Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position paper

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Taking into account higher risk of severe coronavirus disease 2019 (COVID-19) or death among patients with cancer, as well as impaired immunogenicity following anti-SARS-CoV-2 vaccines, in addition to waning immunity, booster dosing appears mandatory in this patient population. This review sought to provide reasonable evidence so as to assist oncologists in their daily practice, helping them decide when an anti-SARS-Cov2 antibodies (Abs) dosage should be scheduled following a full two-dose vaccination and if necessary, propose an early third dose (D3). Such D3 could apply to non-responder patients with anti-Spike (S) Abs titers < 40 binding antibody units (BAU)/mL. For low-responder patients with anti-S Abs titers between 40 BAU/mL and 100/260 BAU/mL (suggested area of uncertainty), an early D3 may similarly be proposed. Nevertheless, this D3 could be administered in a less urgent manner, taking into account associated co-morbidities and regional epidemic incidence rates. This latter strategy may comprise a monthly dosage of anti-S titers so as to better assess the kinetics of waning immunity. For responder patients with anti-S titers above 260 BAU/mL, we suggest to follow the recommendations outlined for the general population. Given this context, patients with anti-S titers above 1000 BAU/mL should be given the possibility to undergo anti-S titer control after 3 months, designed to assess rapid humoral waning immunity. We strongly recommend that patients with cancer be included into observational serological monitoring studies or clinical trials that are dedicated to severe immunocompromised patients without any humoral seroconversion after D3.

Related collections

Most cited references 75

Record: found
Abstract: found
Article: not found

Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection

David Khoury, Deborah Cromer, Arnold Reynaldi … (2021)

Predictive models of immune protection from COVID-19 are urgently needed to identify correlates of protection to assist in the future deployment of vaccines. To address this, we analyzed the relationship between in vitro neutralization levels and the observed protection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using data from seven current vaccines and from convalescent cohorts. We estimated the neutralization level for 50% protection against detectable SARS-CoV-2 infection to be 20.2% of the mean convalescent level (95% confidence interval (CI) = 14.4-28.4%). The estimated neutralization level required for 50% protection from severe infection was significantly lower (3% of the mean convalescent level; 95% CI = 0.7-13%, P = 0.0004). Modeling of the decay of the neutralization titer over the first 250 d after immunization predicts that a significant loss in protection from SARS-CoV-2 infection will occur, although protection from severe disease should be largely retained. Neutralization titers against some SARS-CoV-2 variants of concern are reduced compared with the vaccine strain, and our model predicts the relationship between neutralization and efficacy against viral variants. Here, we show that neutralization level is highly predictive of immune protection, and provide an evidence-based model of SARS-CoV-2 immune protection that will assist in developing vaccine strategies to control the future trajectory of the pandemic.

0 comments Cited 1835 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization

Delphine Planas, David Veyer, Artem Baidaliuk … (2021)

The SARS-CoV-2 B.1.617 lineage was identified in October 2020 in India1-5. Since then, it has become dominant in some regions of India and in the UK, and has spread to many other countries6. The lineage includes three main subtypes (B1.617.1, B.1.617.2 and B.1.617.3), which contain diverse mutations in the N-terminal domain (NTD) and the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein that may increase the immune evasion potential of these variants. B.1.617.2-also termed the Delta variant-is believed to spread faster than other variants. Here we isolated an infectious strain of the Delta variant from an individual with COVID-19 who had returned to France from India. We examined the sensitivity of this strain to monoclonal antibodies and to antibodies present in sera from individuals who had recovered from COVID-19 (hereafter referred to as convalescent individuals) or who had received a COVID-19 vaccine, and then compared this strain with other strains of SARS-CoV-2. The Delta variant was resistant to neutralization by some anti-NTD and anti-RBD monoclonal antibodies, including bamlanivimab, and these antibodies showed impaired binding to the spike protein. Sera collected from convalescent individuals up to 12 months after the onset of symptoms were fourfold less potent against the Delta variant relative to the Alpha variant (B.1.1.7). Sera from individuals who had received one dose of the Pfizer or the AstraZeneca vaccine had a barely discernible inhibitory effect on the Delta variant. Administration of two doses of the vaccine generated a neutralizing response in 95% of individuals, with titres three- to fivefold lower against the Delta variant than against the Alpha variant. Thus, the spread of the Delta variant is associated with an escape from antibodies that target non-RBD and RBD epitopes of the spike protein.

