癌症患者接受免疫检查点抑制剂治疗时的 COVID-19 疫苗接种：系统评价和荟萃分析。
COVID-19 vaccination in patients with cancer receiving immune checkpoint inhibitors: a systematic review and meta-analysis.
机构信息
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
J Immunother Cancer. 2023 Feb;11(2). doi: 10.1136/jitc-2022-006246.
BACKGROUND
Immune checkpoint inhibitors (ICI) can cause off-target inflammatory and immune-related adverse events (irAE). Conceivably, COVID-19 vaccination could trigger an inflammatory and immune response that could induce or aggravate irAE.
METHODS
The objective of this systematic review is to appraise the efficacy and safety of COVID-19 vaccination in patients with cancer treated with ICI. The literature search was performed in PubMed and Embase in English from December 2019 to February 2022. The review included clinical trials, observational cohort studies, case series, and case reports reporting on the clinical efficacy and safety of COVID-19 vaccines on patients with cancer treated with ICI. Outcomes of interest included seroconversion, SARS-CoV-2 infection rate, severe COVID-19, COVID-19 mortality rate. Incidence of ICI irAEs was also ascertained as well as vaccine adverse events. A meta-analysis was conducted to estimate the pooled effect sizes of the outcomes when possible, using random effects models.
RESULTS
Overall, 19 studies were included for the analysis (n=10 865 with 2477 receiving ICI). We analyzed 15 cohort studies, 1 cross-sectional study, and 3 case reports. There were no statistically significant differences in seroconversion rates after the second dose of the vaccine when comparing patients with cancer receiving ICI with patients without cancer (risk ratio, RR 0.97, 95% CI 0.92 to 1.03) or with patients with cancer without active treatment (RR 1.00, 95% CI 0.96 to 1.04). There was a higher probability of seroconversion in patients with cancer treated with ICI compared with patients with cancer treated with chemotherapy (RR 1.09, 95% CI 1.00 to 1.18). In a single study in patients receiving ICI, no differences were observed in risk of irAE between those receiving inactivated vaccine and those unvaccinated (pneumonitis RR 0.88, 95% CI 0.33 to 2.3; rash RR 1.03, 95% CI 0.66 to 1.62; arthralgia RR 0.94, 95% CI 0.51 to 1.75). There were no studies for other types of vaccines comparing vaccinated vs not vaccinated in patients treated with ICI. The most common vaccine-related adverse events were local pain or fatigue. Overall, the quality of evidence was rated as very low.
CONCLUSION
COVID-19 vaccination appears to be effective and safe in patients with cancer receiving ICI.
背景
免疫检查点抑制剂（ICI）可引起非靶向炎症和免疫相关不良事件（irAE）。可以想象，COVID-19 疫苗接种可能会引发炎症和免疫反应，从而引发或加重 irAE。
方法
本系统评价的目的是评估 COVID-19 疫苗接种在接受 ICI 治疗的癌症患者中的疗效和安全性。文献检索在英语的 PubMed 和 Embase 中进行，时间范围为 2019 年 12 月至 2022 年 2 月。该综述包括临床试验、观察性队列研究、病例系列和病例报告，报告了接受 ICI 治疗的癌症患者 COVID-19 疫苗的临床疗效和安全性。感兴趣的结果包括血清转化率、SARS-CoV-2 感染率、重症 COVID-19、COVID-19 死亡率。还确定了 ICI irAEs 的发生率以及疫苗不良反应。当可能时，使用随机效应模型进行荟萃分析以估计结果的汇总效应大小。
结果
总体而言，有 19 项研究被纳入分析（n=10865 例，其中 2477 例接受 ICI 治疗）。我们分析了 15 项队列研究、1 项横断面研究和 3 项病例报告。与未患癌症的患者（风险比，RR0.97，95%置信区间 0.92 至 1.03）或未接受积极治疗的癌症患者（RR1.00，95%置信区间 0.96 至 1.04）相比，接受 ICI 治疗的癌症患者在接受第二剂疫苗后的血清转化率无统计学差异。与接受化疗的癌症患者相比，接受 ICI 治疗的癌症患者更有可能发生血清转化率（RR1.09，95%置信区间 1.00 至 1.18）。在一项针对接受 ICI 治疗的患者的单研究中，接受灭活疫苗和未接种疫苗的患者之间 irAE 的风险无差异（肺炎 RR0.88，95%置信区间 0.33 至 2.3；皮疹 RR1.03，95%置信区间 0.66 至 1.62；关节炎 RR0.94，95%置信区间 0.51 至 1.75）。没有研究比较接受 ICI 治疗的患者中接种疫苗与未接种疫苗之间其他类型疫苗的差异。最常见的疫苗相关不良事件是局部疼痛或疲劳。总体而言，证据质量被评为非常低。
结论
COVID-19 疫苗接种似乎对接受 ICI 治疗的癌症患者有效且安全。
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