Department of Medical Oncology, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Vascular Biology & Cancer Microenvironment Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
Oncologist. 2021 Sep;26(9):e1619-e1632. doi: 10.1002/onco.13828. Epub 2021 Jun 3.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with cancer show worse outcomes compared with patients without cancer. The humoral immune response (HIR) of patients with cancer against SARS-CoV-2 is not well characterized. To better understand it, we conducted a serological study of hospitalized patients with cancer infected with SARS-CoV-2.
This was a unicentric, retrospective study enrolling adult patients with SARS-CoV-2 admitted to a central hospital from March 15 to June 17, 2020, whose serum samples were quantified for anti-SARS-CoV-2 receptor-binding domain or spike protein IgM, IgG, and IgA antibodies. The aims of the study were to assess the HIR to SARS-CoV-2; correlate it with different cancer types, stages, and treatments; clarify the interplay between the HIR and clinical outcomes of patients with cancer; and compare the HIR of SARS-CoV-2-infected patients with and without cancer.
We included 72 SARS-CoV-2-positive subjects (19 with cancer, 53 controls). About 90% of controls revealed a robust serological response. Among patients with cancer, a strong response was verified in 57.9%, with 42.1% showing a persistently weak response. Treatment with chemotherapy within 14 days before positivity was the only factor statistically shown to be associated with persistently weak serological responses among patients with cancer. No significant differences in outcomes were observed between patients with strong and weak responses. All IgG, IgM, IgA, and total Ig antibody titers were significantly lower in patients with cancer compared with those without.
A significant portion of patients with cancer develop a proper HIR. Recent chemotherapy treatment may be associated with weak serological responses among patients with cancer. Patients with cancer have a weaker SARS-CoV-2 antibody response compared with those without cancer.
These results place the spotlight on patients with cancer, particularly those actively treated with chemotherapy. These patients may potentially be more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, so it is important to provide oncologists further theoretical support (with concrete examples and respective mechanistic correlations) for the decision of starting, maintaining, or stopping antineoplastic treatments (particularly chemotherapy) not only on noninfected but also on infected patients with cancer in accordance with cancer type, stage and prognosis, treatment agents, treatment setting, and SARS-CoV-2 infection risks.
与无癌症患者相比，感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的癌症患者预后更差。癌症患者对 SARS-CoV-2 的体液免疫反应（HIR）尚未得到很好的描述。为了更好地了解这一点，我们对感染 SARS-CoV-2 的住院癌症患者进行了血清学研究。
这是一项单中心回顾性研究，纳入 2020 年 3 月 15 日至 6 月 17 日期间因 SARS-CoV-2 住院的成年癌症患者，定量检测其血清样本中针对 SARS-CoV-2 受体结合域或刺突蛋白 IgM、IgG 和 IgA 抗体的水平。本研究的目的是评估 SARS-CoV-2 的 HIR；并将其与不同的癌症类型、分期和治疗方法相关联；阐明 HIR 与癌症患者临床结局的相互作用；比较 SARS-CoV-2 感染患者和非感染患者的 HIR。
我们纳入了 72 例 SARS-CoV-2 阳性患者（19 例癌症患者，53 例对照组）。大约 90%的对照组显示出强大的血清学反应。在癌症患者中，57.9%的患者证实了强烈的反应，42.1%的患者持续显示出较弱的反应。在 SARS-CoV-2 阳性前 14 天内接受化疗治疗是唯一与癌症患者持续较弱的血清学反应相关的统计学因素。在强反应和弱反应患者之间，观察到的结局无显著差异。与非癌症患者相比，所有 IgG、IgM、IgA 和总 Ig 抗体滴度在癌症患者中均显著降低。
一部分癌症患者产生了适当的 HIR。近期化疗治疗可能与癌症患者的弱血清学反应有关。与无癌症患者相比，癌症患者对 SARS-CoV-2 的抗体反应较弱。
这些结果强调了癌症患者，特别是正在接受化疗治疗的患者的重要性。这些患者可能更容易受到严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染，因此，为了为癌症患者（包括非感染患者和感染患者）提供进一步的理论支持（包括具体的例子和相应的机制相关性），以决定开始、维持或停止抗肿瘤治疗（特别是化疗），不仅要根据癌症类型、分期和预后、治疗药物、治疗环境，还要根据 SARS-CoV-2 感染风险，这一点非常重要。
