Efficacy of Severe Acute Respiratory Syndrome Coronavirus-2 Vaccine in Patients With Thoracic Cancer: A Prospective Study Supporting a Third Dose in Patients With Minimal Serologic Response After Two Vaccine Doses

Abstract

Introduction: Coronavirus disease 2019 resulted in a 30% mortality rate in patients with thoracic cancer. Given that patients with cancer were excluded from serum antisevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine registration trials, it is still unknown whether they would develop a protective antispike antibody response after vaccination. This prospective vaccine monitoring study primarily aimed to assess humoral responses to the SARS-CoV-2 vaccine in patients with thoracic cancer.Methods: SARS-CoV-2-spike antibodies were measured using the Abbot Architect SARS-CoV-2 immunoglobulin G immunoassay before the first injection of BNT162b2 mRNA vaccine, at week 4, and 2 to 16 weeks after the second vaccine dose administration. The factors associated with antibody response were analyzed.Results: Overall, 306 patients, with a median age of 67.0 years (interquartile range: 58-74), were vaccinated. Of these, 283 patients received two vaccine doses at 28-day

Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position article

“…Added to chemotherapy negative impact, some factors were found to be significantly associated with a lack of immunization ( 34 , 35 ): age, long-term corticosteroid treatment and lymphocyte count < 1 × 10 9 /L.…”

“…Based on selected serological studies, comparative median anti-S Abs titers, converted in BAU/mL, among the different populations of interest with cancer have been schematized in Fig.1 , as adapted from the series of Barriere et al ( 7 ) using Roche Elecsys or Palich et al ( 27 ), Addeo et al ( 29 ), and Gounant et al ( 35 ) using Abbott IgG II . This illustration clearly depicts the substantial differences in post-vaccination median anti-S titers measured in patients with cancer, varying from 230 ( Roche Elecsys ) to 671 ( Abbott IgG II ) BAU/mL, being four to ten times lower than those observed in healthy controls.…”

“…In the oncology field, three studies with currently available data evaluated the impact of early D3 vaccine injection in poor humoral responders’ patients with LM ( 42 ), with thoracic cancer ( 35 ) and in allogenic transplanted patients in remission of a HM ( 43 ). Nevertheless, these studies employed different serological assays rendering data comparison rather difficult, unless using the conversion factors proposed by the World Health Organization (WHO) (NIBSC code 20/136).…”

“…In the Bichat Hospital study (Paris, France) ( 35 ), overall 306 thoracic cancer patients received two vaccine shots at 28-day intervals. In this same study, a deleterious impact on immunization was recorded, which was revealed to be dependent on age, recent chemotherapy, and chronic corticosteroids.…”

“…As a result, there is, therefore, a group at high risk of reinfection, namely those with low anti-S levels < 40 BAU/mL and another group at low risk of infection, and thus severe COVID-19, with anti-S levels above 100-260 BAU/mL. Of note, 140 BAU/mL corresponds to 1000 AU/mL with Abbott IgG II , this threshold representing the first quartile of the anti-S Abs distribution after the first vaccine shot in thoracic cancer patients ( 35 ). In contrast, patients with HL exhibited a median 118 BAU/mL after two vaccine shots in Addeo A. et al series, resulting in 100 BAU/mL representing the lower limit of this quite consistent window ( 29 ).…”