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Yang Q, He Y, Zhou Y, Jia Q, Dai N, Ma S, Yang X, Zhang X, Sun J. Prolonged Viral Shedding in Cancer Patients with Asymptomatic or Mild Omicron Infection: A Retrospective Study. Infect Drug Resist 2023; 16:7735-7741. [PMID: 38144220 PMCID: PMC10749107 DOI: 10.2147/idr.s431126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023] Open
Abstract
Background This study aimed to investigate the risk factors for persistent viral shedding in cancer patients after Omicron infection. Methods Patients with asymptomatic or mild Omicron infection (≥18 years) who were treated in a makeshift hospital in Shanghai were enrolled from 9 Apr to 11 May, 2022. Deidentified information of all patients were collected retrospectively. Logistic regression model was used to identify risk factors associated with prolonged duration of viral shedding (defined as the time from the day of first positive SARS-CoV-2 RNA test to the first day of two consecutive negative SARS-CoV-2 RNA tests). Results A total of 1442 Omicron-infected patients were enrolled, including 129 cancer patients and 1313 non-cancer patients. The baseline clinical characteristics of cancer and non-cancer patients were balanced by propensity score matching (1:4). Compared with non-cancer patients, a higher odds ratio ([OR] 1.84, 95% CI 1.24-2.76, P = 0.003) of lasting viral shedding for ≥7 days was found in cancer patients. Further subgroup analyses found that cancer patients were at higher risk for prolonged viral shedding in a subgroup of patients without hypertension (OR 1.89), diabetes (OR 1.80), or other chronic disease (OR 2.13), unvaccinated (OR 1.97), and asymptomatic (OR 2.36). In addition, 29 patients with active cancer and 19 patients with inactive cancer were identified. The median duration of viral shedding in the active cancer group was longer than that in the inactive cancer group (10 vs 6 days, P = 0.002). The risk of persistent viral shedding ≥7 days was also increased in the active cancer group (OR 5.33, 95% CI 1.49-21.51, P = 0.013). Conclusion Cancer disease is an independent risk factor for prolonged viral shedding in Omicron infected patients, especially in patients with active cancer.
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Affiliation(s)
- Qiao Yang
- Department of Ultrasound, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, 810007, People’s Republic of China
| | - Ying He
- Department of Psychiatry, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Yi Zhou
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Qinzhu Jia
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Nan Dai
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Siyuan Ma
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400038, People’s Republic of China
| | - Xiu Yang
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People’s Republic of China
| | - Jianguo Sun
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People’s Republic of China
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Nelli F, Giannarelli D, Fabbri A, Virtuoso A, Giron Berrios JR, Marrucci E, Fiore C, Schirripa M, Signorelli C, Chilelli MG, Primi F, Panichi V, Topini G, Silvestri MA, Ruggeri EM. Immune-related adverse events and disease outcomes after the third dose of SARS-CoV-2 mRNA-BNT162b2 vaccine in cancer patients receiving immune checkpoint inhibitors. Cancer Immunol Immunother 2023; 72:3217-3228. [PMID: 37428196 DOI: 10.1007/s00262-023-03489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The clinical implications of the third dose of coronavirus disease 2019 (COVID-19) vaccines in patients receiving immune checkpoint inhibitors are currently unknown. We performed a prospective analysis of the Vax-On-Third study to investigate the effects of antibody response on immune-related adverse events (irAEs) and disease outcomes. METHODS Recipients of the booster dose of SARS-CoV-2 mRNA-BNT162b2 vaccine who had received at least one course of an anti-PD-1/PD-L1 treatment before vaccination for an advanced solid malignancy were eligible. RESULTS The current analysis included 56 patients with metastatic disease (median age: 66 years; male: 71%), most of whom had a lung cancer diagnosis and were being treated with pembrolizumab- or nivolumab-based regimens. The optimal cut-point antibody titer of 486 BAU/mL allowed a dichotomization of recipients into low-responders (Low-R, < 486 BAU/mL) or high-responders (High-R, ≥ 486 BAU/mL). After a median follow-up time of 226 days, 21.4% of patients experienced moderate to severe irAEs without any recrudescence of immune toxicities preceding the booster dose. The frequencies of irAE before and after the third dose did not differ, but an increase in the cumulative incidence of immuno-related thyroiditis was observed within the High-R subgroup. On multivariate analysis, an enhanced humoral response correlated with a better outcome in terms of durable clinical benefit, which resulted in a significant reduction in the risk of disease control loss but not mortality. CONCLUSIONS Our findings would strengthen the recommendation not to change anti-PD-1/PD-L1 treatment plans based on current or future immunization schedules, implying that all these patients should be closely monitored.
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Affiliation(s)
- Fabrizio Nelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy.
