The first study evaluating the clinical characteristics and outcomes of fully vaccinated cancer patients who had peak COVID-19 infections indicates they remained at high risk of hospitalization and death.
The study, published on December 24 in Annals of Oncology showed that fully vaccinated patients who experienced relapse infections had a 65% hospitalization rate, an intensive care ventilation or mechanical ventilation rate of 19%, and a death rate of 13%. The study was conducted by the COVID-19 and Cancer Consortium (CCC19), a group of 129 research centers that has been tracking the impact of COVID-19 on cancer patients since the start of the pandemic.
âCancer patients who develop breakthrough COVID-19 even after a full vaccination can still experience serious results, including death,â said Toni Choueiri, MD, director of the Lank Center for Genitourinary Care in Dana- Farber Cancer Institute and lead author on the report. âThis is why a multi-level approach that includes masking and social distancing, as well as vaccination and a booster against COVID-19 remains an essential approach for the foreseeable future. “
Patients were considered fully immunized after receiving two doses of the BioNTech, Pfizer, or Moderna vaccine, NIAD vaccine, or one dose of the J&J vaccine, with the last dose of vaccine long enough before the COVID-19 breakthrough, to be considered fully vaccinated. The data was collected between November 1, 2020 and May 31, 2021, before booster vaccines were recommended for cancer patients by the United States Centers for Disease Control and Prevention.
âBecause measures of immunity are not routinely collected in clinical care, we do not know if these were patients who developed effective immune responses after vaccination; a lot of emerging data suggests that cancer patients, especially blood cancer patients, do not develop adequate protective antibody responses. It’s important to note that many of the same factors we identified before the vaccine became available – age, co-morbidities, performance status, and cancer progression – still appear to be behind many. poor results, âsaid Jeremy Warner, MD, director of the CCC19 Research Coordinating Center, associate professor at the Vanderbilt-Ingram Cancer Center and lead author of the study.
The consortium identified 1,787 cancer and COVID-19 patients for the study, the vast majority of whom were unvaccinated. The number of fully vaccinated was 54, and 46% of those fully vaccinated had reduced levels of lymphocytes – the T cells and B cells responsible for immunological responses to viruses. Lymphopenia usually occurs in cancer patients receiving anti-CD20 monoclonal antibodies or CAR-T cell treatments for blood malignancies, including lymphoma and leukemia. The study appears to corroborate previous observations that patients with hematologic malignancies are at greater risk of severe outbreaks of COVID-19. However, the number of patients in the study is too small to draw firm conclusions about specific types of cancer therapies that could be associated with breakthrough infections, the researchers noted. Patients on corticosteroid therapy also seemed more likely to be hospitalized.
âSimilar results (high mortality rates among fully vaccinated individuals) have been reported in other populations of immunocompromised patients, such as organ transplant recipients, before the use of additional vaccine doses. The findings come at a time of fears that immune escape mutants such as the omicron strain may emerge from chronically infected patients with weakened immune systems. Thus, the immunocompromised and their close contacts should be target groups for therapeutic and preventive interventions, including outreach and education efforts at the community level, âsaid Dimitrios Farmakiotis, MD, clinician specializing in infectious diseases at the Warren Alpert Medical School at Brown University and Senior Executive. author of the study.
The lead authors of the study are Andrew Schmidt, MD; Chris Labaki, MD; Ziad Bakouny, MD, all from Dana-Farber Cancer Institute; and Chih-Yuan Hsu, PhD, of Vanderbilt-University Medical Center. The lead authors are Choueiri from Harvard, Farmakiotis from Brown University and Warner and Yu Shyr, PhD, from Vanderbilt University Medical Center. Other contributors include Nino Balanchivadze, MD; StÃ©phanie Berg, DO; Sibel Blau, MD; Ahmad Daher, MD, Ph.D.; Talal El Zarif, MD; Christopher Riese, PhD, IA; Elizabeth Griffiths, MD; Jessica Hawley, MD; Brandon Hayes-Lattin, MD; Vidhya Karivedu, MBBS; Tahir Latif, MBBS, MBA; Blanche Mavromatis, MD; Rana McKay; MARYLAND; Ryan Nguyen, DO; Orestis Panagiotou, MD, PhD; Andrew Portuguese, MD; Matthew Puc, MD; Miriam Santos Dutra, Ph.D.; Brett Schroeder, MD; Astha Thakkar, MD; Elizabeth Wulff-Burchfield, MD, and Sanjay Mishra, PhD.