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. 2021 Aug 1;7(8):1141-1148.
doi: 10.1001/jamaoncol.2021.2159.

Difference in SARS-CoV-2 Antibody Status Between Patients With Cancer and Health Care Workers During the COVID-19 Pandemic in Japan

Shu Yazaki  1   2 , Tatsuya Yoshida  1   3 , Yuki Kojima  2   4 , Shigehiro Yagishita  4 , Hiroko Nakahama  5 , Keiji Okinaka  6 , Hiromichi Matsushita  7 , Mika Shiotsuka  8 , Osamu Kobayashi  8 , Satoshi Iwata  8 , Yoshitaka Narita  9 , Akihiro Ohba  10 , Masamichi Takahashi  9 , Satoru Iwasa  1   11 , Kenya Kobayashi  12 , Yuichiro Ohe  3 , Tomokazu Yoshida  13 , Akinobu Hamada  4 , Toshihiko Doi  14 , Noboru Yamamoto  1
Affiliations

Difference in SARS-CoV-2 Antibody Status Between Patients With Cancer and Health Care Workers During the COVID-19 Pandemic in Japan

Shu Yazaki et al. JAMA Oncol. .

Abstract

Importance: Patients with cancer and health care workers (HCWs) are at high risk of SARS-CoV-2 infection. Assessing the antibody status of patients with cancer and HCWs can help understand the spread of COVID-19 in cancer care.

Objective: To evaluate serum SARS-CoV-2 antibody status in patients with cancer and HCWs during the COVID-19 pandemic in Japan.

Design, setting, and participants: Participants were enrolled for this prospective cross-sectional study between August 3 and October 30, 2020, from 2 comprehensive cancer centers in the epidemic area around Tokyo, Japan. Patients with cancer aged 16 years or older and employees were enrolled. Participants with suspected COVID-19 infection at the time of enrollment were excluded.

Exposures: Cancer of any type and cancer treatment, including chemotherapy, surgery, immune checkpoint inhibitors, radiotherapy, and targeted molecular therapy.

Main outcomes and measures: Seroprevalence and antibody levels in patients with cancer and HCWs. Seropositivity was defined as positivity to nucleocapsid IgG (N-IgG) and/or spike IgG (S-IgG). Serum levels of SARS-CoV-2 IgM and IgG antibodies against the nucleocapsid and spike proteins were measured by chemiluminescent enzyme immunoassay.

Results: A total of 500 patients with cancer (median age, 62.5 years [range, 21-88 years]; 265 men [55.4%]) and 1190 HCWs (median age, 40 years [range, 20-70 years]; 382 men [25.4%]) were enrolled. In patients with cancer, 489 (97.8%) had solid tumors, and 355 (71.0%) had received anticancer treatment within 1 month. Among HCWs, 385 (32.3%) were nurses or assistant nurses, 266 (22.4%) were administrative officers, 197 (16.6%) were researchers, 179 (15.0%) were physicians, 113 (9.5%) were technicians, and 50 (4.2%) were pharmacists. The seroprevalence was 1.0% (95% CI, 0.33%-2.32%) in patients and 0.67% (95% CI, 0.29%-1.32%) in HCWs (P = .48). However, the N-IgG and S-IgG antibody levels were significantly lower in patients than in HCWs (N-IgG: β, -0.38; 95% CI, -0.55 to -0.21; P < .001; and S-IgG: β, -0.39; 95% CI, -0.54 to -0.23; P < .001). Additionally, among patients, N-IgG levels were significantly lower in those who received chemotherapy than in those who did not (median N-IgG levels, 0.1 [interquartile range (IQR), 0-0.3] vs 0.1 [IQR, 0-0.4], P = .04). In contrast, N-IgG and S-IgG levels were significantly higher in patients who received immune checkpoint inhibitors than in those who did not (median N-IgG levels: 0.2 [IQR, 0.1-0.5] vs 0.1 [IQR, 0-0.3], P = .02; S-IgG levels: 0.15 [IQR, 0-0.3] vs 0.1[IQR, 0-0.2], P = .02).

