Cytokine release syndrome in a patient with colorectal cancer after vaccination with BNT162b2

Abstract

Patients with cancer are currently prioritized in coronavirus disease 2019 (COVID-19) vaccination programs globally, which includes administration of mRNA vaccines. Cytokine release syndrome (CRS) has not been reported with mRNA vaccines and is an extremely rare immune-related adverse event of immune checkpoint inhibitors. We present a case of CRS that occurred 5 d after vaccination with BTN162b2 (tozinameran)—the Pfizer-BioNTech mRNA COVID-19 vaccine—in a patient with colorectal cancer on long-standing anti-PD-1 monotherapy. The CRS was evidenced by raised inflammatory markers, thrombocytopenia, elevated cytokine levels (IFN-γ/IL-2R/IL-18/IL-16/IL-10) and steroid responsiveness. The close temporal association of vaccination and diagnosis of CRS in this case suggests that CRS was a vaccine-related adverse event; with anti-PD1 blockade as a potential contributor. Overall, further prospective pharmacovigillence data are needed in patients with cancer, but the benefit–risk profile remains strongly in favor of COVID-19 vaccination in this population.

SARS-CoV-2 variants, spike mutations and immune escape

“…Other data indicate that the effect of N501Y alone on neutralization is relatively modest, and other studies using sera from 20 participants in a trial of the BNT162b2 vaccine showed neutralizing titres equivalent to those of pseudoviruses carrying the N501 and Y501 mutations 82 . Other investigations with recombinant viruses carrying N501Y, ΔH69–V70 + N501Y + D614G or E484K + N501Y + D614G demonstrated that compared with the Wuhan-Hu-1 reference virus, only E484K + N501Y + D614G resulted in a small and modest reduction in neutralization by postvaccination sera elicited by two BNT162b2 doses, and only modest differences in neutralization were seen compared with the Wuhan-Hu-1 reference virus 83 .…”

A bioluminescent and homogeneous SARS-CoV-2 spike RBD and hACE2 interaction assay for antiviral screening and monitoring patient neutralizing antibody levels

“…Recent reports described the appearance of SARS-CoV-2 variants harboring mutations within the Spike protein sequence, of which some are associated with increased resistance to mAbs or infectivity 17 – 19 . We decided to evaluate the contribution of mutations within Spike RBD that could influence its interaction with human ACE2 (Fig.…”

“…It is noteworthy that the N501Y mutation has been linked to increased viral infectivity in BALB/c mice 20 , and it has been identified in SARS-CoV-2 variants isolated in UK, South Africa and Brazil. Furthermore, these mutant variants have been reported to be less responsive to recently developed vaccines against SARS-CoV-2 18 , 19 , 21 . However, antibody cocktails could minimize the resistance associated with emerging mutations 22 .…”

Vogt-Koyanagi-Harada Syndrome following COVID-19 and ChAdOx1 nCoV-19 (AZD1222) vaccine

“…Recently a case of Citokine Release Syndrome that occurred 5 days after vaccination with BTN162b2 (tozinameran)—the Pfizer-BioNTech mRNA COVID-19 vaccine—in a patient with colorectal cancer was reported [ 23 ].…”