School of Graduates, Beijing University of Chinese Medicine, Beijing, China.
Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Rev Med Virol. 2024 Jan;34(1):e2495. doi: 10.1002/rmv.2495. Epub 2023 Nov 28.
With the popularity of Coronavirus disease 2019 (COVID-19) vaccine and the development of vaccination strategies, the impact of COVID-19 vaccine on cancer patients receiving immune checkpoint inhibitors (ICIs) is still unclear. In the systematic review and meta-analysis of patients with ICIs, we assessed the serological response of cancer patients receiving COVID-19 vaccine, and explored the risk of immune related adverse events (irAEs). We searched PubMed, EMBASE and Cochrane Library as of 10 June 2023, and included cancer patients who received ICIs and COVID-19 vaccine. The systematic review and meta-analysis include cohort study, cross-sectional study and case report. The outcome included the serological response, Spike-specific T-cell response, irAEs and rare adverse events. When possible, the data were analysed by random effect analysis, and the statistical heterogeneity was assessed by Q-test and I statistics. We explored the sources of heterogeneity through L'Abbe plots, Galbraith radial plots, and sensitivity analysis. The publication bias was evaluated by Egger's, Begg's linear regression test and funnel plot, and the impact of publication bias was further analysed by trim and fill method. 27 studies were eligible (19 cohort studies, 1 cross-sectional study and 7 case reports), involving 8331 patients (with 4724 receiving ICIs). Most studies used mRNA vaccine (BNT162b2 or mRNA-1273). Compared with cancer patients receiving chemotherapy, cancer patients receiving ICIs were significantly more likely to have seroconversion (RR = 1.05, 95%CI 1.01-1.10, P = 0.02). There were no statistically significant differences in seroconversion rates when comparing cancer patients receiving ICIs with controls without cancer (RR = 0.95, 95% CI 0.89-1.01, P = 0.09) or with cancer patients receiving targeted therapy (RR = 1.05, 95% CI 0.79-1.39, P = 0.75). The incidence of irAEs in patients receiving ICIs before and after COVID-19 vaccination was (21.96%, 95%CI 16.66%-28.94%) and (14.88%, 95%CI 8.65%-25.57%), respectively. The most common irAEs were endocrine abnormalities, skin disorders, etc. The certainty of evidence was low in cancer patients with ICIs, compared with those receiving chemotherapy, and very low versus controls without cancer. Cancer patients treated with ICIs seem to be able to receive COVID-19 vaccine safely without increasing the incidence of irAEs.
随着 2019 年冠状病毒病（COVID-19）疫苗的普及和疫苗接种策略的发展，COVID-19 疫苗对接受免疫检查点抑制剂（ICIs）的癌症患者的影响仍不清楚。在对接受 ICIs 治疗的癌症患者的系统评价和荟萃分析中，我们评估了 COVID-19 疫苗接种患者的血清学反应，并探讨了免疫相关不良事件（irAEs）的风险。我们检索了截至 2023 年 6 月 10 日的 PubMed、EMBASE 和 Cochrane 图书馆，并纳入了接受 ICIs 和 COVID-19 疫苗的癌症患者。系统评价和荟萃分析包括队列研究、横断面研究和病例报告。结局包括血清学反应、Spike 特异性 T 细胞反应、irAEs 和罕见不良事件。在可能的情况下，采用随机效应分析进行数据分析，并通过 Q 检验和 I 统计评估统计异质性。我们通过 L'Abbe 图、Galbraith 径向图和敏感性分析来探索异质性的来源。通过 Egger's、Begg 线性回归检验和漏斗图评估发表偏倚，并通过修剪和填充方法进一步分析发表偏倚的影响。有 27 项研究符合条件（19 项队列研究、1 项横断面研究和 7 项病例报告），涉及 8331 名患者（其中 4724 名接受 ICIs 治疗）。大多数研究使用了 mRNA 疫苗（BNT162b2 或 mRNA-1273）。与接受化疗的癌症患者相比，接受 ICIs 治疗的癌症患者发生血清转化的可能性显著更高（RR=1.05，95%CI 1.01-1.10，P=0.02）。与无癌症的对照组（RR=0.95，95%CI 0.89-1.01，P=0.09）或接受靶向治疗的癌症患者（RR=1.05，95%CI 0.79-1.39，P=0.75）相比，接受 ICIs 治疗的癌症患者的血清转化率无统计学显著差异。接受 ICIs 治疗的患者在 COVID-19 疫苗接种前后发生 irAEs 的发生率分别为（21.96%，95%CI 16.66%-28.94%）和（14.88%，95%CI 8.65%-25.57%）。最常见的 irAEs 是内分泌异常、皮肤疾病等。与接受化疗的癌症患者相比，接受 ICIs 治疗的癌症患者的证据确定性为低，与无癌症的对照组相比，证据确定性为极低。接受 ICIs 治疗的癌症患者似乎可以安全地接种 COVID-19 疫苗，而不会增加 irAEs 的发生率。
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