Atkins Katelyn M, Wang Minhao, Silos Katrina D, Joung Sandy Y, Singh Asneh, Peony Olivia, Gasho Jordan O, Lee Yeran, Gastelum Kenia, Filart Beatrice Alessandra, Kwan Alan C, Mendez Marilyn, Liu Yunxian, Belen Patrick, Prostko John C, Frias Edwin C, Ebinger Joseph E, Sharma Sonia, Sobhani Kimia, Cheng Susan
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Cancer Med. 2025 Jul;14(14):e71082. doi: 10.1002/cam4.71082.
Amidst highly transmissible SARS-CoV-2 variants that continue to circulate in the community, individuals with cancer exhibit variations in immunity and susceptibility for reasons that remain poorly understood.
In a longitudinal cohort study with ongoing SARS-CoV-2 serological and outcomes surveillance, we examined adults receiving cancer treatment (cases, n = 229) or who were free of cancer and other major comorbidities (controls, n = 800), prior to the Omicron era onset and onwards (September 24, 2021-March 10, 2024). The main outcomes were longitudinal SARS-CoV-2 anti-spike receptor binding domain IgG (IgG-SRBD) antibody response and Omicron and subvariant infection frequency and severity.
Among the 229 participants with cancer (age 66 ± 12 years, 51% female), the most prevalent subtypes included nonmelanoma skin (23%), breast (20%), and hematologic (18%). In mixed-effects linear models, hematologic cancer and B-cell targeted agents were associated with reduced longitudinal IgG-SRBD response (p < 0.05). In multivariable regression analyses, hematologic cancer (p = 0.037) and B-cell targeted agents (p = 0.030) were associated with increased frequency of new infections. The frequency of new infections resulting in moderate illness was increased in patients with active/recent cancer treatment (44%) versus healthy controls (10%; p < 0.001); there were no severe or critical infections. Patients with hematologic, breast, prostate, or skin cancer (p < 0.01), treated with local therapy (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.05-3.15; p = 0.032), B-cell targeted therapy (OR 4.81; 95% CI 1.78-12.93; p = 0.002), or small molecule agents (OR 2.34; 95% CI 1.05-5.23; p = 0.037) were associated with increased infection severity.
Individuals with hematologic cancer or exposed to B-cell-targeted therapy had reduced humoral immunity and more frequent and severe infections. Active breast, prostate, or skin cancer, or treatment with local therapy or small molecule agents had elevated risk for more severe, but not more frequent, infections. Despite overall low rates of infection associated with lower respiratory disease, certain higher-risk cancer patients may benefit from further protective measures.
在社区中持续传播的高传染性严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变体中，癌症患者的免疫力和易感性存在差异，但其原因仍知之甚少。
在一项正在进行SARS-CoV-2血清学和结局监测的纵向队列研究中，我们对在奥密克戎毒株流行之前及之后（2021年9月24日至2024年3月10日）接受癌症治疗的成年人（病例组，n = 229）或无癌症及其他主要合并症的成年人（对照组，n = 800）进行了研究。主要结局是SARS-CoV-2抗刺突受体结合域免疫球蛋白G（IgG-SRBD）抗体的纵向反应以及奥密克戎毒株及其亚型的感染频率和严重程度。
在229名癌症患者（年龄66±12岁，51%为女性）中，最常见的亚型包括非黑色素瘤皮肤癌（23%）、乳腺癌（20%）和血液系统癌症（18%）。在混合效应线性模型中（P<0.05），血液系统癌症和B细胞靶向药物与IgG-SRBD纵向反应降低相关。在多变量回归分析中，血液系统癌症（P = 0.037）和B细胞靶向药物（P = 0.030）与新感染频率增加相关。正在接受积极/近期癌症治疗的患者出现中度疾病的新感染频率（44%）高于健康对照组（10%；P<0.001）；未出现严重或危急感染。接受局部治疗（比值比[OR]1.82；95%置信区间[CI]1.05-3.15；P = 0.032）、B细胞靶向治疗（OR 4.81；95%CI 1.78-12.93；P = 0.002）或小分子药物治疗（OR 2.34；95%CI 1.05-5.23；P = 0.037）的血液系统、乳腺、前列腺或皮肤癌患者（P<0.01）感染严重程度增加。
血液系统癌症患者或接受B细胞靶向治疗的患者体液免疫降低，感染更频繁、更严重。活动性乳腺癌、前列腺癌或皮肤癌患者，或接受局部治疗或小分子药物治疗的患者发生更严重感染（而非更频繁感染）的风险升高。尽管与下呼吸道疾病相关的总体感染率较低，但某些高风险癌症患者可能受益于进一步的保护措施。
