Patients with cancer at high risk for death due to breakthrough COVID-19 infections
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Fully vaccinated patients with cancer who developed breakthrough COVID-19 infections appeared at high risk for hospitalization and death, according to study results published in Annals of Oncology.
Researchers also reported that patients with hematologic malignancies continued to be overrepresented among the fully vaccinated cancer population with breakthrough infections.
“Patients with cancer who develop breakthrough COVID-19 infections have substantial comorbidities and can suffer from severe outcomes, including ICU admission and death,” Toni K. Choueiri, MD, director of the Lank Center for Genitourinary Oncology and Kidney Cancer at Dana-Farber Cancer Institute and Jerome Nancy Kohlberg chair and professor of medicine at Harvard Medical School, told Healio.
Methodology
Choueiri and colleagues used data from the COVID-19 and Cancer Consortium to evaluate clinical characteristics and outcomes of 54 fully vaccinated patients with cancer (median age, 65.5 years; 65% women; 70% white; 35% with hematologic malignancies) who experienced breakthrough COVID-19 infection.
They considered patients fully vaccinated after receiving two doses of either of the mRNA vaccines (BNT162b2, Pfizer/BioNTech; mRNA-1273, Moderna), the NIAD vaccine or one dose of the Johnson & Johnson vaccine.
The investigators also identified 1,656 unvaccinated patients and 77 partially vaccinated patients eligible for study inclusion.
“One emerging question has been how patients with cancer fare after COVID-19 breakthrough infection, which could have significant implications for this specific vulnerable patient population,” Choueiri said.
All-cause mortality at 30 days among fully vaccinated patients compared with the unvaccinated cohort served as the primary endpoint.
Key findings
Results showed 65% of fully vaccinated patients with breakthrough COVID-19 infection required hospitalization, 19% required ICU admission or mechanical ventilation, and 13% died within 30 days. Researchers observed similar rates in the unvaccinated cohort.
All-cause mortality at 30 days did not differ significantly between the fully vaccinated and unvaccinated cohorts (adjusted OR = 1.08; 95% CI, 0.41-2.82).
The researchers did not use booster vaccinations as part of the vaccinated cohort, as the data on booster doses emerged after the current data collection.
“COVID-19 severity was comparable between vaccinated patients who developed breakthrough infections and unvaccinated patients with cancer even after controlling for potential confounding factors,” Choueiri said. “Of note, this is retrospective study and not randomized, so confounding factors are always possible.”
A significant proportion of fully vaccinated patients with hematologic malignancies had breakthrough COVID-19 infections.
Implications
These findings provide evidence of the importance of not underestimating COVID-19 severity among vaccinated patients with cancer, Choueiri said.
“There is a great need for strict precautions, including social distancing, mask wearing and related health measures such as vaccination of close contacts and booster shot administration, among this vulnerable population,” he added. “The COVID-19 and Cancer Consortium is continuing to collect information on vaccinated patients, especially with booster vaccinations. We will also expand our research to collect more detailed oncology therapies to see if certain therapies given to patients may impact the efficacy of the vaccine.”
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