| | - Diana Giannarelli
- Biostatistics Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Agnese Fabbri
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Antonella Virtuoso
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Julio Rodrigo Giron Berrios
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Eleonora Marrucci
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Cristina Fiore
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Carlo Signorelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Mario Giovanni Chilelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Francesca Primi
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
| | - Valentina Panichi
- Microbiology and Virology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Viterbo, Italy
| | - Giuseppe Topini
- Microbiology and Virology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Viterbo, Italy
| | - Maria Assunta Silvestri
- Microbiology and Virology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Viterbo, Italy
| | - Enzo Maria Ruggeri
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy
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Nelli F, Signorelli C, Fabbri A, Giannarelli D, Virtuoso A, Giron Berrios JR, Marrucci E, Fiore C, Schirripa M, Chilelli MG, Primi F, Panichi V, Topini G, Silvestri MA, Ruggeri EM. Changes in Peripheral Immune Cells after the Third Dose of SARS-CoV-2 mRNA-BNT162b2 Vaccine and Disease Outcomes in Cancer Patients Receiving Immune Checkpoint Inhibitors: A Prospective Analysis of the Vax-on-Third-Profile Study. Cancers (Basel) 2023; 15:3625. [PMID: 37509286 PMCID: PMC10377319 DOI: 10.3390/cancers15143625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Anti-SARS-CoV-2 mRNA vaccines can deeply affect cell-mediated immune responses in immunocompromised recipients, including cancer patients receiving active treatments. The clinical implications of changes in peripheral blood lymphocyte subsets following the third dose of mRNA-BNT162b2 vaccination (tozinameran) in patients on immune checkpoint blockade are not fully understood. We conducted a prospective analysis of the Vax-On-Third-Profile study to evaluate the impact of circulating lymphocyte dynamics on disease outcomes in this subgroup of patients. METHODS Recipients of booster dosing who had received before vaccination at least one course of an anti-PD-1/PD-L1 treatment for an advanced solid tumor were eligible. Immunophenotyping of peripheral blood was performed before the third dose of tozinameran (timepoint-1) and four weeks later (timepoint-2) to quantify the absolute counts of lymphocyte subpopulations, including CD3+CD4+ T cells, CD3+CD8+ T cells, B cells, and NK cells. Logistic regression was used to analyze the relationship between lymphocyte subsets and durable clinical benefit (DCB). The log-rank test and Cox regression model were applied to evaluate the relationship between lymphocyte subpopulations and both vaccine-related time-to-treatment failure (V-TTF) and overall survival (OS). RESULTS We included a total of 56 patients with metastatic disease who were given a third dose of tozinameran between 23 September and 7 October 2021 (median age: 66 years; male: 71%). Most recipients had a diagnosis of lung cancer and were being treated with pembrolizumab or nivolumab. Compared to baseline, the third immunization resulted in an incremental change in the median counts of all lymphocyte subpopulations, which was statistically significant only for NK cells (p < 0.001). A significant correlation was found between NK cell counts and DCB at timepoint-2 (p < 0.001). Multivariate logistic regression analysis of DCB confirmed the predictive significance of high-level NK cell counts (p = 0.020). In multivariate Cox regression analysis, high-level NK cell counts independently predicted longer V-TTF [HR 0.34 (95% CI 0.14-0.80), p = 0.014] and OS [HR 0.36 (95% CI 0.15-0.89), p = 0.027]. CONCLUSIONS Our data suggest expansion of NK cell counts as the most noteworthy change in circulating lymphocytes after the third dose of tozinameran in cancer patients receiving PD-1/PD-L1-targeted agents. This change correlated with enhanced therapeutic efficacy, improving the rate of disease control, and prolonging survival outcomes. Similar findings have not been previously reported, implying that they have proof-of-concept value and warrant further confirmation.
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Affiliation(s)
- Fabrizio Nelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
- Thoracic Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Carlo Signorelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Agnese Fabbri
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonella Virtuoso
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
- Thoracic Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Julio Rodrigo Giron Berrios
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Eleonora Marrucci
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Cristina Fiore
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Mario Giovanni Chilelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Francesca Primi
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Valentina Panichi
- Cytofluorimetry Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Giuseppe Topini
- Cytofluorimetry Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Maria Assunta Silvestri
- Microbiology and Virology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Enzo Maria Ruggeri
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, 01100 Viterbo, Italy
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Lee VHF, Chan SK, Tam YH, Chau TC, Chan JFW, Chan SY, Ip CY, Choi HCW, Ng SCY, Yuen KK. Predictive factors of delayed viral clearance of asymptomatic Omicron-related COVID-19 screened positive in patients with cancer receiving active anticancer treatment. Int J Infect Dis 2023; 132:40-49. [PMID: 37072051 PMCID: PMC10105908 DOI: 10.1016/j.ijid.2023.04.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVES We sought to identify the predictors of delayed viral clearance in patients with cancer with asymptomatic COVID-19 when the SARS-CoV-2 Omicron variants prevailed in Hong Kong. METHODS All patients with cancer who were attending radiation therapy for head and neck malignancies or systemic anticancer therapy saved their deep throat saliva or nasopharyngeal swabs at least twice weekly for SARS-CoV-2 screening between January 1 and April 30, 2022. The multivariate analyses identified predictors of delayed viral clearance (or slow recovery), defined as >21 days for the cycle threshold values rising to ≥30 or undetectable in two consecutive samples saved within 72 hours. Three machine learning algorithms evaluated the prediction performance of the predictors. RESULTS A total of 200 (15%) of 1309 patients tested positive for SARS-CoV-2. Age >65 years (P = 0.036), male sex (P = 0.003), high Charlson comorbidity index (P = 0.042), lung cancer (P = 0.018), immune checkpoint inhibitor (P = 0.036), and receipt of one or no dose of COVID-19 vaccine (P = 0.003) were significant predictors. The three machine learning algorithms revealed that the mean ± SD area-under-the-curve values predicting delayed viral clearance with the cut-off cycle threshold value ≥30 was 0.72 ± 0.11. CONCLUSION We identified subgroups with delayed viral clearance that may benefit from targeted interventions.
