Response to COVID-19 vaccination in patients on cancer therapy: Analysis in a SARS-CoV-2-naïve population

George Cavic; Andrew A Almonte; Sarah M Hicks; Teresa Neeman; Jo-Wai Wang; Sue Brew; Philip Y Choi; Ian Cockburn; Elizabeth E Gardiner; Desmond Yip; Aude M Fahrer; Yada Kanjanapan

doi:10.1111/ajco.14047

Response to COVID-19 vaccination in patients on cancer therapy: Analysis in a SARS-CoV-2-naïve population

Asia Pac J Clin Oncol. 2024 Jan 14. doi: 10.1111/ajco.14047. Online ahead of print.

Authors

George Cavic¹, Andrew A Almonte¹, Sarah M Hicks², Teresa Neeman³, Jo-Wai Wang¹, Sue Brew⁴, Philip Y Choi^{2

5}, Ian Cockburn², Elizabeth E Gardiner², Desmond Yip^{5

6

7}, Aude M Fahrer^{1

8}, Yada Kanjanapan^{5

6}

Affiliations

¹ Research School of Biology, Australian National University, Canberra, Australia.
² John Curtin School of Medical Research, Australian National University, Canberra, Australia.
³ Biological Data Science Institute, Australian National University, Canberra, Australia.
⁴ Medical Oncology Clinical Trials Unit, The Canberra Hospital, Canberra, Australia.
⁵ Department of Medical Oncology, The Canberra Hospital, Canberra, Australia.
⁶ ANU Medical School, Australian National University, Canberra, Australia.
⁷ Department of Haematology, The Canberra Hospital, Canberra, Australia.
⁸ Faculty of Science and Technology, University of Canberra, Canberra, Australia.

PMID: 38221764
DOI: 10.1111/ajco.14047

Abstract

Background: Cancer patients have increased morbidity and mortality from COVID-19, but may respond poorly to vaccination. The Evaluation of COVID-19 Vaccination Efficacy and Rare Events in Solid Tumors (EVEREST) study, comparing seropositivity between cancer patients and healthy controls in a low SARS-CoV-2 community-transmission setting, allows determination of vaccine response with minimal interference from infection.

Methods: Solid tumor patients from The Canberra Hospital, Canberra, Australia, and healthy controls who received COVID-19 vaccination between March 2021 and January 2022 were included. Blood samples were collected at baseline, pre-second vaccine dose and at 1, 3 (primary endpoint), and 6 months post-second dose. SARS-CoV-2 anti-spike-RBD (S-RBD) and anti-nucleocapsid IgG antibodies were measured.

Results: Ninety-six solid tumor patients and 20 healthy controls were enrolled, with median age 62 years, and 60% were female. Participants received either AZD1222 (65%) or BNT162b2 (35%) COVID-19 vaccines. Seropositivity 3 months post vaccination was 87% (76/87) in patients and 100% (20/20) in controls (p = .12). Seropositivity was observed in 84% of patients on chemotherapy, 80% on immunotherapy, and 96% on targeted therapy (differences not satistically significant). Seropositivity in cancer patients increased from 40% (6/15) after first dose, to 95% (35/37) 1 month after second dose, then dropped to 87% (76/87) 3 months after second dose.

Conclusion: Most patients and all controls became seropositive after two vaccine doses. Antibody concentrations and seropositivity showed a decrease between 1 and 3 months post vaccination, highlighting need for booster vaccinations. SARS-CoV-2 infection amplifies S-RBD antibody responses; however, cannot be adequately identified using nucleocapsid serology. This underlines the value of our COVID-naïve population in studying vaccine immunogenicity.

Keywords: COVID-19 vaccine; SARS-CoV-2; seroconversion; serology; solid tumor.

Abstract

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