The Influence of Radioligand Therapy on Immunogenicity Against SARS-CoV-2-A Retrospective Single-Arm Cohort Study of Metastatic Prostate Cancer Patients Receiving PSMA Radioligand Therapy

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a rising threat for immunocompromised cancer patients. The reduced immune defense may be a result of the malignancy itself or a side effect of therapy. While many chemotherapies can severely diminish the effect of vaccines against SARS-CoV-2, the effect of radioligand therapy has not yet been studied so far. Methods: In our database, 64 patient records of patients with metastatic castration-resistant prostate cancer that were treated with PSMA-directed radioligand therapy (PRLT) were randomly selected and checked for specific information (vaccination status, past corona virus disease 2019 (COVID-19) infections, the period between PRLT and vaccination, and antibody titers). A total of 30 patient records had sufficient information to examine the interference between PRLT and the vaccination against SARS-CoV-2. Results: In the analyzed cohort, 96.7% of the patients achieved seroconversion after receiving-on average-the third (booster) vaccination against SARS-CoV-2 and two PRLT cycles with average administered activities of 16.1 ± 7.2 GBq (435.1 ± 194.6 mCi) of lutetium-177 and 13.7 ± 6.6 MBq (0.37 ± 0.18 mCi) of actinium-225 (as part of 'TANDEM therapies') per patient. Conclusions: In the reviewed population, neither the initial response nor the maintenance of a positive immune response against the SARS-CoV-2 virus was undesirably affected by PRLT. The seroconversion rate and the absolute immune titers (in many cases >25,000 BAU/mL) are comparable to the normal population. This result implies the clinically important conclusion that neither an initial nor a booster vaccination against COVID-19 must be postponed if a PRLT is planned (and vice versa).

Keywords: COVID-19; PSMA; SARS-CoV-2; clinical care; humoral response; immunization; prostate cancer; radioligand therapy; vaccination.

Figure 1

Study design with major inclusion and exclusion criteria.

Figure 2

Absolute SARS-CoV2 antibody titers in BAU/mL for two clinical scenarios: Scenario A (left, n = 11), patient was vaccinated and subsequently treated with PRLT, the antibody response was evaluated a sufficient period after PRLT; Scenario B (right, n = 16): patient received vaccination(s) intermittently between PRLT treatment cycles and the antibody response was evaluated after a sufficient period after PRLT or vaccination. Titers of >25,000 BAU/mL represent the upper limit and were included as a value of 25,000 BAU/mL.