Low booster uptake in cancer patients despite health benefits

Jane C Figueiredo^{1

2}, Julia Levy¹, So Yung Choi³, Alexander M Xu⁴, Noah M Merin⁵, Omid Hamid^{1

6}, Tucker Lemos⁵, Nathalie Nguyen¹, Maimoona Nadri¹, Alma Gonzalez¹, Simeon Mahov⁵, Justin M Darrah⁵, Jun Gong¹, Ronald L Paquette⁵, Alain C Mita¹, Robert A Vescio⁵, Sarah J Salvy⁷, Inderjit Mehmi⁶, Andrew E Hendifar¹, Ronald Natale¹, Warren G Tourtellotte^{8

9}, V Krishnan Ramanujan⁹, Carissa A Huynh⁹, Kimia Sobhani⁹, Karen L Reckamp¹, Akil A Merchant⁵

Affiliations

¹ Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
² Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
³ Biostatistics Shared Resource, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁴ Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁵ Division of Hematology and Cellular Therapy, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁶ The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, CA 90025, USA.
⁷ Research Center for Health Equity, Department of Biomedical Sciences, Los Angeles, CA 90048, USA.
⁸ Department of Neurology, Neurological Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁹ Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

PMID: 39286512
PMCID: PMC11404159
DOI: 10.1016/j.isci.2024.110596

Low booster uptake in cancer patients despite health benefits

Jane C Figueiredo et al. iScience. 2024.

. 2024 Jul 26;27(9):110596.

doi: 10.1016/j.isci.2024.110596. eCollection 2024 Sep 20.

Authors

Affiliations

¹ Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
² Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
³ Biostatistics Shared Resource, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁴ Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁵ Division of Hematology and Cellular Therapy, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁶ The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, CA 90025, USA.
⁷ Research Center for Health Equity, Department of Biomedical Sciences, Los Angeles, CA 90048, USA.
⁸ Department of Neurology, Neurological Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁹ Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

PMID: 39286512
PMCID: PMC11404159
DOI: 10.1016/j.isci.2024.110596

Abstract

Patients with cancer are at increased risk of death from COVID-19 and have reduced immune responses to SARS-CoV2 vaccines, necessitating regular boosters. We performed comprehensive chart reviews, surveys of patients attitudes, serology for SARS-CoV-2 antibodies and T cell receptor (TCR) β sequencing for cellular responses on a cohort of 982 cancer patients receiving active cancer therapy accrued between November-3-2020 and Mar-31-2023. We found that 92 · 3% of patients received the primer vaccine, 70 · 8% received one monovalent booster, but only 30 · 1% received a bivalent booster. Booster uptake was lower under age 50, and among African American or Hispanic patients. Nearly all patients seroconverted after 2+ booster vaccinations (>99%) and improved cellular responses, demonstrating that repeated boosters could overcome poor response to vaccination. Receipt of booster vaccinations was associated with a lower risk of all-cause mortality (HR = 0 · 61, p = 0 · 024). Booster uptake in high-risk cancer patients remains low and strategies to encourage booster uptake are needed.

Keywords: Cancer; Disease; Immunity; Patient social context.

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Conflict of interest statement

N.M. holds a consultant or advisory role at Amgen, Kite, Epizyme, TG Therapeutics, ADC Therapeutics, and has research funding from Miltenyi, Teva, and Amgen. J.G. holds a consultant or advisory role at EMD Serono; Elsevier; Exelixis; QED Therapeutics; Natera, Basilea, HalioDx, Eisai, Janssen. O.H. has obtained consulting fees/support meetings/travel/Financial interests in Alkermes, Amgen, Bactonix, Beigene, Bioatla, BMS, Esai, Roche, Genentech, Georgiamune, GigaGen, Grit Bio, GSK, Idera, Immunocore, Incyte, Instilbio, IO Bio, Iovance, Janssen, KSQ, Merck Moderna, Novartis, Obsidian, Pfizer, Regeneron, Sanofi, Seattle Genetics, Tempus, Vial, Zelluna. K.R. holds a consultant or advisory role at Amgen, AstraZeneca, Blueprint, Boehringer Ingelheim, Daiichi Sankyo, EMD Soreno, Genentech, GSK, Janssen, Lilly, Merck KGA, Mirati, Seattle Genetics, Takeda. J.D. holds a consultant or advisory role Kite Pharma and Morphosys. R.V. is on the Speaker’s Bureau for: Amgen, Bristol Myers Squib, Glaxo Smith Klein, Janssen, Karyopharm, and Takeda Pharmaceuticals. A.M. holds a consultant or advisory role at Novartis and Morphosys and has research funding from Amgen and Pfizer.

