SARS-CoV-2 vaccination in patients with GI and hepatobiliary carcinoma: a call for booster vaccination

Monin, Malte B; Baier, Leona; Berger, Moritz; Gorny, Jens Gabriel; Zhou, Taotao; Mahn, Robert; Sadeghlar, Farsaneh; Möhring, Christian; Bremen, Kathrin van; Boesecke, Christoph; Rockstroh, Jürgen K.; Strassburg, Christian P.; Eis‐Hübinger, A. M.; Gonzalez-Carmona, Maria Agnes

doi:10.1136/gutjnl-2022-328169

Cited by 4 publications

(4 citation statements)

References 10 publications

(26 reference statements)

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“…However, a recent study revealed that liver injury caused by COVID‐19 vaccines is much lower compared to acute liver injury caused by SARS‐CoV‐2 infection 4 . Furthermore, during the COVID‐19 pandemic, despite the higher number of reported cases following COVID‐19 vaccinations, previous studies have consistently shown that COVID‐19 vaccines are generally safe and effective, even in individuals with pre‐existing liver disease 18,19 . These findings underscore the importance of vaccination in protecting vulnerable populations from the potentially severe consequences of SARS‐CoV‐2 infection.…”

Section: Discussionmentioning

confidence: 99%

Global burden of vaccine‐associated hepatobiliary and gastrointestinal adverse drug reactions, 1967–2023: A comprehensive analysis of the international pharmacovigilance database

Lee,

Park

et al. 2024

Journal of Medical Virology

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Although previous studies have focused on hepatobiliary and gastrointestinal adverse drug reactions (ADRs) associated with COVID‐19 vaccines, literature on such ADRs with other vaccines is limited, particularly on a global scale. Therefore, we aimed to investigate the global burden of vaccine‐associated hepatobiliary and gastrointestinal ADRs and identify the vaccines implicated in these occurrences. This study utilized data from the World Health Organization (WHO) international pharmacovigilance database to extract reports of vaccine‐associated hepatobiliary and gastrointestinal ADRs from 1967 to 2023 (total reports = 131 255 418). Through global reporting counts, reported odds ratios (ROR) with 95% confidence interval (CI), and information components (IC) with IC0.25, the study examined the association between 16 vaccines and the incidence of hepatobiliary and gastrointestinal ADRs across 156 countries. Of the 6 842 303 reports in the vaccine‐associated ADRs, 10 786 reports of liver injury, 927 870 reports of gastrointestinal symptoms, 2978 reports of pancreas and bile duct injury, and 96 reports of intra‐abdominal hemorrhage between 1967 and 2023 were identified. Most hepatobiliary and gastrointestinal ADRs surged after 2020, with the majority of reports attributed to COVID‐19 messenger RNA (mRNA) vaccines. Hepatitis A vaccines exhibited the highest association with liver injury (ROR [95% CI]: 10.30 [9.65–10.99]; IC [IC0.25]: 3.33 [3.22]), followed by hepatitis B, typhoid, and rotavirus. Specifically, ischemic hepatitis had a significant association with both Ad5‐vectored and mRNA COVID‐19 vaccines. Gastrointestinal symptoms were associated with all vaccines except for tuberculosis vaccines, particularly with rotavirus (11.62 [11.45–11.80]; 3.05 [3.03]) and typhoid (11.02 [10.66–11.39]; 3.00 [2.96]). Pancreas and bile duct injury were associated with COVID‐19 mRNA (1.99 [1.89–2.09]; 0.90 [0.83]), MMR (measles, mumps, and rubella), and papillomavirus vaccines. For intra‐abdominal hemorrhage, inactivated whole‐virus COVID‐19 vaccines (3.93 [1.86–8.27]; 1.71 [0.41]) had the highest association, followed by COVID‐19 mRNA (1.81 [1.42–2.29]; 0.77 [0.39]). Most of these ADRs had a short time to onset, within 1 day, and low mortality rate. Through a global scale database, the majority of ADRs occurred within 1 day, emphasizing the importance of healthcare workers' vigilant monitoring and timely management.

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Section: Discussionmentioning

confidence: 99%

Global burden of vaccine‐associated hepatobiliary and gastrointestinal adverse drug reactions, 1967–2023: A comprehensive analysis of the international pharmacovigilance database

Lee,

Park

et al. 2024

Journal of Medical Virology

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“…In patients with solid cancer, NAB against omicron was detectable in 90% of patients after booster vaccination ( 45 ). Especially for patients with hepatobiliary carcinoma, booster vaccinations are thus already recommended ( 20 ). Of note, data on the effect of booster vaccination in patients with cancer are sparse for the time being.…”

Section: Discussionmentioning

confidence: 99%

“…However, most of the studies focused on patients with hematological cancer or included different types of solid cancer without differentiating between tumor types ( 10 - 19 ). For the time being, differentiated data on patients with gastrointestinal (GI) cancer are sparse ( 20 ). Antibody titers were compared to people in control groups without any history of cancer who were considerably healthier and younger.…”

Section: Introductionmentioning

confidence: 99%

Impaired immunogenicity after vaccination for SARS-CoV-2 in patients with gastrointestinal cancer: does tumor entity matter?

