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Difference in SARS-CoV-2 Antibody Status Between Patients With Cancer and Health Care Workers During the COVID-19 Pandemic in Japan

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To identify the key insights or developments described in this article
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Key Points

Question  Are there differences in seroprevalence and antibody levels for SARS-CoV-2 between patients with cancer and health care workers (HCWs) during the COVID-19 pandemic in Japan?

Findings  In this cross-sectional study including 500 patients with cancer and 1190 HCWs, the seroprevalence was 1.0% in patients and 0.67% in HCWs. However, the levels of IgG antibodies against nucleocapsid and spike protein were significantly lower in patients than in HCWs.

Meaning  These findings indicate that seroprevalence was not different in patients with cancer compared with HCWs, but the immune response to SARS-CoV-2 may differ between patients with cancer and HCWs.

Abstract

Importance  Patients with cancer and health care workers (HCWs) are at high risk of SARS-CoV-2 infection. Assessing the antibody status of patients with cancer and HCWs can help understand the spread of COVID-19 in cancer care.

Objective  To evaluate serum SARS-CoV-2 antibody status in patients with cancer and HCWs during the COVID-19 pandemic in Japan.

Design, Setting, and Participants  Participants were enrolled for this prospective cross-sectional study between August 3 and October 30, 2020, from 2 comprehensive cancer centers in the epidemic area around Tokyo, Japan. Patients with cancer aged 16 years or older and employees were enrolled. Participants with suspected COVID-19 infection at the time of enrollment were excluded.

Exposures  Cancer of any type and cancer treatment, including chemotherapy, surgery, immune checkpoint inhibitors, radiotherapy, and targeted molecular therapy.

Main Outcomes and Measures  Seroprevalence and antibody levels in patients with cancer and HCWs. Seropositivity was defined as positivity to nucleocapsid IgG (N-IgG) and/or spike IgG (S-IgG). Serum levels of SARS-CoV-2 IgM and IgG antibodies against the nucleocapsid and spike proteins were measured by chemiluminescent enzyme immunoassay.

Results  A total of 500 patients with cancer (median age, 62.5 years [range, 21-88 years]; 265 men [55.4%]) and 1190 HCWs (median age, 40 years [range, 20-70 years]; 382 men [25.4%]) were enrolled. In patients with cancer, 489 (97.8%) had solid tumors, and 355 (71.0%) had received anticancer treatment within 1 month. Among HCWs, 385 (32.3%) were nurses or assistant nurses, 266 (22.4%) were administrative officers, 197 (16.6%) were researchers, 179 (15.0%) were physicians, 113 (9.5%) were technicians, and 50 (4.2%) were pharmacists. The seroprevalence was 1.0% (95% CI, 0.33%-2.32%) in patients and 0.67% (95% CI, 0.29%-1.32%) in HCWs (P = .48). However, the N-IgG and S-IgG antibody levels were significantly lower in patients than in HCWs (N-IgG: β, −0.38; 95% CI, −0.55 to −0.21; P < .001; and S-IgG: β, −0.39; 95% CI, −0.54 to −0.23; P < .001). Additionally, among patients, N-IgG levels were significantly lower in those who received chemotherapy than in those who did not (median N-IgG levels, 0.1 [interquartile range (IQR), 0-0.3] vs 0.1 [IQR, 0-0.4], P = .04). In contrast, N-IgG and S-IgG levels were significantly higher in patients who received immune checkpoint inhibitors than in those who did not (median N-IgG levels: 0.2 [IQR, 0.1-0.5] vs 0.1 [IQR, 0-0.3], P = .02; S-IgG levels: 0.15 [IQR, 0-0.3] vs 0.1[IQR, 0-0.2], P = .02).

Conclusions and Relevance  In this cross-sectional study of Japanese patients with cancer and HCWs, the seroprevalence of SARS-CoV-2 antibodies did not differ between the 2 groups; however, findings suggest that comorbid cancer and treatment with systemic therapy, including chemotherapy and immune checkpoint inhibitors, may influence the immune response to SARS-CoV-2.

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Article Information

Accepted for Publication: April 27, 2021.

Published Online: May 28, 2021. doi:10.1001/jamaoncol.2021.2159

Corresponding Author: Tatsuya Yoshida, MD, PhD, Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan 104-0045 (tatyoshi@ncc.go.jp).

Author Contributions: Drs Yazaki and Tatsuya Yoshida had full access to all of the data and take responsibility for their integrity the accuracy of their analysis.

Concept and design: Yazaki, Tatusya Yoshida, Kojima, Yagishita, Nakahama, Shiotsuka, O. Kobayashi, Iwata, Ohe, Tomokazu Yoshida, Hamada, Doi, Yamamoto.

