Evaluation of Antibody Response to SARS-CoV-2 mRNA-1273 Vaccination in Patients With Cancer in Florida | Oncology | JN Learning | AMA Ed Hub

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Key Points

Question Does the immune response to the mRNA-1273 vaccine differ among patients with solid tumors and hematologic cancer?

Findings In this cohort study of 515 patients with cancer, seropositivity after the first and second vaccine doses was 71% and 90%, respectively. Antibody levels after vaccination were substantially higher among patients who were seropositive before vaccination.

Meaning Results of this study suggest that the mRNA-1273 vaccine induced a highly variable seroconversion percentage among patients with cancer; these patients may benefit from additional vaccine doses.

Abstract

Importance Patients with cancer experience high rates of morbidity and mortality after SARS-CoV-2 infection. Immune response to mRNA-1273 vaccination across multiple cancer types and treatments remains to be established.

Objective To quantitate antibody responses after mRNA-1273 vaccination among patients with solid tumors and hematologic cancer and to assess clinical and treatment factors associated with vaccine response.

Design, Setting, and Participants This cohort study included patients with cancer who were aged 18 years or older, spoke English or Spanish, had received their first mRNA-1273 dose between January 12 and 25, 2021, and agreed to blood tests before and after vaccination.

Exposures Receipt of 1 and 2 mRNA-1273 SARS-CoV-2 vaccine doses.

Main Outcomes and Measures Seroconversion after each vaccine dose and IgG levels against SARS-CoV-2 spike protein obtained immediately before the first and second vaccine doses and 57 days (plus or minus 14 days) after the first vaccine dose. Cancer diagnoses and treatments were ascertained by medical record review. Serostatus was assessed via enzyme-linked immunosorbent assay. Paired t tests were applied to examine days 1, 29, and 57 SARS-CoV-2 antibody levels. Binding antibody IgG geometric mean titers were calculated based on log₁₀-transformed values.

Results The 515 participants were a mean (SD) age of 64.5 (11.4) years; 262 (50.9%) were women; and 32 (6.2%) were Hispanic individuals and 479 (93.0%) White individuals; race and ethnicity data on 4 (0.7%) participants were missing. Seropositivity after vaccine dose 2 was 90.3% (465; 95% CI, 87.4%-92.7%) among patients with cancer, was significantly lower among patients with hematologic cancer (84.7% [255]; 95% CI, 80.1%-88.6%) vs solid tumors (98.1% [210]; 95% CI, 95.3%-99.5%), and was lowest among patients with lymphoid cancer (70.0% [77]; 95% CI, 60.5%-78.4%). Patients receiving a vaccination within 6 months after anti-CD20 monoclonal antibody treatment had a significantly lower seroconversion (6.3% [1]; 95% CI, 0.2%-30.2%) compared with those treated 6 to 24 months earlier (53.3% [8]; 95% CI, 26.6%-78.7%) or those who never received anti-CD20 treatment (94.2% [456]; 95% CI, 91.7%-96.1%). Low antibody levels after vaccination were observed among patients treated with anti-CD20 within 6 months before vaccination (GM, 15.5 AU/mL; 95% CI, 9.8-24.5 AU/mL), patients treated with small molecules (GM, 646.7 AU/mL; 95% CI, 441.9-946.5 AU/mL), and patients with low lymphocyte (GM, 547.4 AU/mL; 95% CI, 375.5-797.7 AU/mL) and IgG (GM, 494.7 AU/mL; 95% CI, 304.9-802.7 AU/mL) levels.

Conclusions and Relevance This cohort study found that the mRNA-1273 SARS-CoV-2 vaccine induced variable antibody responses that differed by cancer diagnosis and treatment received. These findings suggest that patients with hematologic cancer and those who are receiving immunosuppressive treatments may need additional vaccination doses.

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Article Information

Accepted for Publication: December 21, 2021.

Published Online: March 10, 2022. doi:10.1001/jamaoncol.2022.0001

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Giuliano AR et al. JAMA Oncology.

Corresponding Author: Anna R. Giuliano, PhD, Moffitt Cancer Center, MRC-CANCONT, 12902 Magnolia Dr, Tampa, FL 33612 (anna.giuliano@moffitt.org).

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

Concept and design: Giuliano, Lancet, Pilon-Thomas, Dong, Tan, Tworoger, Siegel, Mo, Cubitt, Dukes.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Giuliano, Lancet, Pilon-Thomas, Tan, Ball, Cubitt, Dukes, Hensel.

Critical revision of the manuscript for important intellectual content: Giuliano, Lancet, Pilon-Thomas, Dong, Jain, Tworoger, Siegel, Whiting, Mo, Cubitt, Dukes, Hensel, Keenan, Hwu.

Statistical analysis: Dong, Whiting, Mo.

Obtained funding: Giuliano, Tworoger.

Administrative, technical, or material support: Pilon-Thomas, Dong, Jain, Tan, Tworoger, Cubitt, Dukes, Hensel, Keenan, Hwu.

Supervision: Giuliano, Pilon-Thomas, Ball, Cubitt.

Conflict of Interest Disclosures: Dr Giuliano reported receiving grants from Merck & Co, Inc, through Moffitt Cancer Center and personal fees from Merck & Co, Inc, as an advisory board member outside the submitted work. Dr Lancet reported receiving personal fees from Novartis, Bristol Myers Squibb, AbbVie, Astellas Pharma, Takeda Pharmaceutical Co, Daiichi Sankyo, Jazz Pharmaceuticals, Agios Pharmaceuticals, ElevateBio, and Jasper Therapeutics, Inc, outside the submitted work. Dr Tworoger reported receiving grants from the US Department of Defense, Florida Department of Health, and the National Institutes of Health outside the submitted work. Dr Hwu reported receiving grants from Merck & Co, Inc, and from the National Cancer Institute–designated comprehensive cancer center funded in part by a Moffitt Cancer Center support grant during the conduct of the study; he reported receiving personal fees from the Dragonfly Scientific Advisory Board and Immatics Scientific Advisory Board outside the submitted work. No other disclosures were reported.

Funding/Support: This work was funded in part by the Moffitt Cancer Center’s support grant P30CA076292, which supported the center’s Total Cancer Care staff; Chemical Biology Core; the Participant Research, Interventions, and Measurement Core; Cancer Pharmacokinetics and Pharmacodynamics Core; Tissue Core; and Biostatistics and Bioinformatics Shared Resource Core. The state of Florida funds provided to the Moffitt Center for Immunization and Infection Research in Cancer also supported this study. This work was additionally supported in part by research grant MISP 60276 from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. Development of SARS-CoV-2 reagents was partially supported by the National Institute of Allergy and Infectious Diseases Centers of Excellence for Influenza Research and Surveillance contract HHSN272201400008C.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the staff of the Krammer Laboratory at the Icahn School of Medicine at Mount Sinai for providing receptor binding domain and spike expression vectors. We also thank Ligia Pinto, PhD, Frederick National Laboratory for Cancer Research, for the methods to measure IgG responses against the receptor binding domain and S proteins of SARS-CoV-2. They did not receive compensation beyond their usual salary for their contribution to this study.

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