People with cancer should get COVID-19 vaccine, experts say

People with cancer, including those undergoing treatment, should receive COVID-19 vaccines as soon as they are available, according to new guidelines from the National Comprehensive Cancer Network (NCCN).

While people with certain types of cancer and those who receive certain cancer treatments may not respond as well, vaccines should still provide partial protection, which is especially important because some cancer patients are at higher risk. complications from COVID-19.

“Right now there is an urgent need and limited data,” said committee co-leader Steve Pergam, MD, MPH, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, headquarters of the National Institutes of Health. COVID-19 prevention network. “Our number one goal is to help get the vaccine to as many people as possible. This means following existing national and regional guidelines to prioritize people who are more likely to face death or severe illness from COVID-19. The evidence we have shows that people receiving active cancer treatment are at greater risk for worse outcomes from COVID-19, particularly if they are older and have additional comorbidities, such as immunosuppression.

There is still a lot to learn about COVID-19 in people with cancer. Studies have shown that people with blood cancers like leukemia or lymphoma and lung cancer have a greater risk of severe COVID-19 and death, but those with other types, such as breast cancer. breast or lung, do not appear to be at greater risk. Patients with active or advanced cancer are likely to do less well. Although studies of the effects of cancer treatment on COVID-19 outcomes have yielded conflicting results, therapies that cause immune suppression appear to lead to poorer results.

Two mRNA vaccines from Pfizer / BioNTech and Moderna were approved by the Food and Drug Administration in December. These vaccines were 95% and 94% effective in preventing symptomatic COVID-19 in phase III clinical trials. The candidate vaccines from AstraZeneca, Johnson and Johnson, and Novavax are also effective, particularly in preventing serious disease, and are expected to receive emergency use authorization in the coming months. All vaccines have been shown to be safe.

A Centers for Disease Control and Prevention (CDC) advisory committee has developed a vaccine prioritization plan that puts healthcare workers and residents of long-term care facilities first, followed by people over 75 and over. of some essential front-line workers. The CDC then expanded eligibility to include anyone over the age of 65 and those with underlying health conditions, including cancer, that put them at more serious risk of COVID-19. But current supplies are far from sufficient to immunize all eligible people.

The NCCN’s COVID-19 Vaccines Committee, which includes top experts in hematology and oncology in the areas of infectious diseases, vaccine development and administration, medical ethics and information technology on health, recommends that all people with cancer should get vaccinated. The committee also advises that caregivers and people living in the same household as cancer patients should also be vaccinated when eligible.

While clinical trials have shown that vaccines are very effective in reducing the risk of getting sick with COVID-19, it is still not clear to what extent they prevent asymptomatic infection and transmission, the committee therefore emphasizes. the importance of continuing to follow precautions such as wearing masks and social distancing.

Although people on cancer treatment have been excluded from trials for the COVID-19 vaccine, experts say there is no reason to believe the vaccines will not be safe for this group. Currently licensed vaccines do not contain live virus and therefore cannot cause disease, even in immunocompromised people.

“The data we have on these vaccines shows that they are remarkably safe in the general population, based on testing. Admittedly, very few patients with active cancer or in active therapy were included in the trials. But after going through all of the documentation for these two vaccines, it seems remarkably safe, ”Gary Lyman, MD, of Fred Hutch, who helped start the COVID-19 and Cancer Consortium, told the Fred Hutch News Service. “I’m not really worried that there are any big safety surprises for the cancer patient population. The risk of COVID for these patients is high and the risks from the vaccines appear to be very low. “

Although vaccines appear safe for people with cancer, some patients may not respond as well, especially those whose cancer or treatment causes immune suppression. Some blood cancers affect B cells, the white blood cells that produce antibodies, a key player in the vaccine response. Chemotherapy and radiation therapy can deplete white blood cells, and people having a stem cell transplant or receiving CAR-T therapy have their own immune cells killed by chemo or radiation therapy to make room for the new cells.

The NCCN committee recommends that people receiving intensive chemotherapy for leukemia should wait to be vaccinated until their white blood cell counts recover. Stem cell transplant recipients and CAR-T recipients should postpone vaccination for up to three months after the procedure to improve the chances of the vaccine producing a good immune response. People having major surgery should wait at least a few days. But everyone – including patients receiving chemotherapy for solid tumors, targeted therapy, immunotherapy, or radiation therapy – should get a vaccine as soon as possible.

If it is necessary to give priority to people with cancer, the committee recommends moving people on active treatment (except those taking only hormone therapy), those planning to start treatment soon and those who recently completed treatment ranked first. Cancer patients with other risk factors, including advanced age and additional health problems, should also be given priority.

Finally, the guide recognizes the social disparities and inequalities linked to COVID-19 – Blacks and Latin Americans are more likely to be exposed to the coronavirus and more likely to develop serious illness and die from it, but are less likely to be vaccinated.

“One of our main goals is to reduce morbidity and mortality,” said Sirisha Narayana, MD, chair of the ethics committee at the University of California at San Francisco. “We must also take into account the social determinants of health and make special efforts for people living in high-risk communities.”

“The medical community is facing one of the greatest challenges we have ever faced,” added NCCN CEO Robert Carlson, MD. “COVID-19 vaccines exemplify the peaks of scientific achievement. We now need to distribute them quickly, fairly, safely and effectively, using clearly defined and transparent principles. “

Given their higher risk of COVID-19, the NCCN, the American Society of Clinical Oncology and other advocates are calling for people with cancer to be given priority for vaccination.

“People with metastatic and active cancers die at a rate similar to that of people over 75; if we die by the age of 75, we should be vaccinated at the age of 75, ”Kelly Shanahan, an advocate living with metastatic breast cancer, told Cancer Health. “Those of us with active and metastatic cancers don’t have the luxury of staying home. We need to get our treatments and scans and see our oncologists. Keep us away from hospitals – and morgues – by prioritizing us for COVID19 vaccinations!

Click here to read the complete guide to the NCCN COVID-19 vaccine.

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