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Affiliation(s)
- Victor Ho-Fun Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Sik-Kwan Chan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yiu-Ho Tam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Department of Radiotherapy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Tin-Ching Chau
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jasper Fuk Woo Chan
- Department of Microbiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sum-Yin Chan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chun-Yat Ip
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Horace Cheuk-Wai Choi
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sherry Chor-Yi Ng
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwok Keung Yuen
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Hou YZ, Zhang Q, Bai H, Wu T, Chen YJ. Immune-related adverse events induced by programmed death protein-1 inhibitors from the perspective of lymphoma immunotherapy. World J Clin Cases 2023; 11:1458-1466. [PMID: 36926390 PMCID: PMC10011990 DOI: 10.12998/wjcc.v11.i7.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
Lymphoma, which is highly malignant, stems from lymph nodes and lymphoid tissue. Lymphoma cells express programmed death-ligand 1/2 (PD-L1/PD-L2), which binds with programmed cell death 1 protein (PD-1) to establish inhibitory signaling that impedes the normal function of T cells and allows tumor cells to escape immune system surveillance. Recently, immune checkpoint inhibitor immunotherapies such as PD-1 inhibitors (nivolumab and pembrolizumab) have been introduced into the lymphoma treatment algorithm and have shown remarkable clinical efficacy and greatly improve prognosis in lymphoma patients. Accordingly, the number of lymphoma patients who are seeking treatment with PD-1 inhibitors is growing annually, which results in an increasing number of patients developing immune-related adverse events (irAEs). The occurrence of irAEs inevitably affects the benefits provided by immunotherapy, particularly when PD-1 inhibitors are applied. However, the mechanisms and characteristics of irAEs induced by PD-1 inhibitors in lymphoma need further investigation. This review article summarizes the latest research advances in irAEs during treatment of lymphoma with PD-1 inhibitors. A comprehensive understanding of irAEs incurred in immunotherapy can help to achieve better efficacy with PD-1 inhibitors in lymphoma.
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Affiliation(s)
- Yong-Zhe Hou
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA, The 940th Hospital of Joint Logistics Support force of Chinese People's Liberation Army, Lanzhou 730050, Gansu Province, China
- Department of First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou 730030, Gansu Province, China
- Key Laboratory of Stem Cells and Gene Drugs of Gansu Province, Lanzhou 730050, Gansu Province, China
| | - Qin Zhang
- Department of First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou 730030, Gansu Province, China
| | - Hai Bai
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA, The 940th Hospital of Joint Logistics Support force of Chinese People's Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Tao Wu
- Department of Hematology, Center of Hematologic Diseases of Chinese PLA, The 940th Hospital of Joint Logistics Support force of Chinese People's Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Ya-Jie Chen
- Department of First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou 730030, Gansu Province, China
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Zirkenbach VA, Ignatz RM, Öttl R, Cehreli Z, Stroikova V, Kaya M, Lehmann LH, Preusch MR, Frey N, Kaya Z. Effect of SARS-CoV-2 mRNA-Vaccine on the Induction of Myocarditis in Different Murine Animal Models. Int J Mol Sci 2023; 24:ijms24055011. [PMID: 36902442 PMCID: PMC10002951 DOI: 10.3390/ijms24055011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
In the course of the SARS-CoV-2 pandemic, vaccination safety and risk factors of SARS-CoV-2 mRNA-vaccines were under consideration after case reports of vaccine-related side effects, such as myocarditis, which were mostly described in young men. However, there is almost no data on the risk and safety of vaccination, especially in patients who are already diagnosed with acute/chronic (autoimmune) myocarditis from other causes, such as viral infections, or as a side effect of medication and treatment. Thus, the risk and safety of these vaccines, in combination with other therapies that could induce myocarditis (e.g., immune checkpoint inhibitor (ICI) therapy), are still poorly assessable. Therefore, vaccine safety, with respect to worsening myocardial inflammation and myocardial function, was studied in an animal model of experimentally induced autoimmune myocarditis. Furthermore, it is known that ICI treatment (e.g., antibodies (abs) against PD-1, PD-L1, and CTLA-4, or a combination of those) plays an important role in the treatment of oncological patients. However, it is also known that treatment with ICIs can induce severe, life-threatening myocarditis in some patients. Genetically different A/J (most susceptible strain) and C57BL/6 (resistant strain) mice, with diverse susceptibilities for induction of experimental autoimmune myocarditis (EAM) at various age and gender, were vaccinated twice with SARS-CoV-2 mRNA-vaccine. In an additional A/J group, an autoimmune myocarditis was induced. In regard to ICIs, we tested the safety of SARS-CoV-2 vaccination in PD-1-/- mice alone, and in combination with CTLA-4 abs. Our results showed no adverse effects related to inflammation and heart function after mRNA-vaccination, independent of age, gender, and in different mouse strains susceptible for induction of experimental myocarditis. Moreover, there was no worsening effect on inflammation and cardiac function when EAM in susceptible mice was induced. However, in the experiments with vaccination and ICI treatment, we observed, in some mice, low elevation of cardiac troponins in sera, and low scores of myocardial inflammation. In sum, mRNA-vaccines are safe in a model of experimentally induced autoimmune myocarditis, but patients undergoing ICI therapy should be closely monitored when vaccinated.
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Affiliation(s)
| | - Rebecca M. Ignatz
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Renate Öttl
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Zeynep Cehreli
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Vera Stroikova
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Mansur Kaya
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Lorenz H. Lehmann
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, 69120 Heidelberg, Germany
| | - Michael R. Preusch
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, 69120 Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, 69120 Heidelberg, Germany
| | - Ziya Kaya
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-5639617
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Bouza E, Martin M, Alés JE, Aragonés N, Barragán B, de la Cámara R, Pozo JLD, García-Gutiérrez V, García-Sanz R, Gracia D, Guillem V, Jiménez-Yuste V, Martin-Delgado MC, Martínez J, López R, Rodríguez-Lescure Á, Galiana JR, Sureda AM, Tejerina-Picado F, Trilla A, Zapatero A, Palomo E, San-Miguel J. Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:1-25. [PMID: 36322133 PMCID: PMC9910677 DOI: 10.37201/req/087.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes.