Acquisition, analysis, or interpretation of data: Yazaki, Tatusya Yoshida, Yagishita, Nakahama, Okinaka, Matsushita, Shiotsuka, Iwata, Narita, Ohba, Takahashi, Iwasa, K. Kobayashi, Ohe, Tomokazu Yoshida, Hamada, Doi, Yamamoto.

Drafting of the manuscript: Yazaki, Tatusya Yoshida, Yagishita, O. Kobayashi, Narita, Ohba, Tomokazu Yoshida, Hamada, Doi, Yamamoto.

Critical revision of the manuscript for important intellectual content: Yazaki, Tatusya Yoshida, Kojima, Yagishita, Nakahama, Okinaka, Matsushita, Shiotsuka, Iwata, Ohba, Takahashi, Iwasa, K. Kobayashi, Ohe, Tomokazu Yoshida, Hamada, Doi, Yamamoto.

Statistical analysis: Yazaki, Tatusya Yoshida, Yagishita.

Obtained funding: Tatusya Yoshida, Hamada.

Administrative, technical, or material support: Tatusya Yoshida, Kojima, Yagishita, Nakahama, Matsushita, Ohba, Tomokazu Yoshida, Hamada, Yamamoto.

Supervision: Tatusya Yoshida, Yagishita, O. Kobayashi, Iwata, Ohe, Hamada, Doi, Yamamoto.

Other–Specimen collection: Okinaka.

Conflict of Interest Disclosures: Dr Tatusya Yoshida reported receiving grants and personal fees from AstraZeneca, grants and personal fees from Bristol-Myers Squibb, AbbVie, Merck Sharpe & Dohme, Ono Pharmaceutical, and Chugai; personal fees from Novartis, Taiho Pharmaceutical, Eli Lilly, Boehringer Ingelheim, Roche Diagnostics, and Archer; and grants from Takeda Pharmaceutical outside the submitted work. Dr Yagishita reported receiving grants from Boehringer Ingelheim outside the submitted work. Dr Matsushita reported receiving a research and development commission fee from Asahi Kasei Medical Co. outside the submitted work. Dr Narita reported receiving grants from Ono Pharmaceutical, Eisai, Dainippon-Sumitomo, Taiho, and Daiichi-Sankyo outside the submitted work. Dr Ohe reported receiving grants and personal fees from AstraZeneca, Bristol-Myers Squibb, Chugai, Eli Lilly, Janssen, Kyorin, Nippon Kayaku, Novartis, ONO Pharmaceutical, Merck Sharpe & Dohme, Pfizer, Taiho, and Takeda Pharmaceutical; grants from Amgen and Kissei; and personal fees from Boehringer Ingelheim and Celtrion outside the submitted work. Dr Hamada reported receiving grants from the Japan Health Research Promotion Bureau Research Fund and Sysmex Corporation during the conduct of the study. Dr Doi reported receiving grants from Lilly, Merck Sharpe & Dohme, Merck Serono, Pfizer, IQVIA, and Eisai; personal fees from Merck Sharpe & Dohme, Amgen, Takeda, Chugai, Bayer, Rakuten Medical, ONO Pharmaceutical, Astellas, Oncolys BioPharma, and Otsuka Pharma; and grants and personal fees from Daiichi Sankyo, Sumitomo Dainippon, Taiho, Novartis, Janssen, Boehringer Ingelheim, Bristol Myers Squibb, and AbbVie outside the submitted work. Dr Yamamoto reported receiving grants from Chugai, Taiho, Eisai, Eli Lilly, Astellas, Bristol Myers Squibb, Novartis, Daiichi-Sankyo, Pfizer, Boehringer Ingelheim, Kyowa-Hakko Kirin, Bayer, ONO Pharmaceutical Co., Takeda, Janssen, Merck Sharpe & Dohme, Merck, GlaxoSmithKline, Sumitomo Dainippon, Chiome Bioscience, Otsuka; personal fees from ONO Pharmaceutical, Chugai, AstraZeneca, Pfizer, Lilly, Bristol Myers Squibb, Daiichi-Sankyo, Eisai, Otsuka, Takeda, Boehringer Ingelheim, and Cimic outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by a research fund from the Japan Health Research Promotion Bureau Research Fund (2020-A-1) and also partly supported by Sysmex Co, Japan.

Role of the Funder/Sponsor: Sysmex Co was involved with the review of the manuscript and its approval but not with the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank all the patients, their physicians, and the HCWs involved in this study. We also thank the members of the clinical laboratory center for their support.

