Can Cancer Patients Receive a Covid-19 Vaccine?

The novel coronavirus (SARS-CoV-2) has been the target of vaccine development in which scientists have not disappointed the world, and countries are vaccinating their populations according to their resources and health strategies. These days, the most frequent questions from cancer patients and their relatives are: "Should I be vaccinated, which vaccine should I have, will it work, and what will the short- and long-term side effects be?"

As vaccines finally begin reaching cancer patients, we have listed the issues that patients and doctors should be aware of.

Quick Summary (United States National Comprehensive Cancer Network / NCCN Recommendations)

Patients Undergoing Hematopoietic Cell Transplantation or Cellular Therapy

COVID-19 vaccination should follow hematopoietic cell transplantation(allogeneic or autologous) or cellular therapy (for example, chimeric antigen receptor [CAR] T-cell therapy) by at least 3 months as recommended.

Patients with Hematological (Blood and Bone Marrow) Cancers

For patients receiving intensive chemotherapy, COVID-19 vaccination should be postponed until the absolute neutrophil count has recovered.

For patients expected to have limited or no recovery because of disease or treatment, and those receiving long-term maintenance treatment, the COVID-19 vaccine should be given when it becomes available.

Patients with Solid-Organ Cancers

For patients receiving chemotherapy, targeted therapy, checkpoint inhibitor therapy or other immunotherapy, or radiation therapy, the COVID-19 vaccine should be given when available.

For patients undergoing major surgery, COVID-19 vaccination should be postponed until at least a few days after surgery.

We Expect Cancer Patients to Respond to Coronavirus Vaccines

There was previously a view that cancer patients could not produce an immune response to vaccines (that vaccination would not take). However, data on other viral vaccines have shown otherwise. For example, influenza vaccines have a long history of study in cancer patients and generally provide protection (the vaccine takes). The same applies to the pneumococcal vaccine, which cancer patients should generally receive, and we recommend both influenza and pneumococcal vaccination for cancer patients.

Exceptions may involve conditions in which the immune system is extremely weakened and profound immunosuppression occurs, such as hematological cancers (originating in blood and bone marrow). Data on vaccine responses in patients with “extreme” immune suppression are limited, but available data suggest that cancer patients can be successfully vaccinated after this period of immunosuppression has passed.

• Related Topic: Influenza and Pneumonia Vaccines – Do They Protect against Coronavirus, and Who Should Receive Them and When? 

Does Vaccine Type Matter for Cancer Patients?

As of 25 March 2021, there are 80 coronavirus vaccines in human clinical trials, and 23 have reached the final testing stages, namely phase-III. So far, 7 different vaccines have received international approval. At least 77 preclinical vaccines are under active investigation in animals.

Both Pfizer-BioNTech and Moderna Covid vaccines are of the mRNA type. Many other types exist, including protein-based vaccines, adenovirus-based viral vector vaccines and inactivated or attenuated coronavirus vaccines (see our article on the Types of Vaccines Developed against Coronavirus ).

There may be concern that live attenuated virus vaccines are not a good choice for cancer patients. Particularly in those with rapidly progressing disease or receiving chemotherapy, weakened live viruses may cause a low-grade infection.

In Turkey, the Chinese vaccine expected to be most widely available is an inactivated (killed) coronavirus vaccine. Comprehensive (phase-3) clinical research results for this vaccine have still not been published in a scientific journal, but its developer Sinovac has made an official statement:

The Sinovac vaccine was reported to offer 50.6% protection according to results in Brazil and 91.2% according to studies in Turkey.

• Related Topic: What Does It Mean That the Chinese Vaccine Gives Different Results in Different Countries?

With these data, we generally recommend the Sinovac vaccine for our cancer patients; naturally, decisions should be made individually and patients should consult their oncologists. Inactivated vaccines are expected to be used in cancer patients with a safety profile similar to other vaccines.

Meanwhile, the technology used in the genetic or mRNA vaccines developed by both Pfizer-BioNTech and Moderna was originally developed for cancer treatment, and studies have shown that patients can produce immune responses against cancer-related proteins with this type of vaccine.

These genetic vaccines may be most effective for cancer patients, particularly those with solid-organ tumors.

Our Knowledge of Vaccine Effects in Cancer Patients Is Limited

Neither Pfizer-BioNTech's nor Moderna's early data address cancer patients. The two most important questions for cancer patients concern dosing and booster planning. Potential defects in lymphocyte function among cancer patients may require different initial dosing and booster administrations. Regarding timing, it is unclear how active cancer treatment may affect a patient's immune response to vaccination and whether vaccine timing needs to be adjusted around cancer treatment cycles.

Cancer Patients Should Have Priority in Vaccine Access

Those at higher risk of severe Covid-19 clearly need vaccination more, and abundant data show that cancer patients are at higher risk. However, cancer patients are a mixed group: risk varies with early or advanced stage and cancer type. Cancer therefore does not affect every patient equally. For example, data indicate that lung and blood cancer patients are at higher risk.

Individualized risk factors such as cancer treatment type, tumor site and additional illnesses are therefore likely to shape vaccination choices among cancer patients.

In conclusion, we recommend any approved and accessible coronavirus vaccine for our patients diagnosed with cancer, provided their general condition is suitable. Patients should communicate their particular circumstances and concerns to their oncology teams.

RELATED TOPICS

• Covid-19 Current Statistics for the World and Turkey
• Breaking News and Scientific Developments about Coronavirus

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