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Affiliation(s)
- Emilio Bouza
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), España. Patrono de la Fundación de Ciencias de la Salud. Servicio de Microbiología y Enfermedades Infecciosas Hospital General Universitario Gregorio Marañón. Catedrático de Medicina. Universidad Complutense. Madrid.,Correspondence: Emilio Bouza MD, PhD. Instituto de Investigación Sanitaria Gregorio Marañón. C/ Dr. Esquerdo, 46 28007 Madrid, España E-mail:
| | - Miguel Martin
- Universidad Complutense de Madrid. Jefe de Servicio de Oncología del Hospital Gregorio Marañón de Madrid
| | | | | | | | | | - José Luis Del Pozo
- Servicio de Enfermedades Infecciosas. Servicio de Microbiología. Clínica Universidad de Navarra. Pamplona España
| | | | - Ramón García-Sanz
- Laboratorio de HLA y biología molecular en hematología, Universidad de Salamanca. Sociedad Española de Hematología y Hemoterapia
| | | | - Vicente Guillem
- Servicio de Oncología Médica del Instituto Valenciano de Oncología (IVO)
| | | | - Mari Cruz Martin-Delgado
- Servicio Medicina Intensiva Hospital Universitario Torrejón. Universidad Francisco de Vitoria. Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva
| | - Joaquín Martínez
- Servicio de Hematología y Hemoterapia, Hospital 12 de Octubre, Madrid. Universidad Complutense. Madrid
| | - Rafael López
- Oncología Médica del Hospital Clínico Universitario, Santiago de Compostela
| | | | | | - Ana María Sureda
- Servicio de Hematología en Hospital Universitario Quiron Dexeus, Grupo Español de Trasplante y Terapia Celular, Electa del EBMT
| | | | - Antoni Trilla
- Servicio de Medicina Preventiva y Epidemiología del Hospital Clínic de Barcelona. Catedrático de Medicina (Salud Pública) Universidad de Barcelona
| | | | | | - Jesús San-Miguel
- Medicina Clínica y Traslacional de la Clínica Universidad de Navarra
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8
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Harada D, Tamura T, Ninomiya K, Kubo T, Kuyama S, Tachibana S, Inoue K, Chikamori K, Kudo K, Ochi N, Maeda Y, Kiura K. Safety of anti-SARS-CoV-2 messenger RNA vaccine in lung cancer patients undergoing anticancer chemotherapy: A multicenter, prospective, observational, patient-reported outcome study. Thorac Cancer 2022; 14:231-236. [PMID: 36404396 PMCID: PMC9870727 DOI: 10.1111/1759-7714.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND COVID-19 incidence is high in patients with cancer. The fatality rate was high for the Delta variant, necessitating infection prevention by vaccination. This study evaluated the safety of a SARS-CoV-2 vaccine in patients with advanced lung cancer receiving anticancer therapy. METHODS We prospectively enrolled patients receiving anticancer drugs for advanced lung cancer and planning SARS-CoV-2 vaccination. Early side effects within 7 days of vaccination were evaluated using patient-reported outcome (PRO) surveys. Chi-square test and multivariate logistic regression analyses were used. RESULTS Post-vaccination PROs were collected from 406 patients (252 were males). The mean age was 72 years. Treatment at the time of initial vaccination included chemotherapy, immune checkpoint inhibitors (ICI), a combination of chemotherapy and ICI, targeted therapy including tyrosine kinase inhibitors, and others in 115, 93, 45, 147, and six cases, respectively. The vaccines administered were BNT162b2 and mRNA273 in 361 and three cases, respectively and unknown in 42 cases. A total of 16.1% of patients developed fever (38°C) after the second mRNA vaccination (95% confidence interval: 12.6%-20.1%). This rate is comparable to data previously reported in 120 patients and slightly higher than that of healthy participants of the BNT162b2 study. Patients receiving treatment with cytotoxic anticancer agents were more likely to have high fever. Multivariate analysis showed no correlation between fever frequency and patient background. No serious initial adverse events due to vaccination were observed. CONCLUSIONS Anti-SARS-CoV-2 mRNA vaccination is safe; however, post-vaccination fever is more common in patients undergoing lung cancer treatment than in healthy individuals.
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Affiliation(s)
- Daijiro Harada
- Department of Thoracic OncologyNHO Shikoku Cancer CenterMatsuyamaJapan
| | - Tomoki Tamura
- Department of Respiratory MedicineNHO Iwakuni Clinical CenterIwakuniJapan
| | - Kiichiro Ninomiya
- Department of Hematology, Oncology and Respiratory MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Shoichi Kuyama
- Department of Respiratory MedicineNHO Iwakuni Clinical CenterIwakuniJapan
| | - Sayaka Tachibana
- Department of Respiratory MedicineEhime Prefectural Central HospitalMatsuyamaJapan
| | - Koji Inoue
- Department of Respiratory MedicineEhime Prefectural Central HospitalMatsuyamaJapan
| | - Kenichi Chikamori
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterUbeJapan
| | - Kenichiro Kudo
- Department of Respiratory MedicineNational Hospital Organization Okayama Medical CenterOkayamaJapan
| | - Nobuaki Ochi
- General Internal Medicine 4, Kawasaki Medical SchoolOkayamaJapan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory MedicineOkayama University HospitalOkayamaJapan
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9
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Tsiakos K, Gavrielatou N, Vathiotis IA, Chatzis L, Chatzis S, Poulakou G, Kotteas E, Syrigos NK. Programmed Cell Death Protein 1 Axis Inhibition in Viral Infections: Clinical Data and Therapeutic Opportunities. Vaccines (Basel) 2022; 10:vaccines10101673. [PMID: 36298538 PMCID: PMC9611078 DOI: 10.3390/vaccines10101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
A vital function of the immune system is the modulation of an evolving immune response. It is responsible for guarding against a wide variety of pathogens as well as the establishment of memory responses to some future hostile encounters. Simultaneously, it maintains self-tolerance and minimizes collateral tissue damage at sites of inflammation. In recent years, the regulation of T-cell responses to foreign or self-protein antigens and maintenance of balance between T-cell subsets have been linked to a distinct class of cell surface and extracellular components, the immune checkpoint molecules. The fact that both cancer and viral infections exploit similar, if not the same, immune checkpoint molecules to escape the host immune response highlights the need to study the impact of immune checkpoint blockade on viral infections. More importantly, the process through which immune checkpoint blockade completely changed the way we approach cancer could be the key to decipher the potential role of immunotherapy in the therapeutic algorithm of viral infections. This review focuses on the effect of programmed cell death protein 1/programmed death-ligand 1 blockade on the outcome of viral infections in cancer patients as well as the potential benefit from the incorporation of immune checkpoint inhibitors (ICIs) in treatment of viral infections.