Figures

**Figure 1**
Dynamics of SARS-CoV-2 vaccine uptake after primer and booster vaccinations in patients with cancer (A) Plot showing number of patients with cancer who received the primer series (dark blue), 1^st booster (orange), 2^nd or more boosters (light blue) and bivalent booster (red) over time. (B) Plot showing cumulative number of patients with cancer who received the primer series (dark blue), 1^st booster (orange), 2^nd or more boosters (light blue) and bivalent booster (red) over time by age categories (<50, 50–59, 70+) (p-values for difference in vaccine uptake by age: <0.0001 (primer series), <0.0001 (1^st booster), <0.0001 (2^nd+ booster), <0.0001 (bivalent booster). (C) Plot showing cumulative number of patients with cancer who received the primer series (dark blue), 1^st booster (orange), 2^nd or more boosters (light blue) and bivalent booster (red) over time by self-reported race and ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic/Latino, Asian, Other) (p-value for difference in vaccine uptake by race and ethnicity: <0.0001 (primer series), <0.0001 (1^st booster), <0.0001 (2^nd+ booster), 0.0003 (bivalent booster).

**Figure 2**
Box and whisker plots showing peak IgG (S-RBD) antibody levels after primer (n = 404), post-monovalent booster #1 (n = 389) and post-monovalent booster #2 (n = 203) among patients with cancer by selected clinical and vaccine characteristics p values less than 0.05 are bolded.

**Figure 3**
The profiles of the concentrator with the height of nanopillar is 25 UC, (a) heat flux, and (b) RHF Change in six self-reported HR-QOL measures over the course of the pandemic defined by four time periods: (1) Jan-2021 through Aug-2021 when the primer series was recommended/available; (2) Sept-2021 through Mar-2022 when the first monovalent (MV) booster was recommended/available; (3) April-2022 through Sept-2022 when the second MV booster was recommended/available; and (4) Oct-2022 through Mar-2023 when a bivalent booster was recommended/availables. (A) Show scores for anxiety, depression and loneliness; and (B) show scores for informational support, instrumental support and emotional support. Scores for anxiety, depression and support were converted to a T-score, which is used to compare sample scores versus the general population (mean = 50, SD = 10). Higher T-scores correspond to higher levels. For the loneliness scale, scores were summed and ranged from 3 (least) to 9 (most lonely). The arrow depicts the direction of benefit. For each of the four time periods, least-squares means and 95% confidence limits were plotted for patients separately by their infection and vaccination status at that time.

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Update of

Low booster uptake in cancer patients despite health benefits.
Figueiredo JC, Levy J, Choi SY, Xu AM, Merin NM, Hamid O, Lemos T, Nguyen N, Nadri M, Gonzalez A, Mahov S, Darrah JM, Gong J, Paquette RL, Mita AC, Vescio RA, Salvy SJ, Mehmi I, Hendifar AE, Natale R, Tourtellotte WG, Krishnan Ramanujan V, Huynh CA, Sobhani K, Reckamp KL, Merchant AA. Figueiredo JC, et al. medRxiv [Preprint]. 2023 Oct 26:2023.10.25.23297483. doi: 10.1101/2023.10.25.23297483. medRxiv. 2023. Update in: iScience. 2024 Jul 26;27(9):110596. doi: 10.1016/j.isci.2024.110596. PMID: 37961284 Free PMC article. Updated. Preprint.

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Low booster uptake in cancer patients despite health benefits

Affiliations

Low booster uptake in cancer patients despite health benefits

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

References

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