References
1.
WHO. Coronavirus Disease (COVID-19) Dashboard 2021. Accessed February 1, 2021. https://covid19.who.int
2.
Patel  A , Jernigan  DB ; 2019-nCoV CDC Response Team.  Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak—United States, December 31, 2019-February 4, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(5):140-146. doi:10.15585/mmwr.mm6905e1PubMedGoogle ScholarCrossref
3.
Deeks  JJ , Dinnes  J , Takwoingi  Y ,  et al; Cochrane COVID-19 Diagnostic Test Accuracy Group.  Antibody tests for identification of current and past infection with SARS-CoV-2.   Cochrane Database Syst Rev. 2020;6(6):CD013652.PubMedGoogle Scholar
4.
Liang  W , Guan  W , Chen  R ,  et al.  Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.   Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6PubMedGoogle ScholarCrossref
5.
Berghoff  AS , Gansterer  M , Bathke  AC ,  et al.  SARS-CoV-2 testing in patients with cancer treated at a tertiary care hospital during the COVID-19 pandemic.   J Clin Oncol. 2020;38(30):3547-3554. doi:10.1200/JCO.20.01442PubMedGoogle ScholarCrossref
6.
Yu  J , Ouyang  W , Chua  MLK , Xie  C .  SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China.   JAMA Oncol. 2020;6(7):1108-1110. doi:10.1001/jamaoncol.2020.0980PubMedGoogle ScholarCrossref
7.
Bertuzzi  AF , Marrari  A , Gennaro  N ,  et al.  Low incidence of SARS-CoV-2 in patients with solid tumours on active treatment: an observational study at a tertiary cancer centre in Lombardy, Italy.   Cancers (Basel). 2020;12(9):2352. doi:10.3390/cancers12092352PubMedGoogle ScholarCrossref
8.
Rogado  J , Obispo  B , Pangua  C ,  et al.  COVID-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid.   Clin Transl Oncol. 2020;22(12):2364-2368. doi:10.1007/s12094-020-02381-zPubMedGoogle ScholarCrossref
9.
Fillmore  NR , La  J , Szalat  RE ,  et al.  Prevalence and outcome of COVID-19 infection in cancer patients: a national Veterans Affairs study.   J Natl Cancer Inst. 2020;djaa159. doi:10.1093/jnci/djaa159PubMedGoogle Scholar
10.
Wang  Q , Berger  NA , Xu  R .  Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection.   JAMA Oncol. 2021;7(2):220-227. doi:10.1001/jamaoncol.2020.6178PubMedGoogle ScholarCrossref
11.
Miyashita  H , Mikami  T , Chopra  N ,  et al.  Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City.   Ann Oncol. 2020;31(8):1088-1089. doi:10.1016/j.annonc.2020.04.006PubMedGoogle ScholarCrossref
12.
Mehta  V , Goel  S , Kabarriti  R ,  et al.  case fatality rate of cancer patients with COVID-19 in a New York hospital system.   Cancer Discov. 2020;10(7):935-941. doi:10.1158/2159-8290.CD-20-0516PubMedGoogle ScholarCrossref
13.
Dai  M , Liu  D , Liu  M ,  et al.  Patients with cancer appear more vulnerable to SARS-CoV-2: a multicenter study during the COVID-19 outbreak.   Cancer Discov. 2020;10(6):783-791.PubMedGoogle Scholar
14.
Anelli  F , Leoni  G , Monaco  R ,  et al.  Italian doctors call for protecting healthcare workers and boosting community surveillance during covid-19 outbreak.   BMJ. 2020;368:m1254. doi:10.1136/bmj.m1254PubMedGoogle ScholarCrossref
15.
Moscola  J , Sembajwe  G , Jarrett  M ,  et al; Northwell Health COVID-19 Research Consortium.  Prevalence of SARS-CoV-2 antibodies in health care personnel in the New York City area.   JAMA. 2020;324(9):893-895. doi:10.1001/jama.2020.14765PubMedGoogle ScholarCrossref
16.
Garcia-Basteiro  AL , Moncunill  G , Tortajada  M ,  et al.  Seroprevalence of antibodies against SARS-CoV-2 among health care workers in a large Spanish reference hospital.   Nat Commun. 2020;11(1):3500. doi:10.1038/s41467-020-17318-xPubMedGoogle ScholarCrossref
17.
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053.Google ScholarCrossref
18.
Noda  K , Matsuda  K , Yagishita  S ,  et al.  A novel highly quantitative and reproducible assay for the detection of anti-SARS-CoV-2 IgG and IgM antibodies.   Sci Rep. 2021;11(1):5198. doi:10.1038/s41598-021-84387-3PubMedGoogle ScholarCrossref
19.
Park  R , Lee  SA , Kim  SY , de Melo  AC , Kasi  A .  Association of active oncologic treatment and risk of death in cancer patients with COVID-19: a systematic review and meta-analysis of patient data.   Acta Oncol. 2021;60(1):13-19. doi:10.1080/0284186X.2020.1837946PubMedGoogle ScholarCrossref
