Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position article

Abstract

Taking into account higher risk of severe coronavirus disease 2019 or death among patients with cancer, as well as impaired immunogenicity after anti-SARS-CoV-2 vaccines, in addition to waning immunity, booster dosing appears mandatory in this patient population. This review sought to provide reasonable evidence so as to assist oncologists in their daily practice, helping them decide when an anti-SARS-Cov2 antibody (Ab) dosage should be scheduled after a full two-dose vaccination and, if necessary, propose an early third dose (D3). Such D3 could apply to non-responder patients with anti-Spike (S) Abs titres <40 binding Ab unit (BAU)/mL. For lowresponder patients with anti-S Ab titres between 40 BAU/mL and 100/260 BAU/mL (suggested area of uncertainty), an early D3 may similarly be proposed. Nevertheless, this D3 could be administered in a less urgent manner, taking into account associated comorbidities and regional epidemic incidence rates. This latter strategy may comprise a monthly dosage of anti-S titres so as to better assess the kinetics of waning immunity. For responder patients with anti-S titres above 260 BAU/mL, we suggest to follow the recommendations outlined for the general population. Given this context, patients with anti-S titres above 1000 BAU/mL should be given the possibility to undergo anti-S titre control after three months, designed to assess rapid humoral waning immunity. We strongly recommend that patients with cancer be included into observational serological monitoring studies or clinical trials that are dedicated to severe immunocompromised patients without any humoral seroconversion after D3.

Keywords: Anti-Spike antibodies; Booster dose; COVID-19; Cancer; Humoral response; Monitoring; SARS-CoV-2; Third dose; Vaccination; Vaccine.

Fig. 1

Schematic comparative humoral responses in oncology at week 6–8 after BNT162b2 anti-SARS-CoV-2 full vaccination. Range of responses as per anti-S Ab titre converted into binding antibody unit (BAU)/mL (Schematic representation without reporting individual data). Adapted from Barrière et al. (1 => ref 7); Addeo et al. (2 => ref 29); Palich et al. (3 => ref 27); Gounant et al. (4 => ref 35). AU, arbitrary unit; Abs, antibodies; D3, third vaccine dose; BAU/mL = AU/mL ELECSYS ROCHE x 0.972$\left(\approx 1\right)$, BAU/mL = AU/mL ABBOTT x 0.142, Plain black lines indicate median values.

Fig. 2

Authors' recommendations for anti-S Ab monitoring in patients with cancer and for timing of D3 booster dose. D3, third vaccine dose.