Immune-related adverse events and disease outcomes after the third dose of SARS-CoV-2 mRNA-BNT162b2 vaccine in cancer patients receiving immune checkpoint inhibitors.

Abstract

BACKGROUND:

The clinical implications of the third dose of coronavirus disease 2019 (COVID-19) vaccines in patients receiving immune checkpoint inhibitors are currently unknown. We performed a prospective analysis of the Vax-On-Third study to investigate the effects of antibody response on immune-related adverse events (irAEs) and disease outcomes.

METHODS:

Recipients of the booster dose of SARS-CoV-2 mRNA-BNT162b2 vaccine who had received at least one course of an anti-PD-1/PD-L1 treatment before vaccination for an advanced solid malignancy were eligible.

RESULTS:

The current analysis included 56 patients with metastatic disease (median age: 66 years; male: 71%), most of whom had a lung cancer diagnosis and were being treated with pembrolizumab- or nivolumab-based regimens. The optimal cut-point antibody titer of 486 BAU/mL allowed a dichotomization of recipients into low-responders (Low-R, < 486 BAU/mL) or high-responders (High-R, ≥ 486 BAU/mL). After a median follow-up time of 226 days, 21.4% of patients experienced moderate to severe irAEs without any recrudescence of immune toxicities preceding the booster dose. The frequencies of irAE before and after the third dose did not differ, but an increase in the cumulative incidence of immuno-related thyroiditis was observed within the High-R subgroup. On multivariate analysis, an enhanced humoral response correlated with a better outcome in terms of durable clinical benefit, which resulted in a significant reduction in the risk of disease control loss but not mortality.

CONCLUSIONS:

Our findings would strengthen the recommendation not to change anti-PD-1/PD-L1 treatment plans based on current or future immunization schedules, implying that all these patients should be closely monitored.

• Authors: Fabrizio Nelli, Diana Giannarelli, Agnese Fabbri, Antonella Virtuoso, Julio Rodrigo Giron Berrios, Eleonora Marrucci, Cristina Fiore, Marta Schirripa, Carlo Signorelli, Mario Giovanni Chilelli, Francesca Primi, Valentina Panichi, Giuseppe Topini, Maria Assunta Silvestri, Enzo Maria Ruggeri
• Journal: Cancer immunology, immunotherapy : CII (Cancer Immunol Immunother) Vol. 72 Issue 10 Pg. 3217-3228 (Oct 2023) ISSN: 1432-0851 [Electronic] Germany
• PMID: 37428196 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• BNT162 Vaccine
• Immune Checkpoint Inhibitors
• B7-H1 Antigen
• RNA, Messenger

Topics

• Humans
• Male
• Aged
• BNT162 Vaccine
• Immune Checkpoint Inhibitors
• B7-H1 Antigen
• SARS-CoV-2
• COVID-19 (prevention & control)
• Neoplasm Recurrence, Local
• RNA, Messenger