A subset of patients with non-small cell lung cancer (NSCLC) have poor antibody responses to COVID-19 vaccination, according to research published in the Journal of Clinical Oncology.

Patients were more likely to have a poor response if they were older or received the Pfizer-BioNTech vaccine. However, researchers noted that “the very suboptimal vaccine responses generated by these patients with NSCLC cannot be explained solely by these factors.”

For this study, the researchers evaluated 82 patients with NSCLC and 53 healthy control individuals. Both cohorts had received 2 doses of an mRNA COVID-19 vaccine. The NSCLC patients were treated with chemotherapy (48%), immunotherapy (56%), targeted therapy (34%), and radiation (4.8%).

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The researchers found that, 1 month after the second vaccine dose, most patients in the NSCLC cohort had vaccine-specific antibody responses that were similar to responses seen in the control cohort. However, a subset of NSCLC patients had 6-fold lower spike (P <.0001), 7-fold lower receptor binding domain (P =.0002), and 8-fold lower N-terminal domain-specific immunoglobulin G (IgG) antibody titers (P <.0001).

The researchers evaluated whether baseline characteristics influenced response to vaccination among the NSCLC patients and found no difference according to cancer treatment, race, or sex. However, NSCLC patients had lower spike-specific IgG antibody titers if they were older than 70 years of age (vs younger than 60; P <.0034) or received the Pfizer-BioNTech vaccine (vs the Moderna vaccine; P <.0001).

When the researchers looked at neutralizing antibodies (nAbs) against wild-type (WT) SARS-CoV-2, they found that 25% of the NSCLC cohort had lower nAb titers than the control cohort. In fact, 18% of the NSCLC cohort did not generate any detectable nAbs. Overall, nAb titers were 7-fold lower in the NSCLC cohort than in the control cohort (P <.0001).

When the researchers looked at variants of concern, nAb titers were even lower for the NSCLC patients. When compared with titers of nAbs against WT SARS-CoV-2, nAb titers were: 

  • 6.5-fold lower for the delta (B.1.617.2) variant
  • 14-fold lower for the beta (B.1.351) variant
  • More than 50-fold lower for the omicron (B.1.1.529) variant. 

A third vaccine dose significantly increased titers of nAbs against WT SARS-CoV-2 and the omicron variant (P =.0001 for both). However, for omicron, nAb titers decreased significantly (P =.0012) within 3 to 4 months after the third dose.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Valanparambil RM, Carlisle J, Linderman SL, et al. Antibody response to COVID-19 mRNA vaccine in patients with lung cancer after primary immunization and booster: reactivity to the SARS-CoV-2 WT virus and omicron variant. J Clin Oncol. Published online June 27, 2022. doi:10.1200/JCO.21.02986