Covid-19 vaccination for patients with cancer
The information below is current as of early March 2021 and may change in the future as long-term information on covid vaccination accumulates.
Covid-19 vaccines in development
More than 300 vaccines are currently in development, many of which are in the final stages of testing. All of them are designed to protect people from Covid-19, although they are produced in different ways.
The main vaccines with results to date are:
Pfizer-BioTech. It contains a tiny piece of the virus’s genetic code, called RNA, created in a laboratory, that encodes a part of the virus called a “spike protein” that sits on the outside of the virus.
Moderna. Contains an RNA that encodes the spike protein of the virus.
Oxford Astra-Zeneca. Contains a weakened form of a harmless virus that commonly does not develop in humans. The virus has been modified to include the coronavirus spike protein gene. This virus injection aims to prepare the immune system for attack without exposing the body to the virus.
Data released by the UK’s independent drug regulator, the Medicines and Health Products Regulatory Agency (MHRA), has confirmed that Pfizer-BioTech and Oxford-Astra Zeneca are extremely safe.
Initial evidence suggests that a single dose of Pfizer vaccine is less effective for patients with cancer.
The MHRA has evaluated safety reports of nearly 7 million vaccine doses administered prior to January 24, most of which were Pfizer-BioTech injections.
Approximately 22,820 adverse reactions have been reported, which is equivalent to about 3 in 1,000 people vaccinated. Nearly all cases were mild and included arm pain, headaches, and chills.
The researchers measured the level of antibodies in the patients’ blood to test their immune response to the Covid-19 virus. The study found that detectable antibody responses at 3 weeks after the first dose of vaccine were found in:
• 39% of the group with solid cancerous tumors
• 13% of the group with blood cancer
• 97% of the group of cancer-free people
The study showed that when the second dose was given at this point (3 weeks after the first dose), an immune response was found in 95% of the group with solid cancer tumors after 14 days (5 weeks after the first dose). There is no enough data to know if this improved the response of patients with blood cancer, as they have not yet received a second dose.
In contrast, cancer patients who did not receive a second dose after 3 weeks did not see real improvement after 5 weeks:
• 43% of the group with solid cancerous tumors
• 8% of the group with blood cancer
• 100% cancer-free group
The researchers thinks that these results suggest that the 12-week gap between doses of Pfizer-BioTech vaccine could leave many cancer patients vulnerable to severe Covid-19. The study does not suggest that people who were treated for cancer some time ago might have been less likely to respond positively to a single dose.
There are some caveats to be aware of when reviewing the results. The study focused on just one of the vaccines available, and many of the participants with solid tumors were older and more advanced in cancer (meaning it is difficult at this stage to determine if the results will be the same for everyone).
The information is presented with the assistance of prof. Abraham Koten, oncologist, Chairman of the Israel Cancer Association.
Below you will see the answers to the following questions:
- • What is mRNA technology vaccine?
- • Is this technology safe for patients with cancer, including those undergoing cancer treatments — chemotherapy, immunotherapy, radiation therapy, surgery, hormone therapy?
- • Is the vaccination effective for people receiving treatments such as immunotherapy, chemotherapy, and radiation therapy?
- • Is the vaccination suitable for patients with a particularly weakened immune system (immunosuppression)?
- • Are there people who should avoid getting vaccinated?
- • Will the vaccination affect cancer treatment?
- • Can cancer patients get vaccinated?
What is mRNA?
MRNA vaccines are a new type for protection against infectious diseases, based on a technology that has been known in medicine for about ten years. mRNA is a molecule that carries the genetic code of DNA.
Covid mRNA vaccines instruct the body’s cells to produce a harmless spike protein segment similar to that found on the surface of the virus. Once the segment is formed, the cells are destroyed down the mRNA and die off.
As soon as a segment of a protein forms on the surface of an immune cell, the immune system recognizes that the protein does not belong to it, and begins to build an immune response and produce antibodies against it, similar to the body’s natural response to a coronary infection.
Eventually, the body learns how to protect itself from future infections. The advantage of mRNA vaccines, like any others, is that vaccinated people receive this protection without risking serious consequences of the disease. MRNA vaccination do not use a live virus and do not affect our DNA in any way.
Is the vaccination safe for cancer patients including those receiving active cancer treatment – chemotherapy, immunotherapy, radiotherapy, hormonal therapy, surgical treatment?
