key: cord-0822513-hecunq23
authors: Tougeron, David; Hentzien, Maxime; Seitz-Polski, Barbara; Bani-Sadr, Firouze; Bourhis, Jean; Ducreux, Michel; Gaujoux, Sébastien; Gorphe, Philippe; Guiu, Boris; Hoang-Xuan, Khe; Huguet, Florence; Lecomte, Thierry; Lièvre, Astrid; Louvet, Christophe; Maggiori, Léon; Mansi, Laura; Mariani, Pascale; Michel, Pierre; Servettaz, Amélie; Thariat, Juliette; Westeel, Virgine; Aparicio, Thomas; Blay, Jean-Yves; Bouché, Olivier
title: SARS-CoV-2 vaccination for patients with solid cancer: review and point of view of a French oncology inter-group (CGO, TNCD, UNICANCER)
date: 2021-04-01
journal: Eur J Cancer
DOI: 10.1016/j.ejca.2021.03.030
sha: e34cbcf20fba0b292e3d88626acdbb4853acdeaf
doc_id: 822513
cord_uid: hecunq23

The impacts of SARS-CoV-2 pandemic on cancer care are multiple, entailing a high risk of death from COVID-19 in cancer patients treated by chemotherapy. SARS-CoV-2 vaccines represent an opportunity to decrease the rate of severe COVID-19 cases in cancer patients and also to restore normal cancer care. Cancer patients to be targeted for vaccination are difficult to define due to the limited contribution of these patients in the phase III trials testing the different vaccines. It seems appropriate to vaccinate not only cancer patients with ongoing treatment or with a treatment having been completed less than 3 years ago, but also household and close contacts. High-risk cancer patients who are candidates for priority access to vaccination are those treated by chemotherapy. The very high-priority population includes patients with curative treatment and palliative first or second-line chemotherapy, as well as patients requiring surgery or radiotherapy involving a large volume of lung, lymph nodes and/or hematopoietic tissue. When possible, vaccination should be done before cancer treatment begins. SARS-CoV-2 vaccination can be performed during chemotherapy while avoiding periods of neutropenia and lymphopenia. For organisational reasons, vaccination should be performed in cancer care centers and may use mRNA vaccines or non-replicating adenoviral vaccines in non-immunocompromised patients under 65 years old. Considering the current state of knowledge, the benefit-risk ratio strongly favours SARS-CoV-2 vaccination of all cancer patients. In order to obtain more data concerning the safety and effectiveness of vaccines, it is necessary to implement cohorts of vaccinated cancer patients.

a H epatolog y and gastroenterolog y departm ent, P oitiers university hospital and U niversity of P oitiers, P oitiers, F F C D , F rance.

b Internal m edicine and infectious diseases departm ent, R eim s university hospital, R eim s, F rance.

c Im m unolog y laboratory, U R 2C A , N ice university hospital, N ice, F ranc e. d R adiotherapy departm ent, V aud university hospital, L ausanne, G O R T E C /Intergroupe O R L , S witzerland. e D igestive oncolog y departm ent, G ustave R oussy institute, V illejuif, P aris-S aclay university, U N IC A N C E R , F rance.

f D ig estive surgery departm ent, P itié-S alpêtrière hospital, A P -H P , P aris, A C H B T , F ranc e. g C ervico-F acial departm ent, G ustave R oussy institute, V illejuif, P aris-S aclay U niversity,

Intergroupe O R L , F ranc e. h R adiolog y departm ent, M ontpellier university hospital, M ontpellier, S F R , F rance.

i N eurolog y departm ent, P itié-S alpêtrière hospital, A P -H P , P aris-S orbonne U niversité, P aris, IG C N O -A N O C E F F ranc e. j R adiotherapy departm ent, T enon hospital, S orbonne U niversité, A P H P , Institut U niversitaire de C ancérologie, P aris, S F R O , F ranc e. k H epatolog y, g astroenterolog y and digestive onc olog y departm ent, T ours university hospital No drug treatment, except corticosteroid and tocilizumab, has been shown with a high level of evidence to achieve a decreased rate of severe C OV ID-19. SARS-C oV -2 vaccine consequently represents a major hope for cancer patents, by not only limiting severe C OV ID-

The current perspective is focused on SARS-CoV-2 vaccination of adult patients with solid

Our proposals are based on the scientific data concerning SARS-CoV-2 vaccines available on 

disease specialists. In many respects, the available data are sparse, with a low level of evidence (expert agreement or expert opinion).

In about 80% of symptomatic cases of COVID-19, patients do not require special monitoring.

In less than 20% of cases, COVID-19 progress to severe symptoms including an acute respiratory syndrome with a cytokine storm partially related to an insufficient type I and II interferon response [18] . The interferon response decreases not only with age, but also in cancer patients [19] . More specifically, severe COVID-19 in cancer patients is due to the cancer itself, treatments, and the severe comorbidities that are frequently present in these patients.

J o u r n a l P r e -p r o o f

According to country, different SARS-C oV -2 vaccines are available, and several have been approved or are in development (Table 1 ). The Spike protein is the "key" that allows SARS-C oV -2 to enter into our cells and is the target of vaccines. The first two vaccines approved by adenovirus vaccines). The first of these, which is 60-70% effective, was recently been approved by the EMA but remains restricted to the population under 65 years of age, pending ongoing studies in elderly patients [22] . Recently the Russian Sputnik V ® vaccine showed 91.6% efficacy in a phase 3 study [23] . To date, while there exist no specific data on cancer patients, it bears mentioning that these viral vectors, which are non-replicating, are not contraindicated in immunocompromised patients. Indeed, while immunocompromised patients have presented a lower seroconversion rate after influenza vaccine, clinical efficacy is preserved (78% decrease of mortality) [25] .

