Efficacy of mRNA anti-SARS-CoV-2 vaccination and dynamics of humoral immune response in patients with solid tumors: results from the institutional registry of an Italian tertiary cancer center

Abstract

Background: Systemic immunosuppression characterizing cancer patients represents a concern regarding the efficacy of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, and real-world evidence is needed to define the efficacy and the dynamics of humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines. Methods: We conducted an observational study that included patients with solid tumors who were candidates for mRNA anti-SARS-CoV-2 vaccination at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. The primary objective was to monitor the immunologic response to the mRNA anti-SARS-CoV-2 vaccination in terms of anti-spike antibody levels. All the patients received two doses of the mRNA-1273 vaccine or the BNT162b2 vaccine. Healthcare workers served as a control group of healthy subjects. Results: Among the 243 patients included in the present analysis, 208 (85.60%) and 238 (97.94%) resulted seroconverted after the first and the second dose of vaccine, respectively. Only five patients (2.06%) had a negative titer after the second dose. No significant differences in the rate of seroconversion after two vaccine doses were observed in patients as compared with the control group of healthy subjects. Age and anticancer treatment class had an independent impact on the antibody titer after the second dose of vaccination. In a subgroup of 171 patients with available data about the third timepoint, patients receiving immunotherapy with immune checkpoint inhibitors seem to have a higher peak of antibodies soon after the second dose (3 weeks after), but a more pronounced decrease at a late timepoint (3 months after). Conclusions: The systemic immunosuppression characterizing cancer patients did not seem to dramatically affect the humoral response to anti-SARS-CoV-2 mRNA vaccines in our population of patients with solid tumors. Further investigation is needed to dissect the interplay between immunotherapy and longitudinal dynamics of humoral response to mRNA vaccines, as well as to analyze the cellular response to mRNA vaccines in cancer patients.

Relationship Between Corona Virus Infection And Immune Checkpoint Inhibitors

“…Several recent studies have suggested the relationship between ICIs and COVID-19 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18).A melanoma patient treated with nivolumab, an ICI, and bempegaldesleukin, PEGylated interleukin-2 (IL-2), developed COVID-19 pneumonia with no serious adverse outcome [9], however, modification of the immune response to COVID-19 by treatment with ICIs and bempegaldesleukin has been suggested [9]. Treatment with ICIs, tocilizumab plus pembrolizumab showed decreased time to clinical improvement in COVID-19 patients [10,11].Patients with lung cancer treated with ICIs demonstrated no increased incidence of immune-related adverse events associated with mRNA vaccines, while the vaccine immunogenicity was lower [12].…”

“…A cohort study in cancer patients demonstrated that the immune response to COVID vaccination is independent of the anti-cancer immune response in ICI treatment [17]. While the efficacy of mRNA vaccines for SARS-CoV-2 was not affected by the immunosuppression in cancer patients, the relationship between ICI and humoral response to mRNA vaccines in cancer patients needs to be investigated [18]. The lymphopenia occurs in treatment with temozolomide, ICIs, or other anti-cancer drugs, which may negatively affect the mortality with COVID-19 [19].…”