COVID-19 mortality lower after two vaccine doses among patients with cancer
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Patients with cancer had lower rates of SARS-CoV-2 infection and mortality after two doses vs. one dose of COVID-19 vaccines, according to study results from Centre Léon Bérard Cancer Center published in Annals of Oncology.
“Vaccination against COVID-19 is an essential part of cancer treatment,” Jean-Yves Blay, MD, PhD, oncologist, researcher and professor of oncology at University Claude Bernard Lyon 1, corresponding member of the French Academy of Medicine, and director of Centre Léon Bérard, told Healio.
Patients with cancer have a higher risk for COVID-19 mortality than those without cancer, and their immune response is less effective both when they become infected with COVID-19 and after receiving vaccination, according to study background.
Blay and colleagues analyzed the clinical efficacy of SARS-CoV-2 vaccination for patients receiving active cancer treatment after one or two vaccine doses.
“We wanted to evaluate the real-life impact of vaccination at a time [when] it was too often —without proof — recommended to postpone the second shot,” Blay said.
The analysis included 1,503 patients with cancer (median age, 64.8 years; range, 16.7-95.4; 48.9% women) who had no previously documented COVID-19 infection, underwent active cancer treatment at Centre Léon Bérard and received at least one dose of SARS-CoV-2 vaccine from Jan. 4 to April 6, 2021. Researchers reported that fewer than 10% of patients refused the vaccine.
As first doses, 74.9% received BNT162b2 (Pfizer, BioNTech), 21.1% received mRNA-1273 (Moderna) and 4% received ChAdOx1 nCoV-19 (AstraZeneca).
A total of 1,091 (72.6%) received two injections of the vaccine at a median interval of 26 days (range, 13-80) whereas 412 (27.4%) received only one injection; median follow-up after vaccination was 43 days (range 1-130) for this group.
After median follow-up of 44 days for the whole cohort, 24 patients (1.5%) patients developed COVID-19 symptoms with documented SARS-CoV-2 by reverse transcriptase polymerase chain reaction. This included 5% (n = 20) of those who had one dose and 0.4% (n = 4) of those who had two doses (P < .0001).
“With a landmark analysis at 21 days after first dose, these numbers were 4/1,001 (0.4%) vs. 5/283 (1.7%) for patients who received two vs. one dose of the vaccine,” Blay and colleagues wrote.
Three of the 24 patients who became infected with COVID-19 died, including two patients who had hematologic tumors and one who had a solid tumor. Patients vaccinated with one dose vs. two doses had inferior OS within 2 months of the first vaccination date (log rank P = .015) in the overall population and also in a landmark analysis at 21 days (log rank P = .032).
“COVID-19 vaccination was found to be efficient in [patients with cancer],” Blay and colleagues concluded. “Documented COVID-19 was, however, more frequent in patients who received one dose of the vaccine. Overall, death rate in the 2 months following the first vaccination was significantly higher in patients receiving only one dose and in patients with hematologic cancers.”
The results confirm that patients with cancer should receive two doses of the COVID-19 vaccine at 21-to-28-day intervals as recommended by clinical trials, according to Blay. He also called for additional follow-up in this and subsequent cohorts.
For more information:
Jean-Yves Blay, MD, PhD, can be reached at Department of Medical Oncology, Centre Léon Bérard, 28 rue Laënnec, 69373 Lyon Cedex 08 & Université Claude Bérard Lyon, France; email: jean-yves.blay@lyon.unicancer.fr.
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