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Sellés EG, Pieretti DG, Higuero PP, Del Portillo EG, Macías VM, Domínguez MM, Mateos RF, Campos FL, Díaz-Gavela AA, Ferraris G, Couñago F. Total neoadjuvant therapy for locally advanced rectal cancer: a narrative review. Future Oncol 2023; 19:1753-1768. [PMID: 37650764 DOI: 10.2217/fon-2023-0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Locally advanced rectal cancer has traditionally been treated with chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy. However, a new strategy, total neoadjuvant therapy, involves the administration of CRT and neoadjuvant chemotherapy with the aim of eradicating micrometastases earlier and achieving greater control of the disease. The use of total neoadjuvant therapy has shown higher rates of pathological complete response and resectability compared with CRT, including improved survival. Nevertheless, distant relapse is the main cause of morbidity and mortality in locally advanced rectal cancer. To address this, new biomarkers are being developed to predict disease response.
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Affiliation(s)
- Elías Gomis Sellés
- Department of Radiation Oncology, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, 41013, Spain
| | | | - Paula Peleteiro Higuero
- Department of Radiation Oncology, University Hospital Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | | | | | | | - Raquel Fuentes Mateos
- Department of Medical Oncology, University Hospital Ramón y Cajal, Madrid, 28034, Spain
| | - Fernando Lopez Campos
- Radiation Oncology Department, University Hospital Ramon y Cajal, Madrid, 28034, Spain
| | - Ana Aurora Díaz-Gavela
- Quironsalud Madrid University Hospital, Radiation Therapy Department, Medicine Department, School of Biomedical Sciences, Universidad Europea, Madrid, 28223, Spain
| | - Gustavo Ferraris
- Radiotherapy Unit, Centro de Radioterapia Dean Funes, Córdoba, X5003 CVY, Argentina
| | - Felipe Couñago
- San Francisco de Asís and La Milagrosa Hospitals, GenesisCare, Madrid, 28002, Spain
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Cortés A, Casado JL, Longo F, Serrano JJ, Saavedra C, Velasco H, Martin A, Chamorro J, Rosero D, Fernández M, Gion M, Martínez Jáñez N, Soria Rivas A, Alonso Gordoa T, Martínez Delfrade Í, Lage Y, López Miranda E, Olmedo ME, Reguera Puertas P, Gajate P, Molina Cerrillo J, Guerra Alia E, Fuentes Mateos R, Romero B, Rodríguez-Domínguez MJ, Vallejo A, Carrato A. Limited T cell response to SARS-CoV-2 mRNA vaccine among patients with cancer receiving different cancer treatments. Eur J Cancer 2022; 166:229-239. [PMID: 35316750 PMCID: PMC8885286 DOI: 10.1016/j.ejca.2022.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Alfonso Cortés
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - José L Casado
- Infectious Disease Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Federico Longo
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red (CIBERONC), Alcalá de Henares University, Madrid, Spain
| | - Juan J Serrano
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Cristina Saavedra
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Héctor Velasco
- Laboratory of Immunovirology, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Adrián Martin
- Laboratory of Immunovirology, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jesús Chamorro
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Diana Rosero
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - María Fernández
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - María Gion
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Noelia Martínez Jáñez
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ainara Soria Rivas
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Teresa Alonso Gordoa
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Íñigo Martínez Delfrade
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Yolanda Lage
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Elena López Miranda
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - María E Olmedo
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Pablo Reguera Puertas
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Pablo Gajate
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Javier Molina Cerrillo
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Eva Guerra Alia
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Raquel Fuentes Mateos
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Beatriz Romero
- Microbiology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Mario J Rodríguez-Domínguez
- Microbiology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red (CIBER) en Epidemiología y Salud Pública, Spain
| | - Alejandro Vallejo
- Laboratory of Immunovirology, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - Alfredo Carrato
- Medical Oncology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red (CIBERONC), Alcalá de Henares University, Madrid, Spain.
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