实体瘤患者中mRNA抗SARS-CoV-2疫苗接种的疗效及体液免疫反应动态：来自意大利一家三级癌症中心机构登记处的结果
Efficacy of mRNA anti-SARS-CoV-2 vaccination and dynamics of humoral immune response in patients with solid tumors: results from the institutional registry of an Italian tertiary cancer center.
作者信息
Fucà Giovanni, Lecchi Mara, Ciniselli Chiara Maura, Ottini Arianna, Spagnoletti Andrea, Mazzeo Laura, Morelli Daniele, Frati Paola, Stroscia Martina, Ebrahem Elisabella, Sottotetti Elisa, Galli Giulia, D'Elia Maria Grazia, Lobefaro Riccardo, Ducceschi Monika, Di Guardo Lorenza, Bhoori Sherrie, Provenzano Salvatore, Platania Marco, Niger Monica, Colombo Elena, Nichetti Federico, Duca Matteo, Rivoltini Licia, Mortarini Roberta, Baili Paolo, Apolone Giovanni, de Braud Filippo, Verderio Paolo, Damian Silvia
机构信息
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
出版信息
Ther Adv Med Oncol. 2022 Jul 27;14:17588359221108687. doi: 10.1177/17588359221108687. eCollection 2022.
BACKGROUND
Systemic immunosuppression characterizing cancer patients represents a concern regarding the efficacy of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, and real-world evidence is needed to define the efficacy and the dynamics of humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines.
METHODS
We conducted an observational study that included patients with solid tumors who were candidates for mRNA anti-SARS-CoV-2 vaccination at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. The primary objective was to monitor the immunologic response to the mRNA anti-SARS-CoV-2 vaccination in terms of anti-spike antibody levels. All the patients received two doses of the mRNA-1273 vaccine or the BNT162b2 vaccine. Healthcare workers served as a control group of healthy subjects.
RESULTS
Among the 243 patients included in the present analysis, 208 (85.60%) and 238 (97.94%) resulted seroconverted after the first and the second dose of vaccine, respectively. Only five patients (2.06%) had a negative titer after the second dose. No significant differences in the rate of seroconversion after two vaccine doses were observed in patients as compared with the control group of healthy subjects. Age and anticancer treatment class had an independent impact on the antibody titer after the second dose of vaccination. In a subgroup of 171 patients with available data about the third timepoint, patients receiving immunotherapy with immune checkpoint inhibitors seem to have a higher peak of antibodies soon after the second dose (3 weeks after), but a more pronounced decrease at a late timepoint (3 months after).
CONCLUSIONS
The systemic immunosuppression characterizing cancer patients did not seem to dramatically affect the humoral response to anti-SARS-CoV-2 mRNA vaccines in our population of patients with solid tumors. Further investigation is needed to dissect the interplay between immunotherapy and longitudinal dynamics of humoral response to mRNA vaccines, as well as to analyze the cellular response to mRNA vaccines in cancer patients.
背景
癌症患者的全身免疫抑制是关于抗严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗接种效果的一个关注点，需要真实世界的证据来确定基于mRNA的抗SARS-CoV-2疫苗的效力以及体液免疫反应的动态变化。
方法
我们进行了一项观察性研究，纳入了意大利米兰 Fondazione IRCCS Istituto Nazionale dei Tumori 符合mRNA抗SARS-CoV-2疫苗接种条件的实体瘤患者。主要目标是根据抗刺突抗体水平监测对mRNA抗SARS-CoV-2疫苗的免疫反应。所有患者均接受两剂mRNA-1273疫苗或BNT162b2疫苗。医护人员作为健康受试者的对照组。
结果
在本分析纳入的243例患者中，分别有208例（85.60%）和238例（97.94%）在接种第一剂和第二剂疫苗后发生血清转化。仅5例患者（2.06%）在接种第二剂后滴度为阴性。与健康受试者对照组相比，患者在接种两剂疫苗后的血清转化率无显著差异。年龄和抗癌治疗类别对接种第二剂疫苗后的抗体滴度有独立影响。在171例有第三次时间点可用数据的患者亚组中，接受免疫检查点抑制剂免疫治疗的患者在接种第二剂后不久（3周后）抗体峰值似乎较高，但在较晚时间点（3个月后）下降更为明显。
结论
在我们的实体瘤患者群体中，癌症患者的全身免疫抑制似乎并未显著影响对抗SARS-CoV-2 mRNA疫苗的体液反应。需要进一步研究以剖析免疫治疗与对mRNA疫苗的体液反应纵向动态之间的相互作用，以及分析癌症患者对mRNA疫苗的细胞反应。
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