Impaired seroconversion after SARS-CoV-2 mRNA vaccines in patients with solid tumours receiving anticancer treatment

• Published in: European journal of cancer (1990) Vol. 163; pp. 16 - 25
• Main Authors: Amatu, Alessio, Pani, Arianna, Patelli, Giorgio, Gagliardi, Oscar M., Loparco, Marina, Piscazzi, Daniele, Cassingena, Andrea, Tosi, Federica, Ghezzi, Silvia, Campisi, Daniela, Grifantini, Renata, Abrignani, Sergio, Siena, Salvatore, Scaglione, Francesco, Sartore-Bianchi, Andrea
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2022; Elsevier Science Ltd; The Author(s). Published by Elsevier Ltd
• Subjects: 2019-nCoV Vaccine mRNA-1273 - administration & dosage; 2019-nCoV Vaccine mRNA-1273 - immunology; Adult; Aged; Antibodies; Antibodies, Viral - blood; Biomarkers - blood; BNT162 Vaccine - administration & dosage; BNT162 Vaccine - immunology; Cancer; Cancer therapies; Case-Control Studies; Chemotherapy; COVID-19; Drug dosages; Female; Health services; Humans; Immunization; Immunogenicity; Immunogenicity, Vaccine; Immunotherapy; Italy; Logit models; Male; Metastases; Middle Aged; mRNA; mRNA vaccines; Multivariate analysis; Neoplasms - immunology; Neoplasms - therapy; Original Research; Patients; Population; Population studies; Prospective Studies; Regression analysis; Risk Factors; Seroconversion; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Solid tumors; Time Factors; Treatment Outcome; Tumors; Vaccination; Vaccine; Vaccine Efficacy; Vaccines; Viral diseases; Italy; COVID-19; Chemotherapy; Immunogenicity; Immunotherapy; Vaccine; Seroconversion; Cancer
• DOI: 10.1016/j.ejca.2021.12.006
• ISSN: 0959-8049

Patients with solid tumours have high COVID-19 mortality. Limited and heterogeneous data are available regarding the immunogenicity of SARS-CoV-2 mRNA vaccines in this population. This is a prospective, single-centre cohort study aiming at evaluating seroconversion in terms of anti-spike antibodies in a population of patients with solid tumours undergoing cancer therapy within 2 months before the second vaccine dose, as compared with a cohort of controls. Subjects who were not SARS-CoV-2 naïve were excluded, and 171 patients were included in the final study population (150 vaccinated with BNT162b2, 87.7%; 21 with mRNA-1273, 12.3%) and compared with 2406 controls. The median follow-up time from the second dose of vaccination was 30 days (12–42; IQR: 26–34). Most patients had metastatic disease (138, 80.7%). Seroconversion rate was significantly lower in cancer patients than in controls (94.2% versus 99.8%, p < 0.001). At univariate logistic regression analysis, Odds ratio (OR) for seroconversion was also reduced in older individuals (>70 years). A multivariate logistic model confirmed cancer as the only significant variable in impairing seroconversion (OR 0.03, p < 0.001). In the cancer population, a multivariate analysis among clinical variables, including the type of cancer treatment, showed ECOG PS > 2 as the only one of impact (OR 0.07, p = 0.012). There is a fraction of 6% of patients with solid tumours undergoing cancer treatment, mainly with poorer performance status, who fail to obtain seroconversion after SARS-CoV-2 mRNA vaccines. These patients should be considered for enhanced vaccination strategies and carefully monitored for SARS-CoV-2 infection during cancer treatment. •Cancer patients have high COVID-19 mortality and were prioritised for vaccination.•About 6% of cancer patients do not develop protective antibodies after vaccination.•Cancer in active treatment is the main factor impairing seroconversion.•Enhanced vaccination strategies warrant consideration in such a setting of care.