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Affiliation(s)
- Konstantinos Tsiakos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
- Correspondence:
| | - Niki Gavrielatou
- Department of Pathology, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Ioannis A. Vathiotis
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Loukas Chatzis
- Pathophysiology Department, Athens School of Medicine, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Stamatios Chatzis
- Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Hippokration” Hospital, 115 27 Athens, Greece
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Elias Kotteas
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Nikolaos K. Syrigos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
- Dana-Farber Brigham Cancer Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02215, USA
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10
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Immunogenicity and Safety of the BNT162b2 mRNA COVID-19 Vaccine in Patients with Melanoma Treated with Immunotherapy. Cancers (Basel) 2022; 14:cancers14153791. [PMID: 35954454 PMCID: PMC9367332 DOI: 10.3390/cancers14153791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The efficacy and safety of the BNT126b2 vaccine against SARS-CoV-2 has not been thoroughly studied in cancer patients treated with immunotherapy. This research aims to investigate the efficacy and safety of the vaccine in patients with melanoma under immunotherapy; at the same time, through the immunophenotyping of T cells and myeloid cells of the peripheral blood, it will be possible to look for changes in the subpopulations of such cells after vaccinations. The results of the study help establish the efficacy and safety of the vaccine in this population, especially since a theoretical concern exists about the vaccine triggering irAEs. Abstract The BNT162b2 vaccine against SARS-CoV-2 has a proven efficacy and a favorable safety profile. In cancer patients under immunotherapy in the form of immune-checkpoint inhibitors (ICIs), the efficacy of the vaccine has not been thoroughly studied, while a theoretical concern has also been raised about triggering immune-related adverse events (irAEs) by the vaccine. We conducted a prospective, non-interventional study on the immunogenicity and safety of the BNT162b2 vaccine in patients with advanced or metastatic melanoma treated with ICIs. Blood samples were obtained 0–4 days before the first dose and 12–21 days after the second dose of the vaccine for the quantification of the SARS-CoV-2 anti-spike antibody using an ELISA and immunophenotyping of the T and myeloid cell subpopulations. The active recording of AEs for a two-month period was conducted. Forty patients were included in the study. All but one (97.3%) achieved seroconversion after two doses of the vaccine and no correlations of the antibody titers with any of the studied parameters (age, gender, stage and duration of the disease, type of ICI, previous treatment, etc.) were found. Moreover, no differences in the subpopulations of the T cells (including the T-regulatory cells) or the myeloid cells were found pre- and post-vaccination. All AEs were low-grade, while one case of arthritis exacerbation was noted. The seroconversion rate in the studied population was high and was comparable to that of healthy subjects, while no major safety issues were raised during the safety follow-up. Finally, no derangements in the subpopulations of T cells or myeloid cells were noted. This is the first study focusing on the immunogenicity, safety, and effect of anti-SARS-CoV-2 vaccines on the blood-cell immunophenotype status of patients with melanoma treated with ICIs.
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11
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Jiang M, Hu Y, Lin G, Chen C. Dosing Regimens of Immune Checkpoint Inhibitors: Attempts at Lower Dose, Less Frequency, Shorter Course. Front Oncol 2022; 12:906251. [PMID: 35795044 PMCID: PMC9251517 DOI: 10.3389/fonc.2022.906251] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are a revolutionary breakthrough in the field of cancer by modulating patient's own immune system to exert anti-tumor effects. The clinical application of ICIs is still in its infancy, and their dosing regimens need to be continuously adjusted. Pharmacokinetic/pharmacodynamic studies showed a significant plateau in the exposure-response curve, with high receptor occupancy and plasma concentrations achieved at low dose levels. Coupled with concerns about drug toxicity and heavy economic costs, there has been an ongoing quest to reevaluate the current ICI dosing regimens while preserving maximum clinical efficacy. Many clinical data showed remarkable anticancer effects with ICIs at the doses far below the approved regimens, indicating the possibility of dose reduction. Our review attempts to summarize the clinical evidence for ICIs regimens with lower-dose, less-frequency, shorter-course, and provide clues for further ICIs regimen optimization.
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Affiliation(s)
| | | | | | - Chao Chen
- Department of Radiotherapy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
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12
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Janzic U, Bidovec-Stojkovic U, Mohorcic K, Mrak L, Dovnik NF, Ivanovic M, Ravnik M, Caks M, Skof E, Debeljak J, Korosec P, Rijavec M. Solid cancer patients achieve adequate immunogenicity and low rate of severe adverse events after SARS-CoV-2 vaccination. Future Oncol 2022; 18:2537-2550. [PMID: 35678621 PMCID: PMC9245563 DOI: 10.2217/fon-2022-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: SARS-CoV-2 vaccination in cancer patients is crucial to prevent severe COVID-19 disease course. Methods: This study assessed immunogenicity of cancer patients on active treatment receiving mRNA-based SARS-CoV-2 vaccine by detection of anti-SARS-CoV-2 S1 IgG antibodies in serum, before, after the first and second doses and 3 months after a complete primary course of vaccination. Results were compared with healthy controls. Results: Of 112 patients, the seroconversion rate was 96%. A significant reduction in antibody levels was observed 3 months after vaccination in patients receiving immune checkpoint inhibitors versus control participants (p < 0.001). Adverse events were mostly mild. Conclusion: Immunogenicity after mRNA-based vaccine in cancer patients is adequate but influenced by the type of anticancer therapy. Antibody levels decline after 3 months, and thus a third vaccination is warranted.
