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SARS-CoV-2 Antibody Response to 2 or 3 Doses of the BNT162b2 Vaccine in Patients Treated With Anticancer Agents

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What is the immune humoral response to 2 or 3 doses of the BNT162b2 (BioNTech; Pfizer) vaccine in patients treated with anticancer agents for solid cancer?

Findings  In this cohort study including 163 patients, a third vaccine dose strengthened the immune response in 75% of the patients treated with chemotherapy or targeted therapy presenting a weak humoral response after the second dose.

Meaning  The data of this study appear to support the use of a third vaccine dose as a booster dose among patients with active cancer treatment for solid tumors.

Abstract

Importance  Patients with solid cancer are more susceptible to develop SARS-CoV-2 infection and severe complications; the immunogenicity in patients treated with anticancer agents remains unknown.

Objective  To assess the immune humoral response to 2 or 3 doses of the BNT162b2 (BioNTech; Pfizer) vaccine in patients treated with anticancer agents.

Design, Setting, and Participants  A prospective observational cohort study was conducted between February 1 and May 31, 2021. Adults treated with anticancer agents who received 2 or 3 doses of vaccine were included; of these, individuals with a weak humoral response 1 month after the second dose received a third injection.

Interventions  Quantitative serologic testing of antibodies specific for SARS-CoV-2 was conducted before vaccination and during follow-up.

Main Outcomes and Measures  Humoral response was evaluated with a threshold of anti–SARS-CoV-2 spike protein antibody levels at 1000 arbitrary units (AU)/mL to neutralize less-sensitive COVID-19 variants.

Results  Among 163 patients (median [range] age, 66 [27-89] years, 86 men [53%]) with solid tumors who received 2 or 3 doses of vaccine, 122 individuals (75%) were treated with chemotherapy, 15 with immunotherapy (9%), and 26 with targeted therapies (16%). The proportions of patients with an anti-S immunoglobulin G titer greater than 1000 AU/mL were 15% (22 of 145) at the time of the second vaccination and 65% (92 of 142) 28 days after the second vaccination. Humoral response decreased 3 months after the second dose. Treatment type was associated with humoral response; in particular, time between vaccine and chemotherapy did not interfere with the humoral response. Among 36 patients receiving a third dose of vaccine, a serologic response greater than 1000 AU/mL occurred in 27 individuals (75%).

Conclusions and Relevance  The results of this cohort study appear to support the use of a third vaccine dose among patients with active cancer treatment for solid tumors.

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Article Information

Accepted for Publication: November 23, 2021.

Published Online: January 7, 2022. doi:10.1001/jamaoncol.2021.7777

Corresponding Author: Charlotte Fenioux, MD, AP-HP, Hôpital Henri Mondor, Service d’oncologie médicale, One Rue Gustave Eiffel, 94000 Créteil, France (charlotte.fenioux@aphp.fr).

Author Contributions: Dr Fenioux had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Fenioux, Teixeira, Melica, Gallien, Zalcman, Tournigand.

Acquisition, analysis, or interpretation of data: Fenioux, Fourati, Lelievre, Pawlotsky, Tournigand.

Drafting of the manuscript: Fenioux, Fourati, Tournigand.

Critical revision of the manuscript for important intellectual content: Fenioux, Teixeira, Melica, Lelievre, Gallien, Zalcman, Pawlotsky, Tournigand.

Statistical analysis: Fenioux.

Obtained funding: Teixeira.

Administrative, technical, or material support: Fenioux, Teixeira, Fourati, Lelievre, Gallien, Tournigand.

Supervision: Fenioux, Melica, Gallien, Zalcman, Pawlotsky, Tournigand.

Conflict of Interest Disclosures: Dr Teixeira reported receiving grants from AP-HP during the conduct of the study. Dr Fourati reported receiving personal fees from Abbott Diagnostics during the conduct of the study and personal fees from Abbott Diagnostics outside the submitted work. Dr Gallien reported receiving fees for serving as a scientific adviser from Gilead outside the submitted work. Dr Zalcman reported receiving grants from Roche, personal fees from Bristol Myers Squibb, nonfinancial support from Merck Sharp & Dohme, personal fees from AstraZeneca, nonfinancial support from Pfizer, and nonfinancial support from Boehringer Ingelheim outside the submitted work. Dr Pawlotsky reported personal fees from AbbVie, Gilead, Merck, Arbutus, Assembly Biosciences, Regulus, and Memo Therapeutics outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank all the nurses and secretaries of the day clinic of Hôpital Henri Mondor, and more specifically Candice Azaïs, medical secretary, and Thibault Bali, RN, AP-HP, Hôpital Henri Mondor, Service D’oncologie Médicale, Créteil, France, for their help with the management of vaccine and serologic testing scheduling and data acquisition. No compensation was received.

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