key: cord-0764007-grulu27k
authors: Di Noia, V.; Pimpinelli, F.; Renna, D.; Maccallini, M.T.; Gariazzo, L.; Riva, F.; Sperandio, E.; Giannarelli, D.; Cognetti, F.
title: Potentiation of humoral response to BNT162b2 vaccine after the third dose in patients with solid cancer
date: 2022-02-22
journal: Ann Oncol
DOI: 10.1016/j.annonc.2022.02.006
sha: b00991f74160258aa74fd4a1c7a7f45445cb220d
doc_id: 764007
cord_uid: grulu27k

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We had previously reported on the immunogenicity of the BNT162b2 mRNA COVID-19 vaccine (Tozinameran) in a large cohort of patients with cancer after the first and the second doses 1 and we subsequently showed the rapid decline of humoral response over time until 6 months of follow-up. [2] [3] Herein, we describe the serological response to the third dose (also called booster or additional dose) of the vaccine in this frail population.

Study design and methods were reported in supplementary materials. 1 From September to November 2021, 407 patients received the additional third dose at 4-6 months after the completion of their primary vaccine series. The median age was 67 (range 24-89) years.

Breast cancer (28.5%) and lung cancer (19.9%) were the most common tumor subtypes. Most patients (366/407, 89.9%) were on active anti-cancer treatment during the 28-days before the administration. (Fig.1C) .

No severe adverse events after the third dose were observed.

The present study is properly powered to evaluate humoral response to the third dose of the vaccine in patients with cancer. Previous studies were strongly limited by small sample sizes. [4] [5] [6] Our results showed a globally positive response to the additional dose of BNT162b2 mRNA COVID-19 vaccine in patients affected by solid cancer with a relevant potentiation of the humoral response initially acquired after the 2-dose cycle. Although a very high seroconversion rate followed the additional dose, there was a very small subgroup of patients with no detectable humoral response even after the third dose. For these patients, further studies are warranted to assess the existence of other types of immunity (i.e. T-cell immunity) and to explore its correlation with protection from infection.

Nevertheless, the active anticancer treatment did not affect the serological immune response to the third dose and patients receiving chemotherapy seems not have weaker humoral response compared with patients undergoing other types of treatment, in contrast with our previous observations regarding the two doses of the vaccine. [1] [2] [3] The chronic use of steroids was associated with a weaker humoral response also for the third dose.

The present study is still ongoing to evaluate the durability of immune response to the additional dose in a long-term period.

A logarithm scale was used for IgG titer. Inside each box plot, the geometric mean concentrations  standard errors were represented by a black point with error bars; the median is depicted as a thick horizontal line No statistically significant differences were found according to the type of treatment using ANOVA test (p=0.065) *Therapy with monoclonal antibodies including anti-angiogenics and anti-HER-2 § Target therapy is referred to the use of tyrosine kinases inhibitors Dot plots of anti-S IgG titer assessed before and after the additional dose (B) and post-second and third dose (C). A logarithm scale was used for IgG titer. The grey area is the area below the prefixed cut-off of positivity. Inside each dot plot, the geometric mean concentrations  standard errors were represented by a black point with error bars; the median is depicted as a red asterisk. All comparison were significant at p<0.001.

Immunogenicity and safety of COVID-19 vaccine BNT162b2 for patients with solid cancer: a large cohort prospective study from a single institution

Clinical characteristics limiting the durability of humoral response to BNT162b2 in patients with solid cancer

Rapid decline of humoral response to two doses of BNT162b2 vaccine in patients with solid cancer after 6-months: the urgent need of the additional dose!. EJC 2022

Assessment of Response to a Third Dose of the SARS-CoV-2 BNT162b2 mRNA Vaccine in Patients With Solid Tumors Undergoing Active Treatment

Efficacy of booster doses in augmenting waning immune responses to COVID-19 vaccine in patients with cancer. Cancer cell

SARS-CoV-2 Antibody Response to 2 or 3 Doses of the BNT162b2 Vaccine