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Affiliation(s)
- Urska Janzic
- Department of Medical Oncology, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia.,University of Ljubljana, Ljubljana, 1000, Slovenia
| | - Urska Bidovec-Stojkovic
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Katja Mohorcic
- Department of Medical Oncology, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Loredana Mrak
- Department of Medical Oncology, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Nina Fokter Dovnik
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Marija Ivanovic
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Maja Ravnik
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Marina Caks
- Department of Oncology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Erik Skof
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, 1000, Slovenia.,Medical Faculty Ljubljana, University of Ljubljana, Ljubljana, 1000, Slovenia
| | - Jerneja Debeljak
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia
| | - Peter Korosec
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, 1000, Slovenia
| | - Matija Rijavec
- Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory & Allergic Diseases Golnik, Golnik, 4204, Slovenia.,Biotechnical Faculty, University of Ljubljana, Ljubljana, 1000, Slovenia
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13
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Zhu Y, Liu K, Ding D, Wang K, Liu X, Tan X. Chemo-Immunotherapy Regimes for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Network Meta-Analysis and Cost-Effectiveness Analysis. Front Pharmacol 2022; 13:858207. [PMID: 35668931 PMCID: PMC9163401 DOI: 10.3389/fphar.2022.858207] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 12/08/2022] Open
Abstract
Introduction: In 2021, two phase III clinical trials confirmed that toripalimab or camrelizumab combined with gemcitabine and cisplatin (TGP or CGP) provide more benefits in the first-line treatment of R/M NPC than GP. Fortunately, TGP and CGP were recently approved as first-line treatments for cases experiencing R/M NPC by the China National Medical Products Administration in 2021. However, due to the high cost and variety of treatment options, the promotion of chemo-immunotherapeutics in the treatment of R/M NPC remains controversial. Therefore, we performed a cost-effectiveness assessment of the two newly approved treatment strategies to assess which treatments provide the greatest clinical benefits at a reasonable cost. Methods: A cost-effectiveness analysis and network meta-analysis network meta-analysis was conducted based on the JUPITER-02 and CAPTAIN-first Phase 3 randomized clinical trials. A Markov model was expanded for the evaluation of the effectiveness and cost of TGP, CGP, and GP chemotherapy with a 10-years horizon and measured the health achievements in quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and life-years (LYs). We constructed a treatment strategy and other parameters based on two clinical trials and performed one-way and probabilistic sensitivity experiments for the evaluation of the uncertainty in the model. Results: For the model of patients with treatment-R/M NPC, TGP was associated with a total cost of $48,525 and 2.778 QALYs (4.991 LYs), leading to an ICER of $15,103 per QALY ($10,321 per LY) compared to CGP. On comparing the GP chemotherapy, we found TGP and CGP incurred substantial health costs, resulting in ICERs of $19,726 per QALY and $20,438 per QALY, respectively. The risk of adverse events (AEs) and the price of the drugs had significant impacts on the ICER. At the assumed willingness-to-pay (WTP) threshold of $35,673 per QALY, there were approximately 75.8 and 68.5% simulations in which cost-effectiveness was achieved for TGP and CGP, respectively. Conclusion: From the Chinese payer’s perspective, TGP is more possible to be a cost-effective regimen compared with CGP and GP for first-line treatment of patients with R/M NPC at a WTP threshold of $35,673 per QALY.
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Affiliation(s)
- Youwen Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Kun Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Dong Ding
- Department of Oncology, Enshi Central Hospital, Wuhan University, Hubei, China
| | - Kailing Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoting Liu
- Health Management Center, Brain Hospital of Hunan Province, Changsha, China
| | - Xiao Tan
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Xiao Tan,
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14
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Chong KM, Yang CY, Lin CC, Lien WC. Severe immune thrombocytopenia following COVID-19 vaccination (Moderna) and immune checkpoint inhibitor: A case report. Am J Emerg Med 2022; 56:395.e1-395.e3. [PMID: 35339338 PMCID: PMC8932008 DOI: 10.1016/j.ajem.2022.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
Safe and effective prophylactic vaccines are urgently needed to contain the coronavirus disease 2019 (COVID-19) pandemic. However, several vaccination-related adverse effects have been reported. Here, we report a rare case of severe immune thrombocytopenia occurring 3 days after receiving the mRNA-1273 (Moderna) COVID-19 vaccine in an Asian woman with a history of refractory lung adenocarcinoma treated with durvalumab, an immune checkpoint inhibitor. Treatment with platelet transfusion (12 units) and oral prednisolone (1 mg/kg per day) significantly improved her hemoptysis with thrombocytopenia. To the best of our knowledge, this is the first case of ITP following Moderna inoculation among Asians. This study highlights a potential adverse effect of mRNA-based COVID-19 vaccines in cancer patients receiving immune checkpoint inhibitors.