20.
Solodky  ML , Galvez  C , Russias  B ,  et al.  Lower detection rates of SARS-COV2 antibodies in cancer patients versus health care workers after symptomatic COVID-19.   Ann Oncol. 2020;31(8):1087-1088. doi:10.1016/j.annonc.2020.04.475PubMedGoogle ScholarCrossref
21.
Lumley  SF , O’Donnell  D , Stoesser  NE ,  et al; Oxford University Hospitals Staff Testing Group.  Antibody status and incidence of SARS-CoV-2 infection in health care workers.   N Engl J Med. 2021;384(6):533-540. doi:10.1056/NEJMoa2034545PubMedGoogle ScholarCrossref
22.
Verma  R , Foster  RE , Horgan  K ,  et al.  Lymphocyte depletion and repopulation after chemotherapy for primary breast cancer.   Breast Cancer Res. 2016;18(1):10. doi:10.1186/s13058-015-0669-xPubMedGoogle ScholarCrossref
23.
Loulergue  P , Alexandre  J , Iurisci  I ,  et al.  Low immunogenicity of seasonal trivalent influenza vaccine among patients receiving docetaxel for a solid tumour: results of a prospective pilot study.   Br J Cancer. 2011;104(11):1670-1674. doi:10.1038/bjc.2011.142PubMedGoogle ScholarCrossref
24.
Rousseau  B , Loulergue  P , Mir  O ,  et al.  Immunogenicity and safety of the influenza A H1N1v 2009 vaccine in cancer patients treated with cytotoxic chemotherapy and/or targeted therapy: the VACANCE study.   Ann Oncol. 2012;23(2):450-457. doi:10.1093/annonc/mdr141PubMedGoogle ScholarCrossref
25.
Läubli  H , Balmelli  C , Kaufmann  L ,  et al.  Influenza vaccination of cancer patients during PD-1 blockade induces serological protection but may raise the risk for immune-related adverse events.   J Immunother Cancer. 2018;6(1):40. doi:10.1186/s40425-018-0353-7PubMedGoogle ScholarCrossref
26.
Channappanavar  R , Twardy  BS , Suvas  S .  Blocking of PDL-1 interaction enhances primary and secondary CD8 T cell response to herpes simplex virus-1 infection.   PLoS One. 2012;7(7):e39757. doi:10.1371/journal.pone.0039757PubMedGoogle Scholar
27.
Polack  FP , Thomas  SJ , Kitchin  N ,  et al; C4591001 Clinical Trial Group.  Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine.   N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577PubMedGoogle ScholarCrossref
28.
Baden  LR , El Sahly  HM , Essink  B ,  et al; COVE Study Group.  Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine.   N Engl J Med. 2021;384(5):403-416. doi:10.1056/NEJMoa2035389PubMedGoogle ScholarCrossref
29.
Fuereder  T , Berghoff  AS , Heller  G ,  et al.  SARS-CoV-2 seroprevalence in oncology healthcare professionals and patients with cancer at a tertiary care centre during the COVID-19 pandemic.   ESMO Open. 2020;5(5):e000889. doi:10.1136/esmoopen-2020-000889PubMedGoogle Scholar
30.
Cabezón-Gutiérrez  L , Custodio-Cabello  S , Palka-Kotlowska  M , Oliveros-Acebes  E , García-Navarro  MJ , Khosravi-Shahi  P .  Seroprevalence of SARS-CoV-2-specific antibodies in cancer outpatients in Madrid (Spain): A single center, prospective, cohort study and a review of available data.   Cancer Treat Rev. 2020;90:102102. doi:10.1016/j.ctrv.2020.102102PubMedGoogle Scholar
31.
Steensels  D , Oris  E , Coninx  L ,  et al.  Hospital-wide SARS-CoV-2 Antibody screening in 3056 staff in a tertiary center in Belgium.   JAMA. 2020;324(2):195-197. doi:10.1001/jama.2020.11160PubMedGoogle ScholarCrossref
32.
Rudberg  AS , Havervall  S , Månberg  A ,  et al.  SARS-CoV-2 exposure, symptoms and seroprevalence in healthcare workers in Sweden.   Nat Commun. 2020;11(1):5064. doi:10.1038/s41467-020-18848-0PubMedGoogle ScholarCrossref
33.
Pollán  M , Pérez-Gómez  B , Pastor-Barriuso  R ,  et al; ENE-COVID Study Group.  Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study.   Lancet. 2020;396(10250):535-544. doi:10.1016/S0140-6736(20)31483-5PubMedGoogle ScholarCrossref
34.
Havers  FP , Reed  C , Lim  T ,  et al. Seroprevalence of antibodies to SARS-CoV-2 in 10 sites in the United States, March 23-May 12, 2020.  JAMA Intern Med. 2020;180(12):1576-1586. doi:10.1001/jamainternmed.2020.4130
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