Recommendations for vaccination of cancer patients against corona have not yet been formulated. To date, cancer patients receiving active treatment for their disease, including immunotherapy, chemotherapy and radiation therapy, have not participated in studies testing the vaccine and therefore there is a lack of scientific information about its safety and efficacy in these patients.
However, the researchers believe the vaccine is safe for most cancer patients and recommend that they get a vaccinated (see below for an answer to the question about a particularly weakened immune system and people who should avoid the vaccination). At this stage, cancer patients are advised to be vaccinated against the corona virus, unless there is a contraindication.
It is important to note that each patient’s condition is unique, therefore according to the recommendations of Israeli doctors it is necessary to speak with the attending physician before vaccination about whether it is right for you and when it is recommended to get it.
IS THE VACCINation EFFECTIVE FOR PEOPLE WHO RECEIVE TREATMENT SUCH AS IMMUNOTHERAPY, CHEMOTHERAPY AND RADIOTHERAPY?
Certain cancer treatments can reduce the response of the immune system, and in these cases, the vaccination may be less effective. However, partial protection is better than no protection at all, and it is important for cancer patients to reduce the risk and severity of the disease, especially in light of recent evidence of higher rates of more serious diseases.
IS THE VACCINation SUITABLE FOR PEOPLE WITH ESPECIALLY WEAKENED IMMUNE SYSTEM (IMMUNOSUPPRESSION)?
There is insufficient information yet on how the vaccine works for people with particularly weakened immune systems, such as after stem cell transplantation, certain chemotherapy (induction chemotherapy), radical radiation therapy (for example, in patients with lung cancer), leukemia treatment, and lymphotherapy, and also immunotherapy (eg, CAR-T). The vaccine is considered safe, but may not be effective enough at certain stages of cancer treatment. It will probably be recommended to postpone it until the immune system is restored (for at least three months). It is important and recommended to talk to your doctor about the pros and cons of getting vaccinated and when. Clinical trials are currently underway to study how patients with weakened immune systems respond. Updates on this topic will be added after the publication of the research data.
WHO SHOULD AVOID VACCINATION?
People who have an immediate or severe allergic reaction (anaphylactic reaction) to a dose of corona mRNA vaccine should avoid taking any additional dose.
In addition, people who have an immediate or severe allergic reaction to any other vaccine or injection treatment (other than subcutaneous allergy immunotherapy), including a known allergic reaction to polysorbate, a component present in some vaccines, are advised to exercise caution and consult an allergist- immunologist.
Allergy versus benefits of vaccination. In case of vaccination, despite immediate or known allergic reactions, it is necessary to wait 30 minutes to observe the development of an allergic reaction.
A history of severe allergic reactions not associated with vaccines or injectables, such as food, pets, poison, environmental allergies, or latex, does not prevent vaccination. According to the recommendations of Israeli doctors, it is important to talk to your healthcare professional about the pros and cons of getting vaccinated and whether it is right for you.
WILL VACCINE AFFECT CANCER TREATMENT?
There is no evidence that the vaccination affects cancer treatment. Cancer treatment is important to continue as directed by your doctor (hospitals are preparing for safe treatment). It is advisable to discuss with your doctor any concerns you may have.
CAN CANCER PATIENTS GET A VACCINATION?
Overall, the vaccination is considered safe, effective, and provides vital protection for cancer survivors who are not receiving active treatment. The state of health of each person is unique. According to recommendations of Israeli doctors, it is necessary that you talk to your doctor.
I HAVE READ THAT LYMPH NODE TUMOR AS A RESULT OF VACCINATION MAY BE MISTAKED FOR CANCER BY MAMMOGRAPHY, MRI, ETC. WHAT DO I NEED TO KNOW ABOUT THIS?
It is important to know that different types of vaccines can cause temporary swollen lymph nodes, which may indicate that the body is producing antibodies in response to the vaccination as planned.
This edema may appear on imaging and be misinterpreted as suspicion of cancer or progression of a disease, mainly breast cancer, head and neck cancers, melanoma, and lymphoma. For example, in patients who perform routine breast imaging tests, including mammography and MRI, an enlarged gland can be seen with the naked eye.
According to: cancer.org.il and scienceblog.cancerresearchuk.org
Latest updates March 2021