Research on mRNA vaccines started 20 years ago, especially on anti-cancer vaccines with no safety issues [26] . In Phase II/III trials with the Pfizer/BioNTech BNT162b2 vaccine, 4% of patients had previous HIV infection or cancer [20] . Results in this group are not available, but vaccine safety in the overall population was excellent. There is no reason that immunosuppression can lead to adverse events following mRNA vaccines.

Regarding non-replicating viral vector, in the phase III trial with Astra Zeneca/University of Oxford AZD1222 vaccine, immunosuppression was an exclusion criterion [22] . 

effective in patients treated with immune checkpoint inhibitors [28] . All SARS-COV-2 vaccine is possible in cancer patients treated with immune checkpoint inhibitors (Table 2 ) [17] . Nevertheless, it seems reasonable to postpone vaccination in patients with an ongoing severe autoimmune side effect.

On 

The official French guidelines to protect patients with cancer against SARS-CoV-2 infection

Proposals for managing patients with thoracic malignancies during COVID-19 pandemic

Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic

French Sarcoma Group proposals for management of sarcoma patients during the COVID-19 outbreak

Practical recommendations for the management of patients with gastroenteropancreatic and thoracic (carcinoid) neuroendocrine neoplasms in the COVID-19 era

European Society for Medical Oncology. The ESMO Call to Action on COVID-19 vaccinations and patients with cancer: Vaccinate. Monitor. Educate

Priority COVID-19 vaccination for patients with cancer while vaccine supply is limited

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Σοχιετψ φορ Ιµ µ υνοτηεραπψ οφ Χανχερ. ΣΙΤΧ στατεµ εντ ον ΣΑΡ Σ−Χος −2 ϖαχχινατιον ανδ χανχερ ιµ µ υνοτηεραπψ

Ιµ παιρεδ τψπε Ι ιντερφερον αχτιϖιτψ ανδ ινφλαµ µ ατορψ ρεσπονσεσ ιν σεϖερε ΧΟς Ι∆ −19 πατιεντσ

Ιµ µ υνολογιχαλ φεατυρεσ οφ χοροναϖιρυσ δισεασε 2019 ιν πατιεντσ ωιτη χανχερ

Σαφετψ ανδ Εφφιχαχψ οφ τηε ΒΝΤ162β2 µ Ρ ΝΑ Χοϖιδ−19 ς αχχινε

Εφφιχαχψ ανδ Σαφετψ οφ τηε µ Ρ ΝΑ−1273 ΣΑΡ Σ−Χος −2 ς αχχινε

Σαφετψ ανδ εφφιχαχψ οφ τηε ΧηΑδΟξ1 νΧος −19 ϖαχχινε (ΑΖ∆ 1222) αγαινστ ΣΑΡ Σ−Χος −2: αν ιντεριµ αναλψσισ οφ φουρ ρανδοµ ισεδ χοντρολλεδ τριαλσ ιν Βραζιλ, Σουτη Αφριχα, ανδ τηε ΥΚ

Σαφετψ ανδ εφφιχαχψ οφ αν ρΑδ26 ανδ ρΑδ5 ϖεχτορ−βασεδ ηετερολογουσ πριµ ε−βοοστ ΧΟς Ι∆ −19 ϖαχχινε: αν ιντεριµ αναλψσισ οφ α ρανδοµ ισεδ χοντρολλεδ πηασε 3 τριαλ ιν Ρ υσσια

Σεροχονϖερσιον ιν πατιεντσ ωιτη χανχερ ανδ ονχολογψ ηεαλτη χαρε ωορκερσ ινφεχτεδ βψ ΣΑΡ Σ−Χος −2

Χλινιχαλ εφφεχτιϖενεσσ οφ ινφλυενζα ϖαχχινατιον ιν περσονσ ψουνγερ τηαν 65 ψεαρσ ωιτη ηιγη−ρισκ µ εδιχαλ χονδιτιονσ : τηε ΠΡ ΙΣΜΑ στυδψ

Περσοναλιζεδ Ρ ΝΑ µ υτανοµ ε ϖαχχινεσ µ οβιλιζε πολψ−σπεχιφιχ τηεραπευτιχ ιµ µ υνιτψ αγαινστ χανχερ

Αλλεργιχ ρεαχτιονσ ινχλυδινγ αναπηψλαξισ αφτερ ρεχειπτ οφ τηε φιρστ δοσε οφ Πφιζερ−ΒιοΝΤεχη ΧΟς Ι∆ −19 ϖαχχινε

Στατε οφ τηε αρτ αβουτ ινφλυενζα ϖαχχινατιον φορ αδϖανχεδ χανχερ πατιεντσ ρεχειϖινγ ιµ µ υνε χηεχκποιντ ινηιβιτορσ: Ω ηεν χοµ µ ον σενσε ισ νοτ ενουγη

Μορταλιτψ ανδ πυλµ οναρψ χοµ πλιχατιονσ ιν πατιεντσ υνδεργοινγ συργερψ ωιτη περιοπερατιϖε ΣΑΡ Σ−Χος −2 ινφεχτιον: αν ιντερνατιοναλ χοηορτ στυδψ

ΣΑΡ Σ−Χος −2 ϖαχχινατιον ανδ πηασε 1 χανχερ χλινιχαλ τριαλσ

The authors thank Jeffrey A rsham, as he helped with the English language revision of the manuscript.

None declared.

This research did not receive any specific grant from funding agencies in the public, commercial or not-for profit sectors.

The authors have no financial disclosures to declare.J o u r n a l P r e -p r o o f