key: cord-0732170-x59daymp
authors: Mislang, Anna Rachelle; Soto-Perez-de-Celis, Enrique; Russo, Chiara; Colloca, Giuseppe; Williams, Grant R.; O'Hanlon, Shane; Cooper, Lisa; O'Donovan, Anita; Audisio, Riccardo A.; Cheung, Kwok-Leung; Sarrió, Regina Gironés; Stauder, Reinhard; Jaklitsch, Michael; Cairo, Clarito; Gil, Luiz Antonio; Sattar, Schroder; Kantilal, Kumud; Loh, Kah Poh; Lichtman, Stuart M.; Brain, Etienne; Wildiers, Hans; Kanesvaran, Ravindran; Battisti, Nicolò Matteo Luca
title: The SIOG COVID-19 working group recommendations on the rollout of COVID-19 vaccines among older adults with Cancer
date: 2021-03-05
journal: J Geriatr Oncol
DOI: 10.1016/j.jgo.2021.03.003
sha: a509bd2f4a06b2d5373be121b4c583b18c1cf47f
doc_id: 732170
cord_uid: x59daymp

nan

mass immunization is perhaps a more effective preventive health measure and potentially a key exit strategy from this crisis.

To date, data on eight COVID-19 vaccines have been successfully submitted for authorization by the World Health Organization (2) , five vaccines have reported results on efficacy and/or safety (Table 1) , and over 50 are at various stages of development. As vaccines are made available to the general population, their rollout should be prioritized for those at higher risk of adverse outcomes including hospitalization and/or death. Older individuals are traditionally excluded from or underrepresented in clinical trials, and the same holds true for COVID-19 vaccine studies (3) . Similarly, patients with cancer, comorbidities, or immunosuppression have been excluded. Therefore, clinicians are expected to make recommendations based on the risk-benefit ratio and extrapolation of trial data to the real world until more information becomes available.

The efficacy of vaccines relies on an intact host response, which could be disrupted in people with myelosuppression due to cancer or its treatment. Age-related dysregulation and immune dysfunction, called immunosenescence, could potentially result in lower immunogenicity of vaccines in older adults (4) . Physical exercise may augment vaccine-specific antibody responses; however, activities are limited by the imposed counter-pandemic measures. An adjuvanted vaccine may be used to overcome immunosenescence, as shown in the AZD1222 trial (5) .

Variability in the relationship between neutralizing-and binding-antibody titres in older adults was seen in the Ad26.COV2.S trial (6) . Nevertheless, vaccine efficacy appears to be consistent in older subgroups with a trend for lower reactogenicity (Table 1) . Notably, these findings are all based on short-term analyses, where the long-term efficacy is still unclear. Also, these studies did not include frailty measures nor large groups of older individuals, which limit the characterization of those recruited. Longer follow-up from vaccine trials will provide insight into the impact of vaccination on COVID-19 transmissibility, asymptomatic infections, or emerging mutant strains. The role of anticancer treatments, age, frailty and functional status on vaccine efficacy also needs to be investigated. Despite these caveats, the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group advocates for a call to action to prioritize older adults with cancer in the vaccine J o u r n a l P r e -p r o o f rollout to protect this vulnerable group from the adverse outcomes of COVID-19, even in the absence of robust data.

The SIOG COVID-19 Working Group supports the following recommendations on the rollout of the COVID-19 vaccines for all older patients with cancer:

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