Conclusions and relevance: In this cross-sectional study of Japanese patients with cancer and HCWs, the seroprevalence of SARS-CoV-2 antibodies did not differ between the 2 groups; however, findings suggest that comorbid cancer and treatment with systemic therapy, including chemotherapy and immune checkpoint inhibitors, may influence the immune response to SARS-CoV-2.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Tatsuya Yoshida reported receiving grants and personal fees from AstraZeneca, grants and personal fees from Bristol Myers Squibb, AbbVie, Merck Sharp & Dohme, Ono Pharmaceutical, and Chugai; personal fees from Novartis, Taiho Pharmaceutical, Eli Lilly, Boehringer Ingelheim, Roche Diagnostics, and Archer; and grants from Takeda Pharmaceutical outside the submitted work. Dr Yagishita reported receiving grants from Boehringer Ingelheim outside the submitted work. Dr Matsushita reported receiving a research and development commission fee from Asahi Kasei Medical Co. outside the submitted work. Dr Narita reported receiving grants from Ono Pharmaceutical, Eisai, Sumitomo Dainippon, Taiho, and Daiichi Sankyo outside the submitted work. Dr Ohe reported receiving grants and personal fees from AstraZeneca, Bristol Myers Squibb, Chugai, Eli Lilly, Janssen, Kyorin, Nippon Kayaku, Novartis, Ono Pharmaceutical, Merck Sharp & Dohme, Pfizer, Taiho, and Takeda Pharmaceutical; grants from Amgen and Kissei; and personal fees from Boehringer Ingelheim and Celtrion outside the submitted work. Dr Hamada reported receiving grants from the Japan Health Research Promotion Bureau Research Fund and Sysmex Corporation during the conduct of the study. Dr Doi reported receiving grants from Lilly, Merck Sharp & Dohme, Merck Serono, Pfizer, IQVIA, and Eisai; personal fees from Merck Sharp & Dohme, Amgen, Takeda, Chugai, Bayer, Rakuten Medical, Ono Pharmaceutical, Astellas, Oncolys BioPharma, and Otsuka Pharma; and grants and personal fees from Daiichi Sankyo, Sumitomo Dainippon, Taiho, Novartis, Janssen, Boehringer Ingelheim, Bristol Myers Squibb, and AbbVie outside the submitted work. Dr Yamamoto reported receiving grants from Chugai, Taiho, Eisai, Eli Lilly, Astellas, Bristol Myers Squibb, Novartis, Daiichi Sankyo, Pfizer, Boehringer Ingelheim, Kyowa-Hakko Kirin, Bayer, Ono Pharmaceutical Co., Takeda, Janssen, Merck Sharp & Dohme, Merck, GlaxoSmithKline, Sumitomo Dainippon, Chiome Bioscience, Otsuka; personal fees from Ono Pharmaceutical, Chugai, AstraZeneca, Pfizer, Lilly, Bristol Myers Squibb, Daiichi Sankyo, Eisai, Otsuka, Takeda, Boehringer Ingelheim, and Cimic outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram
ITT indicates intention-to-treat; NCC, National Cancer Center; NCCE, National Cancer Center East; CNS, central nervous system.
Figure 2.
Figure 2.. SARS-CoV-2 Antibody Levels in Patients With Cancer (PWC) and Health Care Workers (HCWs)
Nucleocapsid IgG (N-IgG), spike IgG (S-IgG), nucleocapsid IgM (N-IgM), and spike IgM (S-IgM) antibody levels were compared between PWC and HCWs in the intention-to-treat population. The dots depict antibody levels. The boxes represents the first quartile, median, and third quartile; whiskers represent minimum and maximum values. ND indicates not detected.
Figure 3.
Figure 3.. Association Between Cancer Treatment and SARS-CoV-2 Antibody Levels in Patients With Cancer
A, Antibody levels in patients having received or not received chemotherapy; B, antibody levels in patients having received or not received immune checkpoint inhibitors. The dots depict the antibody levels. The boxes represents the first quartile, median, and third quartile; the whiskers represent minimum and maximum values. ICI indicates immune checkpoint inhibitor; CTx, chemotherapy; ND, not detected; N-IgG, nucleocapsid IgG; and S-IgG, spike IgG.
See this image and copyright information in PMC

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