J Dig Cancer Res.  2022 Dec;10(2):107-111. 10.52927/jdcr.2022.10.2.107.

COVID-19 Vaccination in Patients with Gastrointestinal Cancer Receiving Chemotherapy

• Lee J
• Kim DU

• KMID: 2536428
• DOI: http://doi.org/10.52927/jdcr.2022.10.2.107

Abstract

In 2019, coronavirus disease (COVID-19), which originated in Wuhan, has spread worldwide. In most people, COVID-19 symptoms are not severe. However, the mortality rate and severity were high in risk groups such as in older people and patients with underlying diseases. As patients with cancer are one of the risk groups, the vaccination for COVID-19 is emphasized in these patients. However, COVID-19 vaccines are not tested enough in special groups such as in patients with cancer because these vaccines are developed at an unprecedented speed. This causes confusion about whether patients undergoing chemotherapy should be vaccinated or not. In this study, international guidelines and studies were reviewed. Most of the studies recommended vaccination. No evidences of any negative effects for the efficacy or safety were recorded in patients undergoing cytotoxic, targeted, and immune agents. However, in critical conditions such as cytopenia, vaccination must be decided according to the patient’s condition. COVID-19 vaccines were also recommended for patients on surgery or radiation therapy. If possible, vaccine is given before surgery to avoid confusion between surgical complications and side effects of the vaccine. The radiation recall phenomenon after vaccination has been reported in some cases of radiation therapy. Clinicians should consider these situations before vaccinating each patient. We hope that clearer guidelines will be established by accumulating verified data.

Keyword

Digestive system neoplasm; Coronavirus disease-19 vaccines; Drug therapy; Maintenance chemotherapy

Reference

1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. 2020; The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 5:536–544. https://doi.org/10.1038/s41564-020-0695-z. DOI: 10.1038/s41564-020-0695-z. PMID: 32123347. PMCID: PMC7095448.

2. Williamson EJ, Walker AJ, Bhaskaran K, et al. 2020; Factors associated with COVID-19-related death using OpenSAFELY. Nature. 584:430–436. https://doi.org/10.1038/s41586-020-2521-4. DOI: 10.1038/s41586-020-2521-4. PMID: 32640463. PMCID: PMC7611074.

3. Moghadas SM, Vilches TN, Zhang K, et al. 2021; The impact of vaccination on coronavirus disease 2019 (COVID-19) outbreaks in the United States. Clin Infect Dis. 73:2257–2264. https://doi.org/10.1093/cid/ciab079. DOI: 10.1093/cid/ciab079. PMID: 33515252. PMCID: PMC7929033.

4. Yang L, Chai P, Yu J, Fan X. 2021; Effects of cancer on patients with COVID-19: a systematic review and meta-analysis of 63,019 participants. Cancer Biol Med. 18:298–307. https://doi.org/10.20892/j.issn.2095-3941.2020.0559. DOI: 10.20892/j.issn.2095-3941.2020.0559. PMID: 33628602. PMCID: PMC7877167. PMID: d7a4bbd7e3224293ad3bd9b1d1a513e2.

5. Li Q, Chen L, Li Q, et al. 2020; Cancer increases risk of in-hospital death from COVID-19 in persons <65 years and those not in complete remission. Leukemia. 34:2384–2391. https://doi.org/10.1038/s41375-020-0986-7. DOI: 10.1038/s41375-020-0986-7. PMID: 32690880. PMCID: PMC7371786.

6. Lee LYW, Cazier JB, Starkey T, et al. 2020; COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol. 21:1309–1316. 21Erratum in: Lancet Oncol 2020;21:e462. DOI: 10.1016/S1470-2045(20)30442-3. PMID: 32853557. PMCID: PMC7444972.

7. Pinato DJ, Tabernero J, Bower M, et al. 2021; Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study. Lancet Oncol. 22:1669–1680. https://doi.org/10.1016/S1470-2045(21)00573-8. DOI: 10.1016/S1470-2045(21)00573-8. PMID: 34741822. PMCID: PMC8565932.

8. Desai A, Gainor JF, Hegde A, et al. 2021; COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials. Nat Rev Clin Oncol. 18:313–319. 18Erratum in: Nat Rev Clin Oncol 2021;18:320. DOI: 10.1038/s41571-021-00487-z. PMID: 33723371. PMCID: PMC7957448.

9. Shehata MA, Karim NA. 2014; Influenza vaccination in cancer patients undergoing systemic therapy. Clin Med Insights Oncol. 8:57–64. https://doi.org/10.4137/CMO.S13774. DOI: 10.4137/CMO.S13774. PMID: 24855405. PMCID: PMC4011725.

10. Shah MK, Kamboj M. 2018; Immunizing cancer patients: which patients? Which vaccines? When to give? Oncology (Williston Park). 32:254–258. C3PMID: 29847857.

