COVID-19 Booster Shot Helps Vast Majority of Cancer Patients

Most cancer patients who had no measurable immune response after being fully vaccinated for COVID-19 were helped by a third vaccine dose, according to a new study by investigators at the Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine and Montefiore Health System. The findings, published online Monday, November 15th, in Cancer Cell, also show that a "booster" shot is extremely beneficial for all cancer patients, who face a heightened risk of severe disease and dying from COVID-19, and particularly in people who have a blood cancer.

"The speed of recommendations and treatments for COVID-19 has been incredible, but many questions have remained regarding the safety and necessity of booster shots," said Lauren Shapiro, M.D., co-first author of the paper with Astha Thakkar, M.B.B.S, both third-year hematology/oncology fellows at Montefiore Medical Center and Albert Einstein College of Medicine. "Our research now gives data-driven answers about when vaccine protection from COVID-19 wanes for immunocompromised individuals and offers clear guidance about the necessity of vaccination for people with cancer." 

The study involved two groups of patients with cancer. The first was composed of 99 people who were fully vaccinated against COVID-19. They were tested after their initial vaccination for the presence of antiviral antibodies in their blood—the sign of an active immune response that would reduce their risk of severe disease and death from COVID-19. For most patients with detectable antibodies, their antibody levels declined when testing was repeated 4 to 6 months later.

The people in the second group, made up of 88 fully vaccinated patients with cancer, were also tested for the presence of antiviral antibodies in their blood. Sixty-four percent of them had detectable antibodies, while the remaining patients (all but one of whom had blood cancer) tested negative for antibodies. All participants—people with and without antibodies—then received a booster dose of a COVID-19 vaccine. Four weeks later, when their blood was again tested, 79.5% (70 out of 88 people) had antibody levels that were higher than before they received their booster shot. Most notably, 56% of cancer patients who previously had no detectable antibodies after standard vaccination now had them after receiving their booster shot.

"Our study demonstrates in clear terms how the booster shot can make all the difference for some people with compromised immune systems, such as people with cancer," said Balazs Halmos, M.D., M.S., director of the Multidisciplinary Thoracic Oncology Program at Montefiore Health System, professor of medicine at Albert Einstein College of Medicine, and MECC associate director of clinical science. "As our care for cancer patients and vaccine guidelines evolve, we believe these findings underscore the continued benefit vaccines give to all our patients." Dr. Halmos, along with Amit Verma, M.B.B.S., associate director for translational research at MECC and chief of the division of hemato-oncology in the department of oncology at Montefiore, are co-corresponding authors on the paper.

This study is the fourth from MECC investigators focusing on cancer patients and COVID-19. In a paper published in May 2020 in Cancer Discovery, they  found that COVID-19 patients with blood cancers had significantly higher mortality rates compared with patients who had solid tumors. In a follow-up study published in March 2021 in Nature Cancer, they reported their findings on patients' response to their initial COVID-19 infection. In June 2021, this team reported on cancer patients' initial responses to COVID-19 vaccination in Cancer Cell.

In this new study, participants who received the booster had an average age of 69 and were almost evenly split between men and women. Sixty-five percent had blood cancer and 35% had a solid tumor. Most participants, 70%, were vaccinated with the Pfizer-BioNTech vaccine, 25% with Moderna, and 5% with Johnson & Johnson. Approximately 36% of patients were Caucasian, 33% African American, 22% Hispanic, 8% Asian, and 1% belong to other ethnic groups.

Additional Montefiore-Einstein authors are: Sean Campbell, Ph.D., Stefanie Forest, M.D., Ph.D., Kith Pradhan, Ph.D., Jesus Gonzalez-Lugo, M.D., Ryann Quinn M.D., Tushar D. Bhagat, Ph.D., Gaurav S. Choudhary, Ph.D., Margaret McCort, M.D., M.S., R. Alejandro Sica, M.D., Mendel Goldfinger M.D., Swati Goel, M.D., Jesus Anampa, M.D., M.S., David Levitz M.D., Ariel Fromowitz M.D., Akash Pradip Shah, M.S., Charlotte Sklow, Gregory Alfieri, Andrew Racine, M.D., and Lucia Wolgast M.D. Lee Greenberger, Ph.D. from the Leukemia & Lymphoma Society was also an author.

The paper is titled "Efficacy of booster doses in augmenting waning immune responses to COVID-19 vaccine in patients with cancer." This study was supported in part by the Montefiore Einstein Cancer Center (P30 CA013330), NCORP grant 2UG1CA189859-06), Jane and Myles Dempsey Family Fund, and The Leukemia & Lymphoma Society.

About Albert Einstein College of Medicine

Albert Einstein College of Medicine is one of the nation's premier centers for research, medical education and clinical investigation. During the 2020-21 academic year, Einstein is home to 721 M.D. students, 178 Ph.D. students, 109 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,900 full-time faculty members located on the main campus and at its clinical affiliates. In 2020, Einstein received more than $197 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island. For more information, please visit einsteinmed.org, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.

About Montefiore Health System

Montefiore Health System is one of New York's premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 10 hospitals, including the Children's Hospital at Montefiore, Burke Rehabilitation Hospital and more than 200 outpatient ambulatory care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information, please visit www.montefiore.org. Follow us on Twitter and Instagram and LinkedIn, or view us on Facebook and YouTube.

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