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Affiliation(s)
- Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Yao Yang
- Division of Pulmonology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Chin Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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15
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Tamura T, Ninomiya K, Kubo T, Kuyama S, Tachibana S, Inoue K, Chikamori K, Kudo K, Ochi N, Harada D, Maeda Y, Kiura K. Short-term safety of an anti-severe acute respiratory syndrome coronavirus 2 messenger RNA vaccine for patients with advanced lung cancer treated with anticancer drugs: A multicenter, prospective, observational study. Thorac Cancer 2022; 13:453-459. [PMID: 34964270 PMCID: PMC8807248 DOI: 10.1111/1759-7714.14281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Since 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become prevalent worldwide. In severe cases, the case fatality rate is high, and vaccine prevention is important. This study evaluated the safety of receiving SARS-CoV-2 vaccine in patients with advanced lung cancer receiving anticancer therapy. METHODS We prospectively enrolled patients receiving anticancer drugs for advanced lung cancer who planned to receive SARS-CoV-2 vaccination. Early adverse events within 7 days of vaccine injection were evaluated using patient-reported surveys. The chi-square test and multivariate logistic regression analyses were used. RESULTS Among 120 patients receiving lung cancer treatment, 73 were men; the mean age of the patients was 73.5 years. The treatments received for lung cancer at the time of the first vaccine injection were chemotherapy, ICIs, combined chemotherapy and ICIs, and targeted therapies, including tyrosine kinase inhibitors, in 30, 28, 17, and 45 patients, respectively. All patients received SARS-CoV-2 messenger RNA (mRNA) vaccine. After the second mRNA vaccine dose, 15.4% of patients had fever of 38°C (95% confidence interval: 9.34%-23.2%); this rate was slightly higher than that for healthy participants at the time of the BNT162b2 trial. Patients treated with cytotoxic anticancer drugs tended to have high fever. In the multivariate analyses, male sex was associated with higher fever frequencies. However, there were no serious early adverse events due to vaccination. CONCLUSIONS Anti-SARS-CoV-2 mRNA vaccination tends to be safe, but fever following vaccination tends to be more common among patients undergoing lung cancer treatment than among healthy individuals.
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Affiliation(s)
- Tomoki Tamura
- Department of Respiratory MedicineNHO Iwakuni Clinical CenterIwakuniJapan
| | - Kiichiro Ninomiya
- Department of Hematology, Oncology and Respiratory MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Toshio Kubo
- Center for Clinical OncologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Shoichi Kuyama
- Department of Respiratory MedicineNHO Iwakuni Clinical CenterIwakuniJapan
| | - Sayaka Tachibana
- Department of Respiratory MedicineEhime Prefectural Central HospitalMatsuyamaJapan
| | - Koji Inoue
- Department of Respiratory MedicineEhime Prefectural Central HospitalMatsuyamaJapan
| | - Kenichi Chikamori
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterUbeJapan
| | - Kenichiro Kudo
- Department of Respiratory MedicineNational Hospital Organization Okayama Medical CenterOkayamaJapan
| | - Nobuaki Ochi
- General Internal Medicine 4Kawasaki Medical SchoolOkayamaJapan
| | - Daijiro Harada
- Department of Thoracic OncologyNHO Shikoku Cancer CenterMatsuyamaJapan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory MedicineOkayama University HospitalOkayamaJapan
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16
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Figueiredo JC, Ihenacho U, Merin NM, Hamid O, Darrah J, Gong J, Paquette R, Mita AC, Vescio R, Mehmi I, Basho R, Salvy SJ, Shirazipour CH, Caceres N, Finster LJ, Coleman B, Arnow HU, Florindez L, Sobhani K, Prostko JC, Frias EC, Stewart JL, Merchant A, Reckamp KL. SARS-CoV-2 vaccine uptake, perspectives, and adverse reactions following vaccination in patients with cancer undergoing treatment. Ann Oncol 2022; 33:109-111. [PMID: 34687893 PMCID: PMC8527840 DOI: 10.1016/j.annonc.2021.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/02/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- J C Figueiredo
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA.
| | - U Ihenacho
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - N M Merin
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - O Hamid
- The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - J Darrah
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - J Gong
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - R Paquette
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - A C Mita
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - R Vescio
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - I Mehmi
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - R Basho
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - S J Salvy
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - C H Shirazipour
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - N Caceres
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - L J Finster
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - B Coleman
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA
| | - H U Arnow
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA
| | - L Florindez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA
| | - K Sobhani
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | | | - E C Frias
- Abbott Diagnostics, Abbott Park, USA
| | | | - A Merchant
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - K L Reckamp
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA.
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17
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Bolt T, Tufman A, Sellmer L, Kahnert K, Mertsch P, Kovács J, Kauffmann-Guerrero D, Munker D, Manapov F, Schneider C, Behr J, Walter J. Changes in Behavior After Vaccination and Opinions Toward Mask Wearing: Thoracic Oncology Patient–Reported Experiences During the COVID-19 Pandemic. CLINICAL MEDICINE INSIGHTS: ONCOLOGY 2022; 16:11795549221123618. [PMID: 36176285 PMCID: PMC9515761 DOI: 10.1177/11795549221123618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The COVID-19 vaccines, face masks, and social distancing are effective interventions to prevent SARS-CoV-2 infections. In this study, we aimed to determine lung cancer patients’ attitudes toward vaccination, changes in behavior after vaccination, and willingness to continue mask wearing after the pandemic. Methods: We sent out questionnaires to 220 thoracic oncology patients treated at our lung cancer center in May 2021. The questionnaire focused on patients’ vaccination status, self-reported experiences surrounding vaccination, and assessed changes in behaviors before and after vaccination as well as opinions toward mask wearing after the pandemic. Results are presented as absolute and relative frequencies and means with standard deviation and compared using t test, paired t test, and analysis of variance test as well as chi2 test, and Fisher exact text. Results: About 91.0% of patients reported having received at least 1 vaccination. About 73.3% of patients reported having at least 1 reaction to the vaccination. The most common reactions were pain at the injection site, fatigue, and headache. After vaccination, patients increased contact with family and friends, use of public transport, and grocery shopping. Overall, the level of willingness to wear masks beyond the end of the pandemic differed according to vaccination status. Conclusions: Acceptance of the COVID-19 vaccination among thoracic oncology patients in Germany was high. Overall, patients with thoracic malignancies tolerated the COVID-19 vaccination well. Rate of adverse reaction was not higher compared with the general population. After the vaccination, patients increased social contacts and usage of public transport. These changes suggest positive psychological effects on quality of life. While reducing social distancing can increase the risk of infection, our results indicate that an extension of mask mandates after the pandemic would likely be accepted by a majority of thoracic oncology patients, suggesting that our cohort was still aware and in support of other measure of protection.