11. Sakuraba A, Luna A, Micic D. 2022; Serologic response following SARS-COV2 vaccination in patients with cancer: a systematic review and meta-analysis. J Hematol Oncol. 15:15. https://doi.org/10.1186/s13045-022-01233-3. DOI: 10.1186/s13045-022-01233-3. PMID: 35123511. PMCID: PMC8817639. PMID: 6501595620eb4409b5205f23b23faae8.

12. Becerril-Gaitan A, Vaca-Cartagena BF, Ferrigno AS, et al. 2022; Immunogenicity and risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection after Coronavirus Disease 2019 (COVID-19) vaccination in patients with cancer: a systematic review and meta-analysis. Eur J Cancer. 160:243–260. https://doi.org/10.1016/j.ejca.2021.10.014. DOI: 10.1016/j.ejca.2021.10.014. PMID: 34794855. PMCID: PMC8548030.

13. Chiarella SE, Jenkins SM, Smith CY, et al. 2022; Predictors of seroconversion after coronavirus disease 2019 vaccination. Ann Allergy Asthma Immunol. 129:189–193. https://doi.org/10.1016/j.anai.2022.05.026. DOI: 10.1016/j.anai.2022.05.026. PMID: 35640775. PMCID: PMC9144839.

14. Cavanna L, Citterio C, Biasini C, et al. 2021; COVID-19 vaccines in adult cancer patients with solid tumours undergoing active treatment: seropositivity and safety. A prospective observational study in Italy. Eur J Cancer. 157:441–449. https://doi.org/10.1016/j.ejca.2021.08.035. DOI: 10.1016/j.ejca.2021.08.035. PMID: 34601285. PMCID: PMC8410513.

15. Rousseau B, Loulergue P, Mir O, et al. 2012; Immunogenicity and safety of the influenza A H1N1v 2009 vaccine in cancer patients treated with cytotoxic chemotherapy and/or targeted therapy: the VACANCE study. Ann Oncol. 23:450–457. https://doi.org/10.1093/annonc/mdr141. DOI: 10.1093/annonc/mdr141. PMID: 21576285.

16. Keam B, Kim MK, Choi Y, et al. 2017; Optimal timing of influenza vaccination during 3-week cytotoxic chemotherapy cycles. Cancer. 123:841–848. https://doi.org/10.1002/cncr.30468. DOI: 10.1002/cncr.30468. PMID: 27997703.

17. National Comprehensive Cancer Network^® (NCCN^®). 2022. Recommendations of the NCCN^® advisory committee on COVID-19 vaccination and pre-exposure prophylaxis. NCCN®;DOI: 10.1002/cncr.30468.

18. European Society for Medical Oncology (ESMO). 2021. ESMO statements on vaccination against COVID-19 in people with cancer. ESMO;Lugano: DOI: 10.1002/cncr.30468.

19. Mulder SF, Jacobs JF, Olde Nordkamp MA, et al. 2011; Cancer patients treated with sunitinib or sorafenib have sufficient antibody and cellular immune responses to warrant influenza vaccination. Clin Cancer Res. 17:4541–4549. https://doi.org/10.1158/1078-0432.CCR-11-0253. DOI: 10.1158/1078-0432.CCR-11-0253. PMID: 21712444.

20. Oosting SF, van der Veldt AAM, GeurtsvanKessel CH, et al. 2021; mRNA-1273 COVID-19 vaccination in patients receiving chemotherapy, immunotherapy, or chemoimmunotherapy for solid tumours: a prospective, multicentre, non-inferiority trial. Lancet Oncol. 22:1681–1691. https://doi.org/10.1016/S1470-2045(21)00574-X. DOI: 10.1016/S1470-2045(21)00574-X. PMID: 34767759. PMCID: PMC8577843.

21. Keam B, Kang CK, Jun KI, et al. 2020; Immunogenicity of influenza vaccination in patients with cancer receiving immune checkpoint inhibitors. Clin Infect Dis. 71:422–425. https://doi.org/10.1093/cid/ciz1092. DOI: 10.1093/cid/ciz1092. PMID: 31680143.

22. Centers for Disease Control and Prevention (CDC). 2021. Pfizer-BioNTech COVID-19 vaccine reactions & adverse events. CDC;Atlanta: DOI: 10.1093/infdis/jiaa291.

23. Soyfer V, Gutfeld O, Shamai S, Schlocker A, Merimsky O. 2021; COVID-19 vaccine-induced radiation recall phenomenon. Int J Radiat Oncol Biol Phys. 110:957–961. https://doi.org/10.1016/j.ijrobp.2021.02.048. DOI: 10.1016/j.ijrobp.2021.02.048. PMID: 33677050. PMCID: PMC7930806.

24. Stewart R, McDowell L. 2021; Radiation recall phenomenon following COVID-19 vaccination. Int J Radiat Oncol Biol Phys. 111:835–836. https://doi.org/10.1016/j.ijrobp.2021.06.023. DOI: 10.1016/j.ijrobp.2021.06.023. PMID: 34153381. PMCID: PMC8267757.