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Identify cancer patients at highest risk of breakthrough COVID

Identify cancer patients at highest risk of breakthrough COVID


Editor’s Note: See Medscape’s latest COVID-19 news and guidance. coronavirus resource center.

Cancer patients who had an undetectable antibody response after vaccination with COVID-19 had a three-fold higher risk of SARS-CoV-2 breakthrough infection and an increased risk of infection-related hospitalization than those with a positive antibody response. More than six times higher, new research reveals. .

The findings support the use of the SARS-CoV-2 spike protein antibody test to identify patients with the lowest levels of antibody-derived protection and immunity against the virus, the researchers conclude. increase.

“Antibody testing can empower these individuals to take additional precautions to reduce their risk of infection,” says lead author Lennard YW Lee, DPhil, University of Oxford, UK and I am writing with a colleague.

research is publish online December 22nd JAMA Oncology.

people who are Immunodeficiencyincluding cancer patients, are much more likely experience a breakthrough infection After COVID-19 vaccination. However, identifying the people with the lowest degree of protection and thus the highest risk of breakthrough infections is still unclear.

In the current study, Lee and colleagues aimed to understand whether the risk of breakthrough SARS-CoV-2 infection or hospitalization in cancer patients is associated with post-vaccination antibody responses.

Using the UK National COVID Cancer Antibody Survey, the researchers analyzed 4,249 SARS-CoV-2 spike protein antibody test results from 3,555 cancer patients in the general population and 294,230 SARS-CoV-2 spike protein antibody test results from 225,272 non-cancer control patients. evaluated the test results. Antibody testing was performed after the second or third vaccination.

In both the cancer and control groups, individuals who received the third dose had significantly higher antibody titers than those who received only two doses (11,146.5 vs. 8765 U/mL in the cancer cohort, control group 23,667 vs. 12,126.0 U/mL). cohort).

Lee and colleagues found that cancer patients were significantly more likely than cancer-free controls to have an undetectable antispike antibody response (4.68% vs. 0.13%; P. < .001).

leukemia or lymphoma Antibody titers were lowest—19.3% had no detectable vaccine antibody response, compared with 4.2% of patients with solid organ tumors and 0.1% of control patients. Patients receiving systemic anticancer therapy and those with stage IV cancer also tended to have lower antibody titers.

After multivariate adjustment, cancer patients with undetectable antibody responses had a 3-fold higher risk of SARS-CoV-2 breakthrough infection (odds ratio). [OR]3.05; P. < .001) and a 6.5-fold higher risk of SARS-CoV-2-related hospitalization (OR, 6.48; P. < .001) than those showing a positive antibody response.

Overall, in the cancer cohort, 259 patients had a breakthrough infection and 55 patients experienced SARS-CoV-2-related hospitalization after antibody testing. Patients who were hospitalized had significantly lower median antibody titers than those who were not (147.0 U/mL vs. 10,961.0 U/mL).

The findings suggest that the SARS-CoV-2 spike protein antibody test “can identify cancer patients with the lowest levels of antibody-derived protection and immunity against SARS-CoV-2 and COVID-19.” , the authors conclude. They say, to their knowledge, this is the first study to demonstrate such an association.

The authors admit that they have not adequately evaluated the time from vaccination to antibody testing or control for the effects of viral variants. This study was done at the end of the Delta wave and the beginning of the Omicron wave.

Nonetheless, Lee et al. conclude that “broader access to antibody testing for cancer patients needs to be evaluated.” This “may help inform national guidance for clinicians to advise patients, and may provide risk-monitoring strategies that can be used to guide immunization booster programs.”

The findings may also help individuals make more informed choices about personal risks and precautions to reduce the risk of infection and transmission.

However, the authors say antibody testing is “only part of a larger strategy that includes collective efforts to make life safer for vulnerable and immunocompromised patients, including ventilation, filtration and two-way masking.” says.

author of Accompanying editorial efforts to expand vaccine counseling and access, improve access to antibody testing, and provide education on topics ranging from how the virus spreads to how to reduce household transmission, among the most vulnerable. Suggest additional strategies to support people’s needs.

Overall, the editors conclude that the study provides “compelling” evidence that cancer patients are more vulnerable to COVID-19, stating that “vaccines and antibody tests It is a key component of a comprehensive strategy to protect the most vulnerable oncology patients in the ongoing COVID-19.19 pandemic.”

This research was supported by the Universities of Oxford, Birmingham, Southampton, Health and Security UK, and Hematologic Cancers UK. A complete list of author disclosures is available in the original article. The editors have not disclosed any relevant financial relationships.

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