Prevention and Treatment of COVID-19 in Cancer Patients: Challenges in the Omicron Era

The evolution of the SARS-CoV-2 virus presents an ongoing challenge in the prevention and treatment of COVID-19, especially since omicron and its variants began to emerge.

Vaccine development has not kept up with the emergence of new variants. Also, the monoclonal antibodies (mAbs) previously used to prevent and treat his COVID-19 are ineffective against the currently circulating Omicron subvariants.

These developments are of particular concern for patients who are moderately to severely immunocompromised and at increased risk of more severe and persistent symptoms, hospitalization, and death from COVID-19.¹

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Note that many cancer patients are included in that group. Julie Gralow, M.D.Chief Medical Officer and Executive Vice President, American Society of Clinical Oncology (ASCO).

“Patients with hematologic malignancies, solid tumors receiving active cytotoxic chemotherapy or certain immunosuppressive or immunomodulatory biological agents, stem cell or bone marrow transplants and using Patients who may have pneumonia and who are on high-dose corticosteroids meet the CDC’s definition of moderate-to-severe immunodeficiency,” Dr. Gralow explained.

Methods to prevent and treat COVID-19 in these vulnerable patients had to evolve with the SARS-CoV-2 virus.

Vaccine efficacy may vary, but vaccination remains recommended

Even before the emergence of the original Omicron variant (BA.1), cancer patients did not always respond appropriately to COVID-19 vaccination, and the risk of COVID-19 breakthrough and death was , studies suggested it was higher in cancer patients than in the general population. population.^2-6

The breakthrough COVID-19 turned out to be even more common in cancer patients after the emergence of Omicron. Recent studies suggest that cancer patients remain at higher risk of breakthrough COVID-19, hospitalization, and death than the general population.^7,8

Several recent studies in the general population suggest that bivalent mRNA vaccines can provide better protection against omicron subvariants than monovalent mRNA vaccines.^9-11 Other studies suggest that bivalent vaccines may be less effective than monovalent vaccines against currently circulating Omicron subvariants.^12-15

There are limited data showing the efficacy of bivalent vaccines in cancer patients. In one small study, Pfizer-BioNTech’s bivalent vaccine increased his ability to neutralize the virus against the BQ.1.1 subvariant, but not against the XBB.1 and XBB.1.5 subvariants. It was suggested that there was not¹⁶

Antibody responses to vaccination may not be optimal in immunocompromised patients, but “vaccine has the advantage of stimulating multiple arms of the immune system, and even Omicron subvariants have It may offer protection.” Amy Sherman, MDan instructor at Harvard Medical School, an associate physician at Brigham and Women’s Hospital, and a clinician and scientist at the Precision Vaccines Program at Boston Children’s Hospital in Massachusetts.

Patients should be encouraged to get a bivalent booster in addition to the initial monovalent series of vaccines, he said. Sarah Hochman, M.D.Assistant Professor, Grossman School of Medicine, New York University, and Chief of the Infectious Diseases Division, Tisch Hospital, New York, NY.

“As new variants emerge, new vaccines are likely to be created that are better suited to these variants, and it will be important to keep these new boosters up to date,” said Dr. Hochman. .

It has been noted that it is particularly important for hematopoietic stem cell transplant recipients to obtain up-to-date information on vaccination. Dr. Eric Tamis an expert in blood and bone marrow transplantation and hematology oncology at the USC Norris Comprehensive Cancer Center in Keck Medicine, Los Angeles, CA.

“Patients after hematopoietic stem cell transplantation usually need to be re-inoculated three months after the transplant,” he said.