Monin,

Gorny,

Berger

et al. 2023

J Gastrointest Oncol

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Background SARS-CoV-2 immunogenicity in patients with gastrointestinal cancer (GI cancer) following second and third vaccination was analyzed. Methods A total of 125 patients under active anticancer therapy or in follow-up care were included in this prospective study. Seroprevalence of SARS-CoV-2 anti-spike and surrogate neutralization antibodies (NABs) was measured. Results Four weeks after second vaccination, adequate titers of SARS-CoV-2 anti-spike immunoglobulin G (IgG) [≥282.0 binding antibody units (BAU)/mL] were found in 62.2% of patients under treatment versus 96.3% of patients in follow-up care (P<0.01). Sufficient titers of SARS-CoV-2 surrogate NAB (≥85.0%) were found in 32.7% of patients under treatment versus 70.6% in follow-up care (P<0.01). Titers of SARS-CoV-2 anti-spike IgG were especially low in patients with colorectal cancer (CRC). For SARS-CoV-2 surrogate NAB, patients with hepatocellular carcinoma (HCC) and with pancreaticobiliary cancer showed the lowest titers (P<0.01). SARS-CoV-2 anti-spike IgG and SARS-CoV-2 surrogate NAB were associated with a correlation coefficient of 0.93. Reaching a titer of SARS-CoV-2 anti-spike IgG ≥482.0 BAU/mL, protective levels of SARS-CoV-2 surrogate NAB (≥85.0%) could be assumed. Following booster vaccination, all patients reached effective antibody titers. Conclusions Patients with active GI cancer showed impaired immunogenicity after second SARS-CoV-2 vaccination which was overcome by booster vaccination. Our findings were tumor-related and pronounced in patients with CRC and HCC. Waning immunity over time and antibody escape phenomena by variant of concern Omicron must be considered in these especially vulnerable patients.

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“…Although no significant differences between solid tumor types could be demonstrated to date [ 26 ], differentiated data for several tumor types are still missing. In our own preliminary analysis on efficacy of SARS-CoV-2 vaccinations in patients with GI cancer, we could identify patients with active HBC ( n = 39) as especially facing impaired immunogenicity compared to patients with other types of active GI cancer and to patients in follow-up care [ 27 ]. Separating HCC from CCC, there were no differences in antibody levels between the 2 groups of patients with HBC in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Deficient Immune Response following SARS-CoV-2 Vaccination in Patients with Hepatobiliary Carcinoma: A Forgotten, Vulnerable Group of Patients

Monin,

Baier,

Gorny

et al. 2023

Liver Cancer

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Introduction: Data on immune response rates following vaccination for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in patients with hepatobiliary carcinoma (HBC) are rare. However, impaired immunogenicity must be expected due to the combination of chronic liver diseases (CLDs) with malignancy and anticancer treatment. Methods: In this prospective, longitudinal study, 101 patients were included, of whom 59 were patients with HBC under anticancer treatment. A cohort of patients with a past medical history of gastrointestinal cancer, of whom 28.6% had HBC without detectable active tumor disease having been off therapy for at least 12 months, served as control. Levels of SARS-CoV-2 anti-spike IgG, surrogate neutralization antibodies (sNABs), and cellular immune responses were compared. In uni- and multivariable subgroup analyses, risk factors for impaired immunogenicity were regarded. Data on rates and clinical courses of SARS-CoV-2 infections were documented. Results: In patients with HBC under active treatment, levels of SARS-CoV-2 anti-spike IgG were significantly lower (2.55 log10 BAU/mL; 95% CI: 2.33–2.76; p < 0.01) than in patients in follow-up care (3.02 log10 BAU/mL; 95% CI: 2.80–3.25) 4 weeks after two vaccinations. Antibody levels decreased over time, and differences between the groups diminished. However, titers of SARS-CoV-2 sNAB were for a longer time significantly lower in patients with HBC under treatment (64.19%; 95% CI: 55.90–72.48; p < 0.01) than in patients in follow-up care (84.13%; 95% CI: 76.95–91.31). Underlying CLD and/or liver cirrhosis Child-Pugh A or B (less than 8 points) did not seem to further impair immunogenicity. Conversely, chemotherapy and additional immunosuppression were found to significantly reduce antibody levels. After a third booster vaccination for SARS-CoV-2, levels of total and neutralization antibodies were equalized between the groups. Moreover, cellular response rates were balanced. Clinically, infection rates with SARS-CoV-2 were low, and no severe courses were observed. Conclusion: Patients with active HBC showed significantly impaired immune response rates to basic vaccinations for SARS-CoV-2, especially under chemotherapy, independent of underlying cirrhotic or non-cirrhotic CLD. Although booster vaccinations balanced differences, waning immunity was observed over time and should be monitored for further recommendations. Our data help clinicians decide on individual additional booster vaccinations and/or passive immunization or antiviral treatment in patients with HBC getting infected with SARS-CoV-2.

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SARS-CoV-2 vaccination in patients with GI and hepatobiliary carcinoma: a call for booster vaccination

Cited by 4 publications

References 10 publications

Global burden of vaccine‐associated hepatobiliary and gastrointestinal adverse drug reactions, 1967–2023: A comprehensive analysis of the international pharmacovigilance database

Global burden of vaccine‐associated hepatobiliary and gastrointestinal adverse drug reactions, 1967–2023: A comprehensive analysis of the international pharmacovigilance database

Impaired immunogenicity after vaccination for SARS-CoV-2 in patients with gastrointestinal cancer: does tumor entity matter?

Deficient Immune Response following SARS-CoV-2 Vaccination in Patients with Hepatobiliary Carcinoma: A Forgotten, Vulnerable Group of Patients

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