Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients

Lee, Matilda Xinwei; Peng, Siyu; Lee, Ainsley Ryan Yan Bin; Wong, Shi Yin; Tay, Ryan Yong Kiat; Li, Jiaqi; Tariq, Areeba; Goh, Claire; Tan, Yap‐Peng; Tan, Benjamin Kye Jyn; Teo, Chung‐Piaw; Chan, Esther Wai Yin; Ooi, Melissa; Chng, Wee Joo; Chee, Cheng Ean; Ho, Carol LF; Walsh, Robert J.; Wong, Maggie; Su, Yan Kuin; Lezhava, Alexander; Sethi, Sunil; Tan, Shaun; Chan, Yiong Huak; Tan, Kelvin Bryan; Lee, Soo‐Chin; Chai, Louis Yi Ann; Sundar, Raghav

doi:10.47102/annals-acadmedsg.2022302

Cited by 4 publications

(4 citation statements)

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“…However, this overall low COVID-19 infection in the study population could also be due to the fact that, in September 2021, 76.6% of the Singapore population had completed 2 doses of vaccination. 4 At the same time, MOH announced that a third vaccination dose was offered to immunocompromised patients. 4 Additionally, risk mitigation measures were in place with mandatory mask-wearing, and this would also have contributed to a lower risk of COVID-19 infection in cancer patients, as well as in the Singapore population as a whole.…”

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Early COVID-19 booster is beneficial in cancer patients

Samol

2023

Ann Acad Med Singap

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 2019 1 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare s y s t e m s a r o u n d t h e w o r l d , a n d r e n d e r e d immunocompromised patients, such as those with cancer, particularly vulnerable to severe infections.Also unprecedented was the rapid development of several highly effective vaccines, thanks to concerted global efforts. Once COVID-19 vaccinations were available, the Ministry of Health (MOH) in Singapore implemented a nationwide SARS-CoV-2 vaccination programme for healthcare staff in early January 2021, started a pilot for vaccinations for senior citizens in late January 2021, and progressively made the COVID-19 vaccine freely available for all Singaporeans and permanent residents. In line with emerging data thereafter, MOH offered a booster to immunocompromised patients as early as 2 months after the second dose. Currently, as of 7 November 2022, MOH encourages all eligible residents aged 18 years and above 2 to undergo a second COVID-19 booster or a fourth vaccination dose.Other regulatory healthcare institutions recommended administering a COVID-19 booster within 3-6 months of the completion of the initial mRNA vaccination course and the Committee for Medicinal Products for Human Use approved an extra dose of the COVID-19 mRNA vaccines at least 28 days after the second dose. 3 Against this background, the study by Lee et al. is timely. In their large, prospective observational study, the authors 4 presented real-world efficacy data in haematological (40/273) and solid cancer (233/273) patients in Singapore who received 2 doses of an mRNA vaccine, either BNT162b2 or mRNA1273, followed by a 3rd dose of BNT162b2 against SARS-CoV-2 during the COVID-19 pandemic. In total, 273 patients were recruited between July 2021 and March

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confidence: 99%

“…4 At the same time, MOH announced that a third vaccination dose was offered to immunocompromised patients. 4 Additionally, risk mitigation measures were in place with mandatory mask-wearing, and this would also have contributed to a lower risk of COVID-19 infection in cancer patients, as well as in the Singapore population as a whole.…”

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confidence: 99%

Early COVID-19 booster is beneficial in cancer patients

Samol

2023

Ann Acad Med Singap

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“…It should be noted that cancer patients may have a lower immune response to vaccines, attributed to the discordant antibody and cellular responses due to the cancer itself or immunosuppressive therapies [ 3 , 4 , 19 , 23 , 24 ].In addition, it was determined that the SARS-CoV-2 antibody response decreased 3to 5months after the second vaccine dose and a stronger serological response emerged after the third dose of the vaccine in cancer patients. It has beenemphasized that more SARS-CoV-2 vaccine doses are strongly associated with a decrease in the severity of infection in this patient population [ 5 , 25 – 27 ]. Previously, the Centers for Disease Control and Prevention (CDC) recommended a 3-dose primary mRNA vaccine series and accelerated booster dose in immunocompromised patients 8 .…”

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confidence: 99%

“…especially in thosewith hematological malignancies and hematopoietic cell transplantation recipients (HCT) [ 3 , 4 ]. This has led to the recommendation of bivalent/polyvalent vaccines and a higher number of primary and booster doses, especially in cancer patients compared to the normal population [ 5 , 6 ] 5 . In Türkiye, vaccination against SARS-CoV-2 began on January 14th, 2021, with the CoronaVac vaccine (inactivatedvero cell vaccine) as a decision bythe Turkish Ministry of Health and the BNT162b2 (Pfizer-BioNTech, mRNA) vaccine has been available since April 2021 6 .…”

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confidence: 99%

COVID-19 in cancer patients: patient characteristics and outcomes in the post-COVID-19 vaccination period

İSKENDER,

MERT,

TOROS

et al. 2023

Turkish Journal of Medical Sciences

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Background/aim It wasaimed herein to investigate coronavirus disease (COVID-19) in cancer patients and compare hematological and solid organ cancer patients in terms of the course and outcome of this disease. Materials and methods Data from cancer patients with laboratory-confirmed COVID-19 infection were analyzed retrospectively. Risk factors for poor prognosis and the effect of vaccination on the clinical outcomes of the patients were evaluated. Results A total of 403 cancer patients who were diagnosed with COVID-19 between March 1st, 2021, and November 30th, 2022, were included, of whom 329 (81.6%) had solid and 74 (18.4%) had hematological cancers. Hospitalization and intensive care unit (ICU) admission rates were significantly higher in the hematological cancer patients compared to the solid organ cancer patients (73.0% vs. 35.9%, p< 0.001 and 25.7% vs. 14.0%, p= 0.013, respectively). The COVID-19 - related case fatality rate (CFR) was defined as 15.4%, and it was higher in the hematologicalcancer patientsthan inthe solid organ cancer patients (23.0% vs. 13.7%, p= 0.045) and was higher in patients with metastatic/advanced disease compared to the other cancer stages (p< 0.001). In the solid organ cancergroup, hospitalization, ICU admission, and the COVID-19 CFR were higher in patients with respiratory and genitourinary cancers (p< 0.001). A total of 288 (71.8%) patients had receivedCOVID-19 vaccination; 164 (56.94%) had≤2 doses and 124 (43.06%) had≥3 doses. The hospitalization rate was higher in patients with ≤2 doses of vaccine compared to those with ≥3 doses (48.2% vs. 29.8%,p= 0.002). Patients with COVID-19 - related death had higher levels of leucocyte, neutrophil, D-dimer, troponin, C-reactive protein (CRP), procalcitonin, and ferritin and lower levels of lymphocyte than the survivors. In the logistic regression analysis,the risk of COVID-19 - related mortality was higher in the hematological cancer patients(OR:1.726), those who were male (OR:1.757), and with the Pre-Delta/Delta variants (OR:1.817). Conclusion This study revealed that there is an increased risk of COVID-19-related serious events (hospitalization, ICU admission, or death) in patients with hematological cancerscompared with those who have solid organ cancers. It wasalso shown that receiving ≥3 doses of COVID-19 vaccine is more protective against severe illness and the need for hospitalization than ≤2 doses.

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