0 comments Cited 1096 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers

Moriah Bergwerk, Tal Gonen, Yaniv Lustig … (2021)

Background Despite the high efficacy of the BNT162b2 messenger RNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rare breakthrough infections have been reported, including infections among health care workers. Data are needed to characterize these infections and define correlates of breakthrough and infectivity. Methods At the largest medical center in Israel, we identified breakthrough infections by performing extensive evaluations of health care workers who were symptomatic (including mild symptoms) or had known infection exposure. These evaluations included epidemiologic investigations, repeat reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays, antigen-detecting rapid diagnostic testing (Ag-RDT), serologic assays, and genomic sequencing. Correlates of breakthrough infection were assessed in a case–control analysis. We matched patients with breakthrough infection who had antibody titers obtained within a week before SARS-CoV-2 detection (peri-infection period) with four to five uninfected controls and used generalized estimating equations to predict the geometric mean titers among cases and controls and the ratio between the titers in the two groups. We also assessed the correlation between neutralizing antibody titers and N gene cycle threshold (Ct) values with respect to infectivity. Results Among 1497 fully vaccinated health care workers for whom RT-PCR data were available, 39 SARS-CoV-2 breakthrough infections were documented. Neutralizing antibody titers in case patients during the peri-infection period were lower than those in matched uninfected controls (case-to-control ratio, 0.361; 95% confidence interval, 0.165 to 0.787). Higher peri-infection neutralizing antibody titers were associated with lower infectivity (higher Ct values). Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks). The B.1.1.7 (alpha) variant was found in 85% of samples tested. A total of 74% of case patients had a high viral load (Ct value, <30) at some point during their infection; however, of these patients, only 17 (59%) had a positive result on concurrent Ag-RDT. No secondary infections were documented. Conclusions Among fully vaccinated health care workers, the occurrence of breakthrough infections with SARS-CoV-2 was correlated with neutralizing antibody titers during the peri-infection period. Most breakthrough infections were mild or asymptomatic, although persistent symptoms did occur.

0 comments Cited 706 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Eur J Cancer

Journal ID (iso-abbrev): Eur J Cancer

Title: European Journal of Cancer

Publisher: Elsevier Ltd.

ISSN (Print): 0959-8049

ISSN (Electronic): 1879-0852

Publication date PMC-release: 16 December 2021

Publication date (Electronic): 16 December 2021

Affiliations

[a ]Medical Oncology Department, Polyclinique Saint-Jean, Cagnes-sur-Mer, Polyclinique Saint Jean 92 Avenue Dr Donat, France

[b ]Infectious Diseases Department, Côte D'Azur University, CHU de Nice, Hôpital Archet 1, FR-06000, Nice, France

[c ]Pulmonology and Oncology Department, Centre Hospitalier Toulon Sainte-Musse, Toulon, France

[d ]Medical Oncology Department, Centre Hospitalier Antibes Juan-les-Pins, Antibes, France

[e ]Medical Biology Laboratory, Cerballiance Côte D'Azur, 52 Avenue des Alpes FR-06800, Cagnes-sur-mer, France

[f ]Department of Immunology & UR2CA, Côte D'Azur University, CHU Nice, 151 Route Saint-Antoine de Ginestière 06200 Nice, France

[g ]Thoracic Oncology Department & INSERM Centre D'Investigation Clinique 1425, Université de Paris, University Institute of Cancer AP-HP North, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), 46 Rue Henri Huchard, Paris, France

[h ]Department of Virology and INSERM UMR 1137, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), 46 Rue Henri Huchard, Paris, France

Author notes

[∗ ] Corresponding author. Department of medical oncology, Clinique Saint Jean, 92 avenue Dr Donat FR-06800 CAGNES-SUR-MER, FRANCE.

Article

Publisher Item ID: S0959-8049(21)01275-2

DOI: 10.1016/j.ejca.2021.12.011

PMC ID: 8674546

PubMed ID: 35016032

SO-VID: b09c6c3b-1f87-4213-ab11-0e0a447e88eb

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 25 October 2021

Date revision received : 26 November 2021

Date accepted : 1 December 2021

Comments

Comment on this article

scite_

Cited by 11

See all cited by

Most referenced authors 2,345

See all reference authors

- Version 1

Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position paper

Read this article at

Abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 75

Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection

Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 177

Cited by 11

Most referenced authors 2,345