Weak immunogenicity after a single dose of SARS-CoV-2 mRNA vaccine in treated cancer patients

Active cancer and ongoing antineoplastic treatments are major factors for severe coronavirus disease 2019 (COVID-19) death; reasons why the acute respiratory syndrome 2 (SARS-CoV-2) vaccination remains a priority in patients (CPs).1Gosain R. Abdou Y. Singh A. et al.COVID-19 cancer: comprehensive review.Curr Oncol Rep. 2020; 22: 53Crossref PubMed Scopus (191) Google Scholar However, immunocompromized were excluded from studies on mRNA vaccines,2Baden L.R. El Sahly H.M. Essink B. al.Efficacy safety of mRNA-1273 SARS-CoV-2 vaccine.N Engl J Med. 2021; 384: 403-416Crossref (5255) Scholar,3Polack F.P. Thomas S.J. Kitchin N. al.Safety efficacy BNT162b2 covid-19 383: 2603-2615Crossref (7786) could have decreased response to vaccination, as recently demonstrated solid organ transplant recipients.4Boyarsky B.J. Werbel W.A. Avery R.K. al.Immunogenicity single dose messenger RNA vaccine recipients.J Am Med Assoc. Herein, we aimed assess proportion antibody 4 weeks after first injection (Pfizer-BioNTech) CPs health care workers (HCWs) control population. All consecutive with active treatment or last years HCWs who underwent between 17 February 2021 18 March at Pitié Salpêtrière Hospital, Paris, France, selected analysis. The titration antibodies was proposed just before second vaccine. Serum anti-nucleoprotein (N) immunoglobulin G (IgG) anti-spike protein (S) IgG against receptor binding domain (RBD) S1 detected using Abbott chemiluminescent microparticle immunoassay (CMIA), according manufacturer's instructions. presence anti-N used surrogate marker prior COVID-19. Statistical analysis consisted univariable (Chi-square tests) then multivariable (binary logistic regression, including all variables P value < 0.1 analysis) determine associated lack seroconversion CPs. Median titers anti-S compared HCWs, Mood's test. This study approved by Commission Nationale de l'Informatique des Libertés (MR004, registration number: 2221945). measured 110 25 (Table 1). In did not COVID-19 rate only 55%, while it reached 100% HCWs. Titers significantly higher comparison seropositive (680 versus 315 UA/ml, = 0.04). Sex, locations metastatic status similar seroconverters non-seroconverter (Supplementary Table S1, available https://doi.org/10.1016/j.annonc.2021.04.020). After adjustment potential confounders, two strongly no seroconversion: age >65 [odds ratio 3.58, 95% confidence interval (CI) 1.40-9.15, 0.008] chemotherapy (odds 4.34, CI 1.67-11.30, 0.003).Table 1Characteristics serological outcomeCancer (N 110)Sex, n (%) Women66 (60) Men44 (40)Age, years, median (IQR)66 (54-74)Cancer location, (%)aTwo had synchronous cancers (prostate + lung prostate colon). Breast37 (34) Lung15 (14) Gynecological15 Prostate11 (10) Digestive8 (7.3) Kidney7 (6.4) Bladder5 (4.5) Upper aero-digestive tract6 (5.5) Thyroid5 Others3 (2.7)Cancer staging, Local47 (43) Metastatic63 (57)Cancer treatment, (%)bNon-exclusive categories. Chemotherapy38 (35) Targeted therapy26 (24) Immunotherapy17 (16) Hormonotherapy16 (15) Radiotherapy6 Clinical surveillance18 (16)Time serology, days, (IQR)27 (26-28)Positive IgG, (%)cAbbott detection threshold: 0.8 UA/ml 50 IgG.15 (14)Positive IgG. patients64 (58) Among positive 15)12 (80) negative 95)52 (55)Titer UA/mL, (IQR) 64)359 (178-998) 12)657 (366-14, 112) 52)315 (140-748)Health 25)Sex, Women18 (72) Men7 (28)Age, (IQR)55 (38-62)Time (IQR)23 (21-27)Positive IgG.0 (0)Positive IgG.25 (100)Titer (IQR)680 (360-930)IQR, interquartile range; N, nucleoprotein; S, spike protein; SARS-CoV-2, 2.a Two colon).b Non-exclusive categories.c Open table new tab IQR, 2. No symptomatic occurred injections summary, almost half showed vaccine, this low be much worse elderly under chemotherapy. comparison, seroconversion. Moreover, even seroconversion, level lower than expected. conclusion, our findings argue extending 21-day period CPs, performing monitoring particular population, which lead adapting strategy. We would also recommend strategy family friendship circles.