Early treatment of COVID-19 crucial for patients with cancer
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More than 2 years after the COVID-19 pandemic began, new treatments, vaccines and preventive measures have improved safety and disease outcomes for patients with cancer, according to a speaker at Chemotherapy Foundation Symposium.
“We’ve come a long way — there definitely are improved outcomes of COVID-19 in patients with cancer,” Mini Kamboj, MD, infectious disease specialist and chief medical epidemiologist in infection control at Memorial Sloan Kettering Cancer Center, said during a keynote lecture at the symposium. “Monoclonal antibodies are highly effective, but they remain fragile because of the emergence of variants. However, antivirals remain reliable and dependable, but we need to treat early — definitely within the first 5 days. Always try to do it as close to symptom onset as possible.”
In her lecture, Kamboj addressed frequently asked questions about various aspects of COVID-19 vaccination, testing and treatment among patients with cancer.
Co-administration, timing of vaccinations
Co-administration of COVID-19 vaccines with influenza or other vaccines is both safe and beneficial, Kamboj said.
“There can be a little more reactogenicity, but it is usually local,” she added.
Kamboj addressed the optimal timing of COVID-19 vaccination in relation to chemotherapy for patients with cancer.
“We used to think about spacing out chemotherapy and vaccines, but we don’t need to do this for the COVID-19 vaccine, because it’s a multidose vaccine strategy,” Kamboj said. “So, optimization in relation to chemotherapy is generally not required. Some do it to minimize side effects, which is reasonable, but from an immunogenicity or effectiveness standpoint, you don’t really need to do this.”
Kamboj also discussed the role of serologic antibody testing in determining the timing or necessity of a booster in patients with cancer. Clinicians should not assume that antibodies will confer sufficient protection, she said.
“Yes, antibodies correlate with protection, but we do not know what a protective threshold is, and I have seen plenty of patients with high spike antibody levels who still have breakthrough infection,” she said.
Eligibility for revaccination
Kamboj strongly recommended vaccinating patients with cancer who have previously had COVID-19. Vaccination can be timed at about 3 months after the patient’s infection, she said.
“It’s very, very well established that vaccination gives the patient much broader immunity,” she said. “In a virus that has evolved so much and will continue to evolve, vaccination will provide incremental benefit and should be recommended.”
When considering which patients with cancer might be eligible for revaccination, Kamboj said clinicians should think about those who received B-cell depleting therapies, chimeric antigen receptor T-cell therapy and stem cell transplant, when there is evidence of immune reconstitution.
Kamboj emphasized the progress that has been made in optimizing cancer care during the COVID-19 pandemic.
“The pandemic is going to have a lasting impact due to delayed cancer screening — it’s going to take us years and decades to understand,” she said. “But, hopefully, there will be important lessons learned as we face future infectious disease threats.”
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Kamboj M. COVID-19 and cancer. Presented at: 40th Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for Tomorrow; Nov. 9-11, 2022; New York.
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