Impact of chemotherapy and/or immunotherapy on neutralizing antibody response to SARS-CoV-2 mRNA-1237 vaccine in patients with solid tumors

Abstract

Patients with solid tumors have been a risk group since the beginning of the SARS-CoV-2 pandemic due to more significant complications, hospitalizations or deaths. The immunosuppressive state of cancer treatments or the tumor itself could influence the development of post-vaccination antibodies. This study prospectively analyzed 89 patients under chemotherapy and/or immunotherapy, who received two doses of the mRNA-1237 vaccine, and were compared with a group of 26 non-cancer individuals. Information on adverse events and neutralizing antibodies against the ancestral strain of SARS-CoV-2 (WH1) have been analyzed. Local reactions accounted for 65%, while systemic reactions accounted for 46% of oncologic individuals/cancer patients. Regarding the response to vaccination, 6.7% of cancer patients developed low neutralizing antibody levels. Lower levels of neutralizing antibodies between cancer and non-cancer groups were significant in individuals without previous SARS-CoV-2 infection, but not in previously infected individuals. We also observed that patients receiving chemotherapy or chemoimmunotherapy have significantly lower levels of neutralizing antibodies than non-cancer individuals. In conclusion, our study confirms the importance of prioritizing cancer patients receiving anticancer treatment in SARS-CoV-2 vaccination programs.

Keywords: COVID-19; adverse reactions; anticancer therapy; cancer; moderna vaccine; neutralizing antibodies.

Fig. 1

Side effects related to mRNA‐1237 vaccine in solid tumor cohort receiving active cancer treatment (n = 89). Column bar graphs show the frequency of (A) total local reactions (65%) and main different local reactions, and (B) total systemic reactions (46%) and main different systemic reactions.

Fig. 2

Neutralizing activity against WH1. Neutralization titers from participants' plasmas at different time points. Boxes show the median and the interquartile range (25^th and 75^th percentiles) and whiskers the 10^th and 90^th percentiles. P values correspond to Peto–Peto rank test with Benjamini & Hochberg adjustment. Below is indicated the previous SARS‐CoV‐2 infection status before vaccination. GMT, Geometric mean titer. Uninfected cancer patients n = 67; infected cancer patients n = 22; uninfected controls n = 15; infected controls n = 11.

Fig. 3

Neutralization titer regarding cancer treatment. Boxes show the median and the interquartile range (25^th and 75^th percentiles) and whiskers the 10^th and 90^th percentiles. P values correspond to Peto–Peto rank test with Benjamini & Hochberg adjustment. ChT, Chemotherapy; ChTIT, Chemoimmunotherapy; IT, Immunotherapy.