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Inhibition of SARS-CoV-2 Omicron BA.1 and BA.4 Variants After Fourth Vaccination or Tixagevimab and Cilgavimab Administration in Patients With Cancer

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

Patients with cancer are at high risk for severe COVID-19 and show impaired immune responses after vaccination.1,2 Specifically, levels of neutralizing antibodies against variants of concern, including Delta (B.1.617.2) and Omicron (B.1.1.529), are lower in patients with cancer than in those without.3 Fourth vaccination dose or administration of monoclonal neutralizing antibodies, such as tixagevimab and cilgavimab, is being considered, although data supporting this strategy are limited, especially in the context of currently circulating variants, such as BA.4.

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Article Information

Accepted for Publication: July 22, 2022.

Published Online: September 22, 2022. doi:10.1001/jamaoncol.2022.4226

Corresponding Author: Matthias Preusser, MD, Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (matthias.preusser@meduniwien.ac.at).

Author Contributions: Drs Mair and Preusser had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Fong and Preusser contributed equally as co–last authors.

Concept and design: Mair, Mitterer, Berger, Valenta, Fong, Preusser.

Acquisition, analysis, or interpretation of data: Mair, Mitterer, Gattinger, Berger, Fong, Preusser.

Drafting of the manuscript: Mair, Valenta, Preusser.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Mair.

Obtained funding: Valenta, Preusser.

Administrative, technical, or material support: Mair, Mitterer, Gattinger, Berger, Fong, Preusser.

Supervision: Mair, Valenta, Preusser.

Conflict of Interest Disclosures: Dr Mair reported receiving nonfinancial support from Pierre Fabre outside the submitted work. Dr Valenta reported receiving personal fees from Viravaxx AG and Worg Pharmaceuticals; receiving grants from HVD Biotech, Viravaxx AG, and Worg Pharmaceuticals outside the submitted work; and holding a patent for Molecular Interaction Assay (pending) and a patent for SARS-CoV-2 vaccine (pending). Dr Preusser reported receiving personal fees from Bayer, Bristol Myers Squibb, Novartis, Gerson Lehrman Group, CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, AstraZeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dohme, Tocagen, Adastra, and Gan & Lee Pharmaceuticals outside the submitted work. No other disclosures were reported.

Funding/Support: This study was funded by the Austrian Federal Ministry for Digital and Economic Affairs; the National Foundation for Research, Technology and Development; and the Christian Doppler Research Association. This study was also funded from the research budget of the Medical University of Vienna and the budget of the Südtiroler Sanitätsbetrieb.

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: Barbara Ziegler (Medical University of Vienna, Vienna, Austria) provided excellent technical assistance. Rainer Puhr, PhD (Medical University of Vienna, Vienna, Austria); Anna S. Berghoff, MD, PhD (Medical University of Vienna, Vienna, Austria); Thomas Buratti, MD (Franz Tappeiner Hospital, Merano, Italy); Helmuth Haslacher, MD, PhD (Medical University of Vienna, Vienna, Austria); Wolfgang W. Lamm, MD (Medical University of Vienna, Vienna, Austria); Markus Raderer, MD (Medical University of Vienna, Vienna, Austria); Selma Tobudic, MD (Medical University of Vienna, Vienna, Austria); and Thorsten Fuereder, MD (Medical University of Vienna, Vienna, Austria), assisted with data and samples collection as well as writing and editing of the final manuscript. These individuals received no additional compensation, outside of their usual salary, for their contributions.

References
1.
Pinato  DJ , Patel  M , Scotti  L ,  et al; OnCovid Study Group.  Time-dependent COVID-19 mortality in patients with cancer: an updated analysis of the OnCovid Registry.   JAMA Oncol. 2022;8(1):114-122. doi:10.1001/jamaoncol.2021.6199 PubMedGoogle ScholarCrossref
2.
Corti  C , Antonarelli  G , Scotté  F ,  et al.  Seroconversion rate after vaccination against COVID-19 in patients with cancer-a systematic review.   Ann Oncol. 2022;33(2):158-168. doi:10.1016/j.annonc.2021.10.014 PubMedGoogle ScholarCrossref
3.
Mair  MJ , Mitterer  M , Gattinger  P ,  et al.  Enhanced SARS-CoV-2 breakthrough infections in patients with hematologic and solid cancers due to Omicron.   Cancer Cell. 2022;40(5):444-446. doi:10.1016/j.ccell.2022.04.003 PubMedGoogle ScholarCrossref
4.
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.2013.281053PubMedGoogle ScholarCrossref
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