Adequate response to SARS-CoV-2 vaccine in cancer patients

Results from both the VOICE and CAPTURE study showed that cancer patients in general have an adequate response to SARS-CoV-2 infection and/or SARS-CoV-2 vaccination.

Patients with cancer have an increased risk of complications from SARS-CoV-2 infection [1]. Vaccination is recommended, but the impact of chemotherapy and immunotherapy on immunogenicity and safety is still unclear [2]. The prospective, multicentre, non-inferiority VOICE trial (NCT04715438) aimed to assess the impact of immunotherapy, chemotherapy, and chemo-immunotherapy on immunogenicity and safety of SARS-CoV-2 vaccination in patients treated for a solid tumour [3].

VOICE compared 4 cohorts: individuals without cancer (A) and patients with solid tumours who were treated with immunotherapy (B), chemotherapy (C), or chemo-immunotherapy (D). Participants received 2 mRNA-1273 vaccinations 28 days apart. The primary endpoint was SARS-CoV-2 Spike S1-specific IgG serum antibody response, defined as >10 binding antibody units (BAU)/mL, 28 days after the second vaccination. An adequate response was defined as a cut-off level of 300 BAU/mL based on the neutralising capacity of vaccine-induced antibodies. First results were presented by Dr Sjoukje Oosting (University Medical Center Groningen, The Netherlands).

In total, 743 of 791 enrolled participants were antibody-negative at baseline, received 2 mRNA-1273 vaccinations 28 days apart, and completed assessments on day 28 after the second vaccination (per protocol population). The primary endpoint was achieved in 100%, 99.3%, 97.4%, and 100% of the participants in cohorts A, B, C, and D. The antibody response was considered adequate after the second vaccination in respectively 99.6%, 93.1%, 83.8%, and 88.8% in cohorts A, B, C, and D. Moreover, spike-specific T cell responses were detected in 46.7% of suboptimal and non-responders. No new safety signals were observed.

“These data show that vaccination with mRNA-1273 is safe in patients receiving immunotherapy, chemotherapy, or chemo-immunotherapy for a solid tumour,” concluded Dr Oosting. “Seroconversion rate is very high after 2 vaccinations and non-inferior to controls. However, a significant minority of patients does not develop an adequate antibody response. An additional booster may turn inadequate into adequate responders. In addition, longer follow-up will indicate if there is a difference in the duration of immune response between patients and controls.”

In line with these results, results from CAPTURE (NCT03226886), presented by Dr Scott Shepherd (Royal Marsden NHS Foundation Trust, UK) [4], showed that infection with SARS-CoV-2 induces durable immune responses in cancer patients. However, haematological malignancy patients had impaired immune responses that were disease and treatment-specific (anti-CD20), but with evidence suggestive of compensation from T cells. In addition, neutralising responses to Beta and Delta variants are reduced when compared with wildtype SARS-CoV-2. CAPTURE also showed a diminished serological response to vaccination in patients with haematological malignancies, in particular a diminished serological response to Delta variant. However, prior SARS-CoV-2 infection booster vaccines induced responses. “These results lend support to prioritisation of all cancer patients for further booster vaccination,” concluded Dr Shepherd.

1. Venkatesulu BP, et al. JNCI Cancer Spectr. 2021; 5(2):pkaa102.
2. Garassino MC, et al. Ann Oncol. 2021;32:579–581.
3. Oosting S, et al. Vaccination against SARS-CoV-2 in patients receiving chemotherapy, immunotherapy, or chemo-immunotherapy for solid tumors. Abstract LBA8, ESMO Congress 2021, 16–21 September.
4. Shepherd STC, et al. Adaptive immunity to SARS-CoV-2 infection and vaccination in cancer patients: The CAPTURE Study. Abstract 1557O, ESMO Congress 2021, 16–21 September.

 

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Posted on 19 November 2021