COVID-19 vaccine booster dose benefits patients with cancer
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Patients with cancer who had no measurable immune response following full COVID-19 vaccination had “excellent potentiation” after receiving a third, booster dose, according to results of a study in Cancer Cell.
“Our research supports COVID-19 booster vaccination for the majority of patients with cancer as we show broad boosting of antibody titers in both patients with solid tumors and hematologic malignancies,” Lauren C. Shapiro, MD, hematology and oncology fellow at Montefiore Medical Center and Albert Einstein College of Medicine, told Healio. “It also highlights the significant evidence of waning immunity 4 to 6 months after standard vaccination that can be rescued to levels even higher than the post-standard vaccination. Overall, we believe our findings underscore the continued benefit COVID-19 vaccines, including booster shots, given to all our patients.”
The current study builds off ongoing research at Montefiore Einstein Cancer Center, including a finding in June that, following standard COVID-19 vaccination, most patients with cancer developed robust antiviral immunity, as measured by anti-spike IgG antibodies. Within that study, however, approximately 20% of patients with blood cancer had lower seroconversion rates, identifying a population in need of novel immunization strategies, Shapiro said.
“We hoped to evaluate whether booster vaccination could provide new protection to those patients,” Shapiro told Healio. “Given our previous studies, we also found ourselves in a unique position to capture evidence of waning immunity months after standard vaccination (especially given breakthrough infections being reported worldwide), and how effective booster vaccination may be in recovering this waning immune response with the goal to provide longer, more durable protection against COVID-19 to patients with cancer.”
Shapiro and colleagues analyzed two cohorts of patients with cancer: a follow-up immunity cohort of 99 patients (median age, 68 years; range, 30-91; 60% women) fully vaccinated against COVID-19 and tested after initial vaccination for the presence of antiviral antibodies, and a cohort of 88 patients (median age, 69 years; range, 30-91; 52% women) who also received a booster dose of the COVID-19 vaccine.
Results showed that most of those in the follow-up cohort who had detectable antibodies saw those antibodies decline on repeat testing 4 to 6 months later.
Four weeks after receiving the booster dose, 79.5% of those in the booster cohort had antibody levels higher than before they received the shot. Moreover, 56% of those who had no detectable antibodies after standard vaccination had them after receiving the booster shot.
“We do note, however, that patients who have received prior anti-CD20 therapy — especially within the last 6 months — or Bruton tyrosine kinase inhibitor therapy are at increased risk for lack of response to booster vaccination,” Shapiro said.
Shapiro said the 56% seroconversion rate pleasantly surprised the research team.
“That the majority of these patients had evidence of enhanced T-cell activity despite a lack of antibody response also surprised us, suggesting other types of immune protection may also be playing a role in potential protection from COVID-19 infection,” Shapiro said. “Our evidence of waning immunity over time did not surprise us; however, it was great to see how well booster vaccination can dramatically boost immunity with just an additional vaccine dose.”
Shapiro called for further research that could aid the smaller segment of patients with cancer, particularly those with hematologic malignancies and who received prior B-cell depleting therapies, who lack a measurable antibody response after standard vaccination.
“We would like to see future research focus on novel immunization strategies to protect these patients, including potential switch (heterologous) vaccination, prophylactic antibody therapeutics, and further investigation on alternative methods of immune protection, such as T-cell activity,” Shapiro told Healio. “Our group has initiated a randomized controlled trial evaluating the use of homologous vs. heterologous COVID vaccination specifically in those patients with cancer who continue to lack measure antibody response after booster vaccination. Accrual will start imminently.”
For more information:
Lauren C. Shapiro, MD, can be reached at Department on Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461; email: lshapiro@montefiore.org.
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