Oregon Health & Science University Oregon Health & Science University Tualatin, Oregon
Patients with cancer are at high risk of severe COVID-19. Guidelines recommend COVID-19 mRNA vaccination for patients with cancer with no additional safety issues over the general population. However, patients with cancer receiving a vaccine may not always respond. Depending on tumor types, chemotherapy, or immunologic therapy there can be a large variability in antibody response. Also a shorter duration between doses and more doses of vaccines may be required to enhance an adequate immune response. Patients with cancer who develop COVID-19 following vaccination have substantial comorbidities and can present with severe infections with increased rates of mortality. There are several variables placing patients at higher risk including those with hematologic malignancies. The stem cell transplant and chimeric antigen receptor T cell patients cannot form antibodies for some time after transplant so appropriate timing of vaccines is still unknown. Newly approved under emergency authorization are prophylactic antibodies which may help bridge the gap in those who will not respond, or have low response to vaccines. The timing and efficacy of these therapies are also under current debate and will need more studies to guarantee cancer patients the best outcomes.
Learning Objectives:
Describe the risk of COVID-19 infections in cancer patients
Understand the types of COVID vaccines that are preferred in cancer patients
Utilize immunologic rationales for patients who are at high risk of not responding to COVID-19 vaccines
Rationalize the potential timing and use of tixagevimab plus cilgavimab in cancer patients