Using the nation’s largest COVID-19 data resource, a research team found that the COVID-19 vaccine offered protection for most patients with cancer. However, patients with certain types of cancer—especially those with hematologic malignancies—had a higher and widely varied risk of breakthrough COVID-19 infections after being vaccinated. These findings were published by Song et al in the Journal of Clinical Oncology.
NC3 Analysis
A team of 13 investigators from 10 research institutes across the country to analyzed data from the National COVID Cohort Collaborative (N3C).
“This is one of the largest COVID real-world data resources in the world and the largest in the United States,” said corresponding study author Jing Su, PhD, Assistant Professor in the Indiana University School of Medicine Department of Biostatistics and Core Associate Director of Real-World Data for the cancer center’s Biostatistics and Data Management Core. NC3 includes more than 12.5 million patients and 4.5 million COVID-19 patients. Researchers examined data from more than 64,000 patients with cancer who were vaccinated against COVID-19.
“We systematically screened major cancer types and major treatment types, as well as other risk factors such as age, comorbidities, sex, race, geographic locations, and [more] to qualitatively know the contribution of each risk factor and the specific rates of each cancer subgroup as well as the contribution of treatment categories for … patients,” Dr. Su said. “This type of analysis is only possible because we have a huge COVID cohort and control cohort.”
Results
Among the key findings:
- The risk of breakthrough infection was reduced after the second vaccine dose for all cancers.
- Patients with hematologic cancers, including leukemia, multiple myeloma, and lymphoma, were at a higher risk of breakthrough COVID-19 infection; those with blood cancers had a greater risk than solid cancers.
- The Moderna vaccine was more effective than the Pfizer vaccine for protecting patients with hematologic cancers, especially patients with multiple myeloma.
These findings could help guide clinical care and treatment for patients with cancer infected with COVID-19, Dr. Su said. Beyond the pandemic, this research could also help when developing immune-based cancer treatments. Some immunotherapies rely on a patient’s immune capacities, and these findings could help researchers predict which patient populations may respond best to specific treatments.
“In fact, the COVID pandemic provides a unique opportunity for us to screen the immune competence among all patients with cancer at a national level,” Dr. Su said. “We could use this to imitate the differential immune capacities among patients with cancer. This could guide us to better understand whether … patients will have good responses to cancer vaccines and if they are at a higher risk of infection of other viruses, such as the flu.”
The research group is now working to answer additional questions about waning immunity and the effectiveness of booster shots.
“With the surging of new variants, especially the BA.2, we don't know whether there will be another wave down the road,” Dr. Su said. “We are monitoring the situation to see what new variants will mean for patients with cancer and how to best protect them through vaccination.”
Disclosure: This research was supported by the Indiana University Melvin and Bren Simon Comprehensive Cancer Center Support Grant from the National Cancer Institute and the Indiana University Precision Health Initiative. For full disclosures of the study authors, visit ascopubs.org.
