “At least for cancer patients, two doses are very important for a robust antibody response.”
Dr Pankil Shah said the study is unique because, unlike a few studies in the past that assessed immune response on or within seven days of the second dose, this study waited three to four days. weeks to get results.
Patients with high-risk cancers, especially those receiving anti-CD20 antibodies, should continue to take precautions even after being vaccinated, according to the study. “They should always be aware that they could potentially be at risk because their body has not responded to the vaccination,” said Dr Pankil Shah.
Reference: Addeo A, Shah PK, Bordry N, et al. Immunogenicity of SARS-CoV-2 messenger RNA vaccines in cancer patients. Cancer cell. 2021. doi: 10.1016 / j.ccell.2021.06.009
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