Introduction
Lung cancer (LC) patients (p) represent a subgroup of p in whom the infection by SARS-CoV-2 could attained higher rates of morbidity and mortality. Therefore, those p were recommended to receive SARS-CoV-2 vaccines (V) once they were approved. However, little was known regarding the degree of immunity after vaccination, potential interactions with oncology treatments and V-adverse events (AE) in this population. More uncertainty involved the need for a third (3) dose (D) of the V in this population or its efficacy in controlling the Omicron variant, which ousted Delta variant by the end of 2021 in Spain. The aim of this prospective study is to evaluate the immune response to the SARS-CoV-2 V in LCp. Secondary objectives include V-related AE, V impact on survival, immune response, toxicity and survival outcomes in p>75 y, (re)infection after V, complications and mortality.
Methods
LCp who receive the V against SARS-COV-2 were candidates to participate in this study. A pre-V quantitative IgG spike determination was performed to identify p with previous infection, but asymptomatic course. After V, IgG have been repeated at 3-6, 7-9, and 12 months since the first (1) D. V-related AEs, serological results, clinical data, and survival have been collected.
Results
From 3/31-5/15, 2021 126 p have participated in the study. 61.9% were male, median age was 66 y (46- 83), 88.1% were NSCLC, 76% had stage IV at diagnosis. Systemic therapy included EGFR/ALK/ROS1/RET/MET oral inhibitors (19.9%), immunotherapy (IT) (41.8%), IT-chemotherapy (CT) (14.1%) and CT (19.9%). 9p were not receiving active therapy. 9 p had COVID symptomatic infection prior any dose of the V, with positive baseline IgG in 6p. No vaccine-related AE were reported in this group. 4 additional p had positive baseline IgG. Out of 126 p, 94.3% received MODERNA® on behalf of the Hospital Vaccination Program for 1 and 2 D. 97p (77%) received MODERNA® as third (3)D according to National Health Care guidelines. AES with 1-2D were generally mild and included local pain (35%), asthenia (6%) and myalgia (4%). These were slightly more frequent in p>75, especially after 2D (42%, 15%, 42%). More frequent AE after 3D included pain (20.6%), asthenia (6.2%) and myalgia (7.2%). Pain after 3D occurred in 21.1% of p>75. All but 1p developed IgG after 1-2D. Median IgG levels were 2228.9 UI/mL (9,91-8169) at 3-6 months (m), which were sustained at 7-9 m [2335.8 UI/mL, (87-3696)]. All p>75 seroconverted. 9 infections occurred after V during the sixth wave of pandemic (all a/paucisymptomatic with no admissions). 4 out of these 9 p had received 3D, 2 of them were reinfections. 32 deaths were reported in this cohort, with no COVID-related deaths
Conclusions
• SARS-COV-2 V are safe irrespective of systemic therapy in our cohort of LCp.• AE and efficacy were similar regardless the age groups.• Most of the p developed immunity after 2D , which was maintained over time.• Rates of infection were low but more frequent with the Omicron variant and with milder clinical course after V.
Keywords
SARS-CoV-2, Vaccine, Lung Cancer