Limited T cell response to SARS-CoV-2 mRNA vaccine among patients with cancer receiving different cancer treatments

• Published in: European journal of cancer (1990) Vol. 166; pp. 229 - 239
• Main Authors: Cortés, Alfonso, Casado, José L., Longo, Federico, Serrano, Juan J., Saavedra, Cristina, Velasco, Héctor, Martin, Adrián, Chamorro, Jesús, Rosero, Diana, Fernández, María, Gion, María, Martínez Jáñez, Noelia, Soria Rivas, Ainara, Alonso Gordoa, Teresa, Martínez Delfrade, Íñigo, Lage, Yolanda, López Miranda, Elena, Olmedo, María E., Reguera Puertas, Pablo, Gajate, Pablo, Molina Cerrillo, Javier, Guerra Alia, Eva, Fuentes Mateos, Raquel, Romero, Beatriz, Rodríguez-Domínguez, Mario J., Vallejo, Alejandro, Carrato, Alfredo
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2022; Elsevier Science Ltd; The Author(s). Published by Elsevier Ltd
• Subjects: 2019-nCoV Vaccine mRNA-1273; Antibodies, Viral; Cancer; Cancer therapies; Cancer vaccines; CD4 antigen; CD8 antigen; Cellular response; Chemotherapy; Complications; Coronaviruses; COVID-19; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - adverse effects; Cyclin-dependent kinases; Dosage; Health care; Humans; Humoral response; Immune response (humoral); Immunization; Immunogenicity; Immunoglobulin G; Immunotherapy; Kinases; Lymphocytes; Lymphocytes T; Medical personnel; mRNA; mRNA Vaccines; Neoplasms - therapy; Original Research; Patients; Prospective Studies; Safety; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Solid tumors; Solid tumours; Tumors; Vaccination; Vaccines; Vaccines, Synthetic; SARS-CoV-2; Humoral response; Solid tumours; Vaccination; Cellular response
• DOI: 10.1016/j.ejca.2022.02.017
• ISSN: 0959-8049

Patients with cancer (PC) are at high risk of acquiring COVID-19 and can develop more serious complications. Deeper understanding of vaccines immunogenicity in this population is crucial for adequately planning vaccines programs. The ONCOVac study aimed to comprehensively assess the immunogenicity of mRNA-1273 vaccine in terms of humoral and cellular response. We conducted a prospective, single-center study including patients with solid tumours treated with cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6i), immunotherapy (IT) or chemotherapy (CT). Patients were enrolled previously to vaccination with mRNA-1273. We also involved health care workers (HCW) to serve as a control group. We took blood samples before first dose administration (BL), after first dose (1D), and after second dose (2D). The primary objective was to compare the rate and magnitude of T cell response after second dose whereas safety and humoral response were defined as secondary objectives. We also collected patient reported outcomes after both the first and second vaccine dose and a six-month follow-up period to diagnose incident COVID-19 cases was planned. The rate of specific anti-S serologic positivity (anti-S IgG cut-off point at 7,14 BAU/mL) was significantly higher in HCW compared to PC after 1D (100% versus 83.8%; p = 0.04), but similar after 2D (100% versus 95.8%; p = 0.5). This difference after 1D was driven by PC treated with CT (100% versus 64.5%; p = 0.001). Cellular response after 2D was significantly lower in PC than in HCW for both CD4+ (91.7% versus 59.7%; p = 0.001) and CD8+ (94.4% versus 55.6%; p < 0.001) T cells. We found a difference on pre-existing CD4+ T cell response in HCW comparing to PC (36% and 17%, p = 0.03); without difference in pre-existing CD8+ T cell response (31% and 23%, p = 0.5). After excluding patients with pre-existing T cell response, PC achieved even lower CD4+ (50.9% versus 95.5%, p < 0.001) and CD8+ (45.5% versus 95.5%, p < 0.001) T cell response compared with HCW. Regarding safety, PC reported notably more adverse events than HCW (96.6% versus 69.2%, p < 0.001). We demonstrated that PC showed a similar humoral response but a lower T cell response following two doses of mRNA-1273 vaccination. Further studies are needed to complement our results and determine the implication of low T cell response on clinical protection of PC against COVID-19. •Cancer patients showed lower humoral response after one dose of mRNA-1273 vaccine.•Humoral response achieves similar levels after full vaccination.•Cellular response was significantly lower in cancer patients compared to controls.