COVID-19 vaccination and breakthrough infections in patients with cancer

A L. Schmidt, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
C Labaki, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
C-Y Hsu, Department of Biostatistics, Vanderbilt University, Nashville, USA.
Z Bakouny, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
N Balanchivadze, Hematology and Oncology Fellowship Program, Henry Ford Cancer Institute, Detroit, USA.
S A. Berg, Department of Internal Medicine and Cancer Biology, Division of Hematology and Oncology, Cardinal Bernardin Cancer Centre, Loyola University Chicago, Maywood, USA.
S Blau, Division of Oncology, Northwest Medical Specialties, Tacoma, USA; Division of Hematology, University of Washington, Seattle, USA.
A Daher, Hartford HealthCare Medical Group, Hartford, USA.
T El Zarif, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
C R. Friese, University of Michigan School of Nursing, School of Public Health, and Rogel Cancer Centre, Ann Arbor, USA.
E A. Griffiths, Leukemia Section, Roswell Park Comprehensive Cancer Centre, Buffalo, USA.
J E. Hawley, Herbert Irving Comprehensive Cancer Centre, Columbia University Irving Medical Centre, New York, USA; University of Washington/Fred Hutchinson Cancer Research Center, Seattle, USA.
B Hayes-Lattin, Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, USA.
V Karivedu, Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Centre, Columbus, USA.
T Latif, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, USA.
B H. Mavromatis, Department of Cancer, Oncology, Hematology, UPMC Western Maryland, Cumberland, USA.
R R. McKay, Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, USA.
Gayathri Nagaraj, Division of Medical Oncology & Hematology, Department of Medicine, Loma Linda University Cancer Centre, Loma Linda, USA.Follow
R H. Nguyen, Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, USA.
O A. Panagiotou, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA.
A J. Portuguese, Division of Hematology, University of Washington, Seattle, USA.
M Puc, Department of Surgery, Section of Thoracic Surgery, Virtua Health, Marlton, USA.
M Santos Dutra, Segal Cancer Centre of the Jewish General Hospital, Montréal, Canada.
B A. Schroeder, Virginia Mason Cancer Institute, Seattle, USA.
A Thakkar, Division of Oncology, Montefiore Medical Centre, Bronx, USA.
E M. Wulff-Burchfield, Department of Medicine, Divisions of Medical Oncology and Palliative Medicine, The University of Kansas Health System, Westwood, USA.
S Mishra, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA.
D Farmakiotis, Department of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, USA.
Yu Shyr, Department of Biostatistics, Vanderbilt University, Nashville, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA.
J L. Warner, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA; Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, USA; Department of Biomedical Informatics, Vanderbilt University, Nashville, USA. Electronic address: Jeremy.Warner@vumc.org.
T K. Choueiri, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.Follow

Document Type

Article

Publication Date

12-24-2021

Publication Title

Annals of oncology : official journal of the European Society for Medical Oncology

E-ISSN

1569-8041

Abstract

BACKGROUND: Vaccination is an important preventive health measure to protect against symptomatic and severe COVID-19. Impaired immunity secondary to an underlying malignancy or recent receipt of antineoplastic systemic therapies can result in less robust antibody titers following vaccination and possible risk of breakthrough infection. As clinical trials evaluating COVID-19 vaccines largely excluded patients with a history of cancer and those on active immunosuppression (including chemotherapy), limited evidence is available to inform the clinical efficacy of COVID-19 vaccination across the spectrum of patients with cancer. PATIENTS AND METHODS: We describe the clinical features of patients with cancer who developed symptomatic COVID-19 following vaccination and compare weighted outcomes with those of contemporary unvaccinated patients, after adjustment for confounders, using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19). RESULTS: Patients with cancer who develop COVID-19 following vaccination have substantial comorbidities and can present with severe and even lethal infection. Patients harboring hematologic malignancies are over-represented among vaccinated patients with cancer who develop symptomatic COVID-19. CONCLUSIONS: Vaccination against COVID-19 remains an essential strategy in protecting vulnerable populations, including patients with cancer. Patients with cancer who develop breakthrough infection despite full vaccination, however, remain at risk of severe outcomes. A multilayered public health mitigation approach that includes vaccination of close contacts, boosters, social distancing, and mask-wearing should be continued for the foreseeable future.

DOI

10.1016/j.annonc.2021.12.006

PubMed ID

34958894

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