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Affiliation(s)
- Toki Bolt
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Amanda Tufman
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Laura Sellmer
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Kathrin Kahnert
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Pontus Mertsch
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Julia Kovács
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Thoracic Surgery, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Dieter Munker
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
| | - Farkhad Manapov
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Radiation Oncology, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
| | - Christian Schneider
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Thoracic Surgery, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
| | - Juergen Behr
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
| | - Julia Walter
- Department of Medicine V, University Hospital, LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), München, Germany
- Department of Thoracic Surgery, Thoracic Oncology Centre Munich, Ludwig-Maximilian University of Munich, München, Germany
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Kelly-Goss MR, Badran YR, Dougan M. Update on Immune Checkpoint Inhibitor Enterocolitis. Curr Gastroenterol Rep 2022; 24:171-181. [PMID: 36264425 PMCID: PMC9583048 DOI: 10.1007/s11894-022-00852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitor (ICI) therapy revolutionized the treatment of multiple solid and hematologic malignancies. Yet, with it came profound inflammatory toxicities that mimic autoimmune diseases, termed immune-related adverse events (irAEs). Prominent among these is gastrointestinal inflammation, including a spectrum of gastritis, enteritis, and colitis. Here we synthesize an approach to immune checkpoint related enterocolitis (irEC) - including diagnostics and therapeutics - underpinned by new insights into the mechanism behind these phenomena. RECENT FINDINGS This review presents updated insights on how to approach irEC, including novel approaches to selective immunosuppressive therapy, the role of fecal microbiota transplant, and the underlying cellular mechanisms of irEC. This review provides an update on irEC diagnosis and therapy, with considerations of new therapies and special patient populations. The field of gastrointestinal irAEs requires additional investigation, which will ultimately provide the tools required for patients to continue to receive life-saving ICI therapy.
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Affiliation(s)
- Molly R. Kelly-Goss
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA ,Harvard Medical School, Boston, MA 02115 USA
| | - Yousef R. Badran
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA ,Harvard Medical School, Boston, MA 02115 USA ,Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Michael Dougan
- Harvard Medical School, Boston, MA 02115 USA ,Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
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Kieber-Emmons T. Cancer Patients and COVID-19 Vaccination. Monoclon Antib Immunodiagn Immunother 2021; 40:233-236. [DOI: 10.1089/mab.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas Kieber-Emmons
- Department of Pathology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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20
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Ma Y, Liu N, Wang Y, Zeng J, Hu YY, Hao W, Shi H, Zhu P, Lv J, Fan W, Wang X. Immune checkpoint blocking impact and nomogram prediction of COVID-19 inactivated vaccine seroconversion in patients with cancer: a propensity-score matched analysis. J Immunother Cancer 2021; 9:jitc-2021-003712. [PMID: 34845005 PMCID: PMC8634011 DOI: 10.1136/jitc-2021-003712] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with cancer on active immune checkpoint inhibitors therapy were recommended to seek prophylaxis from COVID-19 by vaccination. There have been few reports to date to discuss the impact of progression cell death-1 blockers (PD-1B) on immune or vaccine-related outcomes, and what risk factors that contribute to the serological status remains to be elucidated. The study aims to find the impact of PD-1B on vaccination outcome and investigate other potential risk factors associated with the risk of seroconversion failure. METHODS Patients with active cancer treatment were retrospectively enrolled to investigate the interaction effects between PD-1B and vaccination. Through propensity score matching of demographic and clinical features, the seroconversion rates and immune/vaccination-related adverse events (irAE and vrAE) were compared in a head-to-head manner. Then, a nomogram predicting the failure risk was developed with variables significant in multivariate regression analysis and validated in an independent cohort. RESULTS Patients (n=454) receiving either PD-1B or COVID-19 vaccination, or both, were matched into three cohorts (vac+/PD-1B+, vac+/PD-1B-, and vac-/PD-1B+, respectively), with a non-concer control group of 206 participants. 68.1% (94/138), 71.3% (117/164), and 80.5% (166/206) were seropositive in vac+/PD-1B+cohort, vac+/PD-1B- cohort, and non-cancer control group, respectively. None of irAE or vrAE was observed to be escalated in PD-1B treatment except for low-grade rash.The vaccinated patients with cancer had a significantly lower rate of seroconversion rates than healthy control. A nomogram was thus built that encompassed age, pathology, and chemotherapy status to predict the seroconversion failure risk, which was validated in an independent cancer cohort of 196 patients. CONCLUSION Although patients with cancer had a generally decreased rate of seroconversion as compared with the healthy population, the COVID-19 vaccine was generally well tolerated, and seroconversion was not affected in patients receiving PD-1B. A nomogram predicting failure risk was developed, including age, chemotherapy status, pathology types, and rheumatic comorbidity.
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Affiliation(s)
- Yifei Ma
- Department of Orthopedics & Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Nianqi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Youlong Wang
- Department of General Surgery, Hainan Hospital of PLA General Hospital, Sanya City, Hainan Province, People's Republic of China
| | - Jiling Zeng
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Ying-Ying Hu
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Wu Hao
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Huazheng Shi
- Department of Nuclear Medicine, Shanghai Universal Medical Imaging Center, Shanghai, People's Republic of China
| | - Pengfei Zhu
- Department of Clinical Laboratory, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Jun Lv
- Department of Infectious Diseases and Hepatology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Wei Fan
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Xinjia Wang
- Department of Orthopedics & Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
- Department of Orthopedics, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
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21
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Chu CY, Lee CH, Huang YH. Taiwan dermatological association recommendations for coronavirus disease of 2019 vaccination in patients treated with immunotherapeutics. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_50_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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