COVID-19 vaccination is safe and efficacious for cancer patients receiving immune checkpoint inhibitors (ICIs) and should not interrupt therapy, according to researchers.
The researchers observed a low rate of new immune-related adverse events (irAEs) among patients who were vaccinated within 90 days of ICI treatment. In addition, there was no excess risk of COVID-19 in this patient group, the researchers reported.
The team reported these results in the Journal of the National Comprehensive Cancer Network.
The researchers conducted an electronic pharmacy record analysis of patients with cancer who received a COVID-19 mRNA vaccine between January 16, 2021, and March 27, 2021. Patients also received ICI therapy within 90 days before or after their first vaccine dose.
A total of 408 patients (median age, 71 years; 53% men) were included in the study. Patients were receiving treatment for thoracic cancer (30%), genitourinary cancer (21%), upper gastrointestinal cancer (12%), melanoma (12%), gynecologic cancer (10%), sarcoma (5%), head and neck cancer (5%), lower gastrointestinal cancer (3%), glioblastoma (1%), lymphoma (1%), and breast cancer (1%).
The ICIs patients received included pembrolizumab only (65%), nivolumab only (24%), combination ipilimumab plus nivolumab (10%), ipilimumab only (0.7%), or all 3 agents (0.3%). Most patients (95%) received the Pfizer-BioNTech COVID-19 vaccine.
The researchers followed patients for 90 days after the first vaccine dose. During that time, 27 patients (7%) experienced a new irAE — 21 with grade 1 events, 2 with grade 2 events, and 4 with grade 3 events.
Grade 1 events included dermatitis (n=10), arthralgias (n=3), diarrhea (n=2), pneumonitis (n=2), transaminitis (n=2), thyroiditis (n=1), and arthritis and rash (n=1). The grade 2 events were pneumonitis (n=1) and arthritis and rash (n=1). The grade 3 events were diarrhea (n=3) and colitis (n=1).
Among 54 patients with previous irAEs from ICIs, 3 (6%) experienced a recurrent irAE after vaccination. Among 52 patients who started a new immunotherapy agent after vaccination, 9 (17%) had an irAE.
Two patients were diagnosed with COVID-19 after vaccination. Eleven patients had been diagnosed with COVID-19 before vaccination.
“Our data do not show a higher risk of immune toxicity among ICI-treated patients who received the COVID-19 vaccine, including those newly started on therapy. The findings should encourage new and third-dose vaccine uptake among patients with cancer receiving ICI treatment, without interruption of cancer therapy,” the researchers concluded.
Limitations of this study include the absence of a temporally aligned comparison group of patients receiving ICI therapy who did not undergo COVID-19 vaccination, and a sample size not large enough to capture the risk of post-vaccine rare events.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Widman AJ, Cohen B, Park V, McClure T, Wolchok J, Kamboj M. Immune-related adverse events among COVID-19-vaccinated patients with cancer receiving immune checkpoint blockade. J Natl Compr Canc Netw. 2022;20(10):1134-1138. doi:10.6004/jnccn.2022.7048