Immunogenicity of SARS-CoV-2 vaccines in patients with breast cancer

Abstract

Purpose: To explore the immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with breast cancer based on type of anticancer treatment. Methods: Patients with breast cancer had anti-spike antibody concentrations measured ⩾14 days after receiving a full SARS-CoV-2 vaccination series. The primary endpoint was IgA/G/M anti-spike antibody concentration. Multiple regression analysis was used to analyze log10-transformed antibody titer concentrations. Results: Between 29 April and 20 July 2021, 233 patients with breast cancer were enrolled, of whom 212 were eligible for the current analysis. Patients who received mRNA-1273 (Moderna) had the highest antibody concentrations [geometric mean concentration (GMC) in log10: 3.0 U/mL], compared to patients who received BNT162b2 (Pfizer) (GMC: 2.6 U/mL) (multiple regression adjusted p = 0.013) and Ad26.COV2.S (Johnson & Johnson/Janssen) (GMC: 2.6 U/mL) ( p = 0.071). Patients receiving cytotoxic therapy had a significantly lower antibody titer GMC (2.5 U/mL) compared to patients on no therapy or endocrine therapy alone (3.0 U/mL) ( p = 0.005). Patients on targeted therapies (GMC: 2.7 U/mL) also had a numerically lower GMC compared to patients not receiving therapy/on endocrine therapy alone, although this result was not significant ( p = 0.364). Among patients who received an additional dose of vaccine ( n = 31), 28 demonstrated an increased antibody response that ranged from 0.2 to >4.4 U/ mL. Conclusion: Most patients with breast cancer generate detectable anti-spike antibodies following SARS-CoV-2 vaccination, though systemic treatments and vaccine type impact level of response. Further studies are needed to better understand the clinical implications of different antibody levels, the effectiveness of additional SARS-CoV-2 vaccine doses, and the risk of breakthrough infections among patients with breast cancer.

Humoral Immune Response after COVID-19 mRNA Vaccination in Patients with Liver Cirrhosis: A Prospective Real-Life Single Center Study

“…We speculate that this surprising result could be due to the different types of mRNA vaccine used in cirrhotic patients (Moderna, 1273 mRNA vaccine) and in the HCWs reference group (Pfizer-BioNTech, BNT162b2 mRNA vaccine). Our hypothesis is supported by previously published studies where the Moderna-1273 mRNA vaccine induced significantly higher anti-S titers compared to other types of vaccination in the general population [28][29][30] and in immunocompromised subjects [31,32]. In addition, two studies evaluating the effectiveness of COVID-19 vaccination in cirrhotic patients demonstrated that a single dose of Johnson & Johnson vaccine [21] or two doses of BNT162b2 mRNA vaccine [24] were associated to a suboptimal antibody response.…”

Immunogenicity of mRNA-1273 and BNT162b2 in Immunocompromised Patients: Systematic Review and Meta-analysis Using GRADE

“…Most studies evaluated the 2-dose primary series (n = 81, 82.7%). Patients received 2 doses of the primary series followed by 1 booster dose in 17 studies (17.3%) [66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82]. Most studies did not specify whether the mRNA-1273 booster dose was a true booster (i.e., 50 mcg mRNA/dose) or a third dose of the primary series (i.e., 100 mcg mRNA/dose).…”

Immune responses and clinical outcomes following the third dose of SARS-CoV-2 mRNA-BNT162b2 vaccine in advanced breast cancer patients receiving targeted therapies: a prospective study

“…These changes would have a positive impact on vaccination outcomes because they trigger a "viral mimicry" response, characterized by interferon production and expression of interferon-stimulated genes (31,32). Nonetheless, several clinical trials have observed impaired humoral responses after an initial two-dose series for patients receiving CDK4/6 inhibitors (12)(13)(14). Regardless of the diversity of the control group in these studies (patients on endocrine therapy or healthy volunteers), the serological findings of the current research are widely consistent with the available evidence.…”

“…Currently, breast cancer patients receive different kinds of therapy, with monoclonal antibodies against human epidermal growth factor receptor 2 (HER2) and cyclindependent kinase 4/6 (CDK4/6) inhibitors being the most commonly used targeted agents (9,10). While limited data are available on HER-2-targeted therapies (11), the relationship between CKD4/6 inhibitors and the efficacy of vaccination remains controversial and concerns only the first or second immunization (12)(13)(14)(15)(16). Secondary neutropenia and lymphopenia occurring in most patients on CDK4/6 inhibition may hamper immune responses to vaccination (17).…”