严重急性呼吸综合征冠状病毒 2 疫苗在胸部癌症患者中的疗效：一项支持在两剂疫苗接种后血清学应答轻微的患者中接种第三剂疫苗的前瞻性研究。
Efficacy of Severe Acute Respiratory Syndrome Coronavirus-2 Vaccine in Patients With Thoracic Cancer: A Prospective Study Supporting a Third Dose in Patients With Minimal Serologic Response After Two Vaccine Doses.
机构信息
Thoracic Oncology Department, Université de Paris, North-Paris Cancer University Institute, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1425, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France.
Virology Department, Université de Paris, INSERM Unité Mixte de Recherche (UMR) 1137 Infection, Antimicrobials, Modelling, Evolution, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France.
出版信息
J Thorac Oncol. 2022 Feb;17(2):239-251. doi: 10.1016/j.jtho.2021.10.015. Epub 2021 Nov 16.
INTRODUCTION
Coronavirus disease 2019 resulted in a 30% mortality rate in patients with thoracic cancer. Given that patients with cancer were excluded from serum antisevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine registration trials, it is still unknown whether they would develop a protective antispike antibody response after vaccination. This prospective vaccine monitoring study primarily aimed to assess humoral responses to the SARS-CoV-2 vaccine in patients with thoracic cancer.
METHODS
SARS-CoV-2-spike antibodies were measured using the Abbot Architect SARS-CoV-2 immunoglobulin G immunoassay before the first injection of BNT162b2 mRNA vaccine, at week 4, and 2 to 16 weeks after the second vaccine dose administration. The factors associated with antibody response were analyzed.
RESULTS
Overall, 306 patients, with a median age of 67.0 years (interquartile range: 58-74), were vaccinated. Of these, 283 patients received two vaccine doses at 28-day intervals. After a 6.7-month median follow-up, eight patients (2.6%) contracted proven symptomatic SARS-CoV-2 infection, with rapid favorable evolution. Of the 269 serologic results available beyond day 14 after the second vaccine dose administration, 17 patients (6.3%) were still negative (<50 arbitrary units/mL, whereas 34 (11%) were less than 300 arbitrary units/mL (12.5th percentile). In multivariate analysis, only age (p < 0.01) and long-term corticosteroid treatment (p = 0.01) were significantly associated with a lack of immunization. A total of 30 patients received a third vaccine dose, with only three patients showing persistently negative serology thereafter, whereas the others exhibited clear seroconversion.
CONCLUSIONS
SARS-CoV2 vaccines were found to be efficient in patients with thoracic cancer, most of them being immunized after two doses. A third shot given to 1% of patients with persistent low antibody titers resulted in an 88% immunization rate.
简介
2019 年冠状病毒病导致胸癌患者的死亡率达到 30%。鉴于癌症患者被排除在血清抗严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗注册试验之外，目前仍不清楚他们在接种疫苗后是否会产生保护性的刺突抗体反应。本前瞻性疫苗监测研究主要旨在评估胸癌患者对 SARS-CoV-2 疫苗的体液反应。
方法
在接种 BNT162b2 mRNA 疫苗前、第 4 周和第 2 至 16 周时，使用 Abbott Architect SARS-CoV-2 免疫球蛋白 G 免疫分析法测量 SARS-CoV-2 刺突抗体。分析与抗体反应相关的因素。
结果
共有 306 名中位年龄为 67.0 岁（四分位距：58-74）的患者接受了疫苗接种。其中 283 名患者在 28 天间隔内接受了两剂疫苗。中位随访 6.7 个月后，8 名患者（2.6%）感染了有症状的 SARS-CoV-2，且病情迅速好转。在第二次疫苗接种后第 14 天之后的 269 份血清学结果中，17 名患者（6.3%）仍为阴性（<50 个任意单位/mL），而 34 名患者（11%）的抗体滴度小于 300 个任意单位/mL（12.5%位数）。多变量分析显示，只有年龄（p<0.01）和长期皮质类固醇治疗（p=0.01）与未免疫显著相关。共 30 名患者接受了第三剂疫苗，此后仅 3 名患者的血清学检测结果仍为阴性，而其余患者均出现明显的血清转化。
结论
SARS-CoV2 疫苗在胸癌患者中被证明是有效的，大多数患者在接种两剂疫苗后即可获得免疫。对 1%持续低抗体滴度的患者给予第三剂疫苗，可使免疫率达到 88%。
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