Heterogeneous immunogenicity of SARS-CoV-2 vaccines in cancer patients receiving radiotherapy

Abstract

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Vaccination considerations for patients receiving cancer therapy

“…This concise article is intended to provide practical support for primary care providers when vaccinating their patients who have been diagnosed with cancer. The recommendations in this brief will increase primary care providers' • Safe to administer during immunosuppressive cancer therapy • For optimal response, administer 2 wk before start of therapy or 3 mo after completion of treatment • If time sensitive (eg, influenza), administer when immunosuppression is at its lowest level • Vaccine response may be reduced if given while patient is receiving radiation therapy • If patient has received anti-B-cell therapy, defer vaccination for a minimum of 6-12 mo following treatment for optimal response • If applicable, verify immunity after cancer treatment is complete and give booster(s) when indicated Data from the Government of Canada, 6 Lopez et al, 7 Papp et al, 8 Wumkes et al, 9 Bowes et al, 10 and the National Advisory Committee on Immunization. 11…”

“…4,5 Live vaccines are attenuated and must replicate within the host to create an immune response (Table 1). [6][7][8][9][10][11] Live vaccines are contraindicated in immunosuppressed patients. 6,7,12 Non-live vaccines include inactivated, toxoid, subunit, conjugate, mRNA, and viral vector vaccines.…”

Cancer Patients and the COVID-19 Vaccines: Considerations and Challenges

“…Radiotherapy has also been associated with decreased seropositivity following vaccination. A subset of the Cancer, COVID-19 and Vaccination (CANVAX) prospective cohort study included 33 patients who had received thoracic radiotherapy, the majority of which had non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) [ 31 ]. Of these patients, 14 had received stereotactic body, palliative, or definitive radiotherapy, 13 had received chemotherapy, and 9 had potentially immunosuppressive medical conditions; 79% of patients received radiotherapy prior to vaccination with either the Moderna, Pfizer, or AstraZeneca vaccine.…”

“…Of these patients, 14 had received stereotactic body, palliative, or definitive radiotherapy, 13 had received chemotherapy, and 9 had potentially immunosuppressive medical conditions; 79% of patients received radiotherapy prior to vaccination with either the Moderna, Pfizer, or AstraZeneca vaccine. This analysis found that antibody concentrations against the spike protein were significantly lower in the 33 patients treated with thoracic radiotherapy compared to vaccinated healthy controls ( p = 0.01) [ 31 ]. However, though lower antibody concentrations were noted between patients with thoracic malignancies who received radiotherapy versus those who did not, the difference was not statistically significant ( p = 0.07) [ 31 ].…”

“…This analysis found that antibody concentrations against the spike protein were significantly lower in the 33 patients treated with thoracic radiotherapy compared to vaccinated healthy controls ( p = 0.01) [ 31 ]. However, though lower antibody concentrations were noted between patients with thoracic malignancies who received radiotherapy versus those who did not, the difference was not statistically significant ( p = 0.07) [ 31 ]. Moreover, amongst patients receiving radiotherapy, those with immunosuppressive conditions (including those receiving chemotherapy) were found to have significantly lower antibody concentrations; 44% of patients with immunosuppressive conditions had antibody levels < 100 U/mL, compared to 13% without ( p = 0.04) [ 31 ].…”