Responses to SARS-CoV-2 Vaccination in Patients with Cancer (ReCOVer Study): A Prospective Cohort Study of the Hellenic Cooperative Oncology Group

Abstract

Data on the effectiveness and safety of approved SARS-CoV-2 vaccines in cancer patients are limited. This observational, prospective cohort study investigated the humoral immune response to SARS-CoV-2 vaccination in 232 cancer patients from 12 HeCOG-affiliated oncology departments compared to 100 healthcare volunteers without known active cancer. The seropositivity rate was measured 2–4 weeks after two vaccine doses, by evaluating neutralising antibodies against the SARS-CoV-2 spike protein using a commercially available immunoassay. Seropositivity was defined as ≥33.8 Binding-Antibody-Units (BAU)/mL. A total of 189 patients and 99 controls were eligible for this analysis. Among patients, 171 (90.5%) were seropositive after two vaccine doses, compared to 98% of controls (p = 0.015). Most seronegative patients were males (66.7%), >70-years-old (55.5%), with comorbidities (61.1%), and on active treatment (88.9%). The median antibody titers among patients were significantly lower than those of the controls (523 vs. 2050 BAU/mL; p < 0.001). The rate of protective titers was 54.5% in patients vs. 97% in controls (p < 0.001). Seropositivity rates and IgG titers in controls did not differ for any studied factor. In cancer patients, higher antibody titers were observed in never-smokers (p = 0.006), women (p = 0.022), <50-year-olds (p = 0.004), PS 0 (p = 0.029), and in breast or ovarian vs. other cancers. Adverse events were comparable to registration trials. In this cohort study, although the seropositivity rate after two vaccine doses in cancer patients seemed satisfactory, their antibody titers were significantly lower than in controls. Monitoring of responses and further elucidation of the clinical factors that affect immunity could guide adaptations of vaccine strategies for vulnerable subgroups.

The Effect of Smoking on Humoral Response to COVID-19 Vaccines: A Systematic Review of Epidemiological Studies

“…Another report did not specify the enrolled population. In 17 out of 23 studies, current smokers showed significant lower antibody titre, and in a few reports, highlighted a more rapid lowering of the vaccine-elicited IgG compared with nonsmokers [19,20,[26][27][28][29][30]32,34,[36][37][38][39][40][41]43,44]. In particular, accelerated antibody decline was reported in the prospective assessments by Ferrara et al [20], Zhang et al [27], and Malavazos et al [30].…”

“…The vast majority of the current body of evidence suggests that smoking has a negative impact on the humoral response to COVID-19 vaccines, with both potential lower response and more rapid lowering of the vaccine-elicited IgG titres. However, the literature available so far does not allow us to firmly ascertain whether the effect is related to duration of smoking or number of cigarettes smoked per day [20,31,38].…”

“…Across the found body of evidence, the pathophysiologic bases for the impact of active or ever smoking on the humoral response to COVID-19 vaccines have not been entirely suggested. Linardou et al speculated that the smoking-attributable immunosuppressive effect is mediated by direct effects on T cells and the dendritic-cell system, which impairs host response to vaccination [38,[48][49][50]. A recently published study from the VASCO project, an ongoing broad Italian study on the response to BNT162b2 mRNA COVID-19 vaccine in HCWs [16][17][18]20], underlined that cigarette smoking affects the ability to form memory cells that are critical to the maintenance of the protective immune response induced by vaccines, as well as smoking being associated with increased monocyte-macrophages counts, which may influence the clearance of circulating antibodies, whose half-life is of average 3-4 weeks (depending on IgG isotype and attributes) [18,20].…”

mRNA-COVID19 vaccination can be considered safe and tolerable for frail patients

“…Three cancer-related deaths were considered unrelated to the BNT162b2 vaccine 36 . One patient died due to myocardial infarction -the authors cannot complete rule out that this event was vaccine Questionnaire 39,41 . Review of medical records 42 .…”

“…2nd dose AEs: fever 5.8% -14.1%, local reactions 12.6% -33.46%, fatigue 10.4% -8.9%, arthralgia/myalgia 5.2% 38 . Overall: 45% -69% injection site pain, myalgia 9.5% -15%, bone No grade 3 / 4 side effects were recorded 18,35,37,39,41,42 . Low rate of grade 3 / 4 AE: 2.1% vaccine related AE grade 3 16 , 3.3% of patients after the 1st inoculum and 1.4% after the booster 38 .…”