Vaccination safe for patients with renal cell carcinoma who received checkpoint inhibitors
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COVID-19 vaccination appeared safe for patients with renal cell carcinoma receiving immune checkpoint inhibitors, according to retrospective study results presented at International Kidney Cancer Symposium.
Researchers reported a higher rate of post-vaccination symptoms among this group than controls. However, researchers hypothesized that may have been due to more frequent visits.
“In this heterogenous population of patients with renal cell carcinoma receiving immune checkpoint inhibitors, COVID-19 vaccination was overall well-tolerated and safe,” Hannah Dzimitrowicz, MD, hematology-oncology fellow at Duke University Medical Center, told Healio. “Despite the limitations of this being a single-institution, retrospective study, this is valuable information to share with patients when considering COVID-19 vaccination in the context of ongoing immunotherapy.”
Patients with cancer — particularly those receiving anti-cancer therapy — are at high risk for severe COVID-19 disease and mortality.
“Vaccinating patients with cancer ... against COVID-19 is important to mitigate this risk,” Dzimitrowicz said. “However, patients on active cancer treatment — including immune checkpoint inhibitors — were excluded from trials of COVID-19 vaccines, and the safety and efficacy of COVID-19 vaccination [for] patients with renal cell carcinoma receiving immune checkpoint inhibitors are not well-described.”
Dzimitrowicz and colleagues aimed to assess adverse effects, immune-related adverse events and rates of COVID-19 infection after vaccination among a real-world cohort of patients with renal cell carcinoma on immune checkpoint inhibitor therapy.
Researchers identified patients with renal cell carcinoma who received at least one dose of an FDA-authorized COVID-19 vaccine between Dec. 1, 2020, and April 1, 2021. All patients had at least 3 months of follow-up.
Dzimitrowicz and colleagues retrospectively reviewed patient encounters during the 3-month post-vaccination period. Adverse events attributed to vaccination served as the primary outcome. Researchers also assessed subsequent immune-related adverse events and COVID-19 infection.
The analysis included 36 patients who had received immune checkpoint inhibitors, as well as 36 controls who had a history of renal cell carcinoma but were not receiving systemic therapy. Those receiving immune checkpoint inhibitors had been on treatment for a median 333 days (range, 13-1,320) prior to their first vaccine dose.
Eight (22.2%) of the patients receiving immune checkpoint inhibitors reported vaccination-related symptoms. These included three patients (8.3%) with chills, two patients (5.6%) with headache, two patients (5.6%) with fatigue, and one (2.8%) each with nausea, vomiting, fever, diarrhea, injection site pain, myalgia or rash. One person in the control group developed premature ventricular contractions.
Rates of post-vaccination symptoms in this study appeared lower than those observed in COVID-19 vaccination trials.
“We saw a lower rate of recorded vaccine-related adverse events [among] patients in our study, particularly control patients [who were] not receiving systemic therapy,” Dzimitrowicz said. “This is likely due to the limitations of retrospective chart review, which only captures what is recorded from patient visits or messages rather than a clinical trial with rigorous monitoring.”
Two patients (5.6%) who received immune checkpoint inhibitors developed new or worsening immune-related adverse events that required systemic steroids and/or treatment hold. One developed colitis and the other developed adrenal insufficiency.
The rate of new or worsening immune-related adverse events after vaccination was no higher than historically reported, according to researchers.
One immune checkpoint inhibitor-treated patient (2.8%) developed COVID-19 infection after one vaccine dose. No patients developed COVID-19 after receiving two vaccine doses.
“We are actively collecting patient surveys regarding adverse events after COVID-19 vaccination to supplement the findings of this study,” Dzimitrowicz told Healio. “This will hopefully provide additional information regarding any potential symptoms after vaccination that were not captured in medical records. Larger cohort studies of patients receiving immune checkpoint inhibitors are important to fully assess the safety and efficacy of COVID-19 vaccination in this population.”
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Dzimitrowicz H, et al. Abstract N19. Presented at: International Kidney Cancer Symposium; Nov. 5-6, 2021; Austin, Texas.
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