The National Comprehensive Cancer Network (NCCN) has released updated recommendations on COVID-19 vaccination and pre-exposure prophylaxis for patients with cancer.
These recommendations clarify that most patients with active cancer or a recent history of cancer should receive 3 doses of an mRNA COVID-19 vaccine as their primary series.
These patients should also receive 2 booster doses of an mRNA vaccine, for a total of 5 doses.
Specifically, NCCN recommends a 3-dose primary series for:
- Patients with solid tumors who received cancer therapy within 1 year of the initial vaccine administration
- All patients with active hematologic malignancies, regardless of treatment status or type
- Recipients of hematopoietic stem cell transplant (HSCT) or engineered cellular therapy
- Cancer patients who have concurrent immunocompromising conditions, such as HIV, and those receiving systemic corticosteroids and other immunosuppressive agents separate from cancer therapy.
Two booster doses (5 total doses) are recommended for patients who meet these criteria. These patients can receive their first booster as soon as 3 months after completing the primary 3-dose series and the second booster at least 4 months after the first.
Patients with a history of cancer who do not meet the criteria to receive a third primary series vaccine dose should only receive 1 booster dose, at least 5 months after their 2 primary doses.
According to NCCN recommendations, the mRNA vaccines (Pfizer-BioNTech and Moderna) are preferred for the primary series and boosters in most situations. Patients who received a first dose of the Janssen/Johnson & Johnson vaccine should receive a booster dose with an mRNA vaccine.
In fact, mix-and-match dosing for boosters is appropriate across vaccines, according to NCCN. The guidance suggests that heterologous prime boost strategies may have the potential to extend immune protection and could simplify the logistics of vaccine administration. However, the research in this area is ongoing.
Impact of Cancer Treatment, Other Considerations
NCCN recommends that most patients with cancer receive COVID-19 vaccination as soon as possible, regardless of their cancer treatment. However, there are some exceptions.
Patients with solid tumors undergoing major surgery should not be vaccinated within a few days prior to or after their surgery. Vaccination should be delayed at least 3 months for patients undergoing HSCT or receiving cellular therapy.
Patients with hematologic malignancies receiving intensive cytotoxic chemotherapy should not be vaccinated until they experience absolute neutrophil count recovery (unless they are not expected to recover).
The NCCN guidance also recommends pre-exposure prophylaxis with tixagevimab plus cilgavimab (Evusheld) for certain immunocompromised patients, including all individuals undergoing active cancer therapy.
This prophylaxis is not a substitute for vaccination, according to NCCN. Furthermore, there is no need to delay COVID-19 vaccination after receipt of monoclonal antibodies, including tixagevimab plus cilgavimab.
In addition to its recommendations for cancer patients, NCCN recommends that household members and other close contacts of people with cancer get vaccinated according to recommendations from the US Centers for Disease Control and Prevention.
Recommendations of the National Comprehensive Cancer Network® (NCCN®) Advisory Committee on COVID-19 vaccination and pre-exposure prophylaxis. NCCN: Cancer and COVID-19 vaccination. Published April 27, 2022. Accessed April 28, 2022. https://www.nccn.org/covid-19