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. 2023 Feb 1;9(2):188-196.
doi: 10.1001/jamaoncol.2022.5974.

Association of SARS-CoV-2 Spike Protein Antibody Vaccine Response With Infection Severity in Patients With Cancer: A National COVID Cancer Cross-sectional Evaluation

Lennard Y W Lee  1   2 , Michael Tilby  3 , Thomas Starkey  2 , Maria C Ionescu  4 , Alex Burnett  5 , Rosie Hattersley  6 , Sam Khan  7 , Martin Little  8 , Justin K H Liu  9 , James R Platt  10 , Arvind Tripathy  11 , Isabella Watts  12 , Sophie Therese Williams  13 , Nathan Appanna  14 , Youssra Al-Hajji  15 , Matthew Barnard  4 , Liza Benny  4 , Andrew Buckley  4 , Emma Cattell  16 , Vinton Cheng  9 , James Clark  17 , Leonie Eastlake  18 , Kate Gerrand  4 , Qamar Ghafoor  3 , Simon Grumett  3 , Catherine Harper-Wynne  19 , Rachel Kahn  20 , Alvin J X Lee  21 , Anna Lydon  22 , Hayley McKenzie  23 , Hari Panneerselvam  24 , Jennifer Pascoe  3 , Grisma Patel  25 , Vijay Patel  16 , Vanessa Potter  26 , Amelia Randle  27 , Anne S Rigg  28 , Tim Robinson  29 , Rebecca Roylance  30 , Tom Roques  31 , Stefan Rozmanowski  4 , René L Roux  8 , Ketan Shah  8 , Martin Sintler  32 , Harriet Taylor  33 , Tania Tillett  34 , Mark Tuthill  8 , Sarah Williams  3 , Andrew Beggs  2 , Tim Iveson  35 , Siow Ming Lee  36 , Gary Middleton  37 , Mark Middleton  1 , Andrew S Protheroe  38 , Matthew W Fittall  39 , Tom Fowler  40 , Peter Johnson  41 ; UK COVID Cancer Programme
Collaborators, Affiliations

Association of SARS-CoV-2 Spike Protein Antibody Vaccine Response With Infection Severity in Patients With Cancer: A National COVID Cancer Cross-sectional Evaluation

Lennard Y W Lee et al. JAMA Oncol. .

Abstract

Importance: Accurate identification of patient groups with the lowest level of protection following COVID-19 vaccination is important to better target resources and interventions for the most vulnerable populations. It is not known whether SARS-CoV-2 antibody testing has clinical utility for high-risk groups, such as people with cancer.

Objective: To evaluate whether spike protein antibody vaccine response (COV-S) following COVID-19 vaccination is associated with the risk of SARS-CoV-2 breakthrough infection or hospitalization among patients with cancer.

Design, setting, and participants: This was a population-based cross-sectional study of patients with cancer from the UK as part of the National COVID Cancer Antibody Survey. Adults with a known or reported cancer diagnosis who had completed their primary SARS-CoV-2 vaccination schedule were included. This analysis ran from September 1, 2021, to March 4, 2022, a period covering the expansion of the UK's third-dose vaccination booster program.

Interventions: Anti-SARS-CoV-2 COV-S antibody test (Elecsys; Roche).

Main outcomes and measures: Odds of SARS-CoV-2 breakthrough infection and COVID-19 hospitalization.

Results: The evaluation comprised 4249 antibody test results from 3555 patients with cancer and 294 230 test results from 225 272 individuals in the noncancer population. The overall cohort of 228 827 individuals (patients with cancer and the noncancer population) comprised 298 479 antibody tests. The median age of the cohort was in the age band of 40 and 49 years and included 182 741 test results (61.22%) from women and 115 737 (38.78%) from men. There were 279 721 tests (93.72%) taken by individuals identifying as White or White British. Patients with cancer were more likely to have undetectable anti-S antibody responses than the general population (199 of 4249 test results [4.68%] vs 376 of 294 230 [0.13%]; P < .001). Patients with leukemia or lymphoma had the lowest antibody titers. In the cancer cohort, following multivariable correction, patients who had an undetectable antibody response were at much greater risk for SARS-CoV-2 breakthrough infection (odds ratio [OR], 3.05; 95% CI, 1.96-4.72; P < .001) and SARS-CoV-2-related hospitalization (OR, 6.48; 95% CI, 3.31-12.67; P < .001) than individuals who had a positive antibody response.

Conclusions and relevance: The findings of this cross-sectional study suggest that COV-S antibody testing allows the identification of patients with cancer who have the lowest level of antibody-derived protection from COVID-19. This study supports larger evaluations of SARS-CoV-2 antibody testing. Prevention of SARS-CoV-2 transmission to patients with cancer should be prioritized to minimize impact on cancer treatments and maximize quality of life for individuals with cancer during the ongoing pandemic.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Little reported receiving personal fees from Pfizer educational presentation outside the submitted work. Dr Clark reported receiving personal fees from Novartis and Pfizer outside the submitted work. Dr Grumett reported receiving personal fees from Merck, BMS, Pfizer, Eisai, and Eusa outside the submitted work. Dr Harper-Wynne reported receiving honoraria from Pfizer, Roche, Seagen, Gilead, and Novartis outside the submitted work. Dr Lydon reported receiving support from Bayer Financial to attend an international oncology meeting outside the submitted work. Dr Robinson reported receiving a grant from Daiichi Sankyo to attend an educational workshop outside the submitted work. Dr Roylance reported receiving consulting fees for congress support from Lilly and Daiichi/AZ, personal fees for advisory board attendance from GI Therapeutics, consulting fees from Iqvia, personal fees for advisory board attendance from Pfizer, and personal fees for congress support from BMS and Roche outside the submitted work. Dr G. Middleton reported receiving grants from BMS and AZ, consulting fees for speaking and serving on the advisory board from Roche, Servier, and Pfizer outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Median SARS-CoV-2 Antibody Titers and Responses in Patients With Cancer Based on Cancer Subtype
Blue dots represent spike protein antibody vaccine response (COV-S) titers. Blue error bars denote IQR; black error bars, 95% CI. ICD-10 indicates International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.
Figure 2.
Figure 2.. Median Antibody Titers and Percentage of Positive Spike Protein Antibody Vaccine Response (COV-S) in Patients With Cancer Who Experienced Breakthrough Infections and Hospitalizations
Bars represent percentage of positive COV-S responses. Blue dots represent median antibody titers. Blue error bars denote IQR; black error bars, 95% CI.
Figure 3.
Figure 3.. Association Between Antibody Titer and Risk of SARS-CoV-2 Breakthrough Infection and Hospitalization
Graphs show the association between antibody titer and risk of SARS-CoV-2 breakthrough infection (A) and hospitalization (B). Gray area represents 95% CI. The blue vertical line is the cutoff at 5000 U/mL, at which odds ratios (ORs) were performed.
Figure 4.
Figure 4.. Association Between Median Antibody Titer and Breakthrough Infections and Hospitalization by Cancer Subtype
Graphs show rates of breakthrough infections (A) and hospitalization (B) by cancer subtype in association with median antibody titer. In both graphs, the diagonal dotted lines are trend lines to visualize the association between median spike protein antibody vaccine response (COV-S) antibody titer and the outcome rate percentage (infection [A] or hospitalization [B]). These trend lines were calculated from the cancer subtypes (solid circles) for each graph.
See this image and copyright information in PMC

Comment in

References

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