Update on COVID-19 Vaccines
Since the first COVID-19 vaccines were approved, Dr. Moore has been advising people diagnosed with cancer about what they need to know about being vaccinated. In this episode, she gives us an update on COVID vaccines, as well what people with allergies to polyethylene glycol and polysorbate should consider before being vaccinated.
Listen to the podcast to hear Dr. Moore explain:
how the technology of the Johnson & Johnson vaccine differs from the technology of the Pfizer-BioNTech and Moderna vaccines
why the vaccines can’t be compared head-to-head
how she is advising people with polyethylene glycol and polysorbate allergies about the COVID vaccines
what people currently being treated for breast cancer need to consider before being vaccinated
Dr. Halle Moore is director of breast medical oncology and co-director of the Comprehensive Breast Cancer Program at Cleveland Clinic's Taussig Cancer Institute. She's also associate professor of medicine at the Cleveland Clinic Lerner College of Medicine. Her research focuses on breast cancer treatment and issues related to cancer survivorship.
— Last updated on January 12, 2022, 7:52 PM
Jamie DePolo: Hello, thanks for listening. Dr. Halle Moore is director of breast medical oncology and co-director of the Comprehensive Breast Cancer Program at the Cleveland Clinic. Her research focuses on breast cancer treatment and the issues related to cancer survivorship. Since the first COVID-19 vaccines were approved, she has been advising people diagnosed with cancer about what they need to know about being vaccinated.
She joins us today to give an update on COVID vaccines, including talking about the new Johnson & Johnson vaccine as well as what people with allergies to polyethylene glycol and polysorbate should consider before being vaccinated.
Dr. Moore, welcome to the podcast.
Dr. Halle Moore: Thank you, it’s a pleasure to be with you.
Jamie DePolo: So, let’s start with the new Johnson & Johnson vaccine. I know it’s a single-shot vaccine, and I know that the Pfizer-BioNTech and Moderna vaccines require two doses, so that’s one difference. And I also know that the Pfizer and Moderna vaccines use messenger RNA technology, or what’s been called mRNA technology, while the Johnson & Johnson vaccine is what’s called a viral vector vaccine. So, could you explain those differences to us?
Dr. Halle Moore: Sure. So, the Moderna and the Pfizer vaccines, which were the first to be approved, use messenger RNA, which basically provides the instruction for your body to make protein, and specifically that famous spike protein that we’ve heard about, while the J&J vaccine uses an adenovirus, which delivers genetic information which can then allow your body’s own RNA to copy that information to, again, produce a spike protein, which hopefully would then, with any of the vaccines, allow one’s body to mount an immune response to help protect the individual against future infection by the SARS-CoV-2, or the COVID-19, virus.
Jamie DePolo: Okay, thank you. And for the J&J vaccine you said it uses an adenovirus. That’s the virus that causes colds, am I right?
Dr. Halle Moore: So, that is similar to a common cold virus, and in the J&J vaccine they’ve engineered that virus so that it no longer has the ability to replicate itself. So it should be very safe, for instance, compared with other live virus vaccines, which we often avoid in people who have suppressed immune systems.
Jamie DePolo: Okay, and just to clarify in case anyone is confused, the Moderna and Pfizer vaccines also use a killed virus that can’t replicate. Those are not live virus vaccines either.
Dr. Halle Moore: So, actually the Moderna and Pfizer vaccines don’t use any virus at all. They directly provide the messenger RNA, which gives the instructions to make the protein.
Jamie DePolo: Oh, thank you, thank you for clearing up my confusion. So, now if we look at these two types of technologies that are used to make the vaccine, is one better or safer for people who have cancer, or is there no difference?
Dr. Halle Moore: We don’t really know because none of the studies have specifically included cancer patients, and we don’t have a lot of long-term results on any of these studies. So that information hopefully will be coming along. Currently, the CDC has not given any specific recommendations that cancer patients should routinely avoid any of these vaccines.
Jamie DePolo: Okay, thank you. And I know there was a little bit of controversy when the media first started talking about the Johnson & Johnson vaccine, because the research was showing that it’s 66% protective against moderate to severe COVID, which is a little bit lower than the 95% effectiveness of the Pfizer vaccine and the 94.1% effectiveness of the Moderna vaccine. But my understanding is that that 66% statistic was globally, so that was everywhere, and that in the United States, the Johnson and Johnson vaccine was 72% effective and also 85% effective in protecting against severe disease, which is what everyone wants to avoid.
So, all of that background is kind of a very long way of asking, is it fair to compare these vaccines head-to-head because the research hasn’t really done that?
Dr. Halle Moore: Right. So you know, it is likely that there’s some differences in efficacy between the different vaccines, but right now we actually don’t have any studies that allow that type of direct comparison. And you’re right that when we’re talking about severe disease, and specifically when we’re talking about risk for hospitalization or death from the virus, all of these vaccines are highly effective. So, currently, we’re kind of suggesting if you have access to a vaccine it’s a good idea to get that.
The only way to really know if one is superior to another would be to have a trial making that direct comparison because the trials that we have, have had different patient populations that they’ve included and were also done at different times and different locations, and there may have been different variants of the virus in circulation at the time the studies were done, so it’s really very difficult to compare one study to another.
Jamie DePolo: Okay, thank you. And I do want to get you to emphasize this, that you and Dr. Fauci have both said that you’re advising people to get any COVID vaccine they can get.
Dr. Halle Moore: Yes. So again, given the importance of getting the entire population vaccinated as quickly as possible, we do generally encourage people to get whichever vaccine they have available to them.
Jamie DePolo: Now I want to switch gears a little bit and talk about people who have polyethylene glycol and polysorbate allergies. These compounds are used as emulsifiers to hold ingredients together in some of the vaccines and some medicines. And the Centers for Disease Control has said that people with a known severe allergy to polyethylene glycol should not get the Pfizer or the Moderna vaccines. So I’m wondering, does the Johnson & Johnson vaccine contain polyethylene glycol, and then there’s also the other ingredient that’s related but not exactly the same, polysorbate. So, does the Johnson & Johnson vaccine contain either one of those ingredients?
Dr. Halle Moore: Well, the Johnson & Johnson vaccine does not contain polyethylene glycol, but it does contain polysorbate. And so someone who has an allergy to polyethylene glycol may be able to get the Johnson & Johnson vaccine, although there is some cross reactivity between hypersensitivity to one agent and another, so we want to be really careful to make sure that the allergy is to the compound that you think it’s to and may require a consultation with an allergist if you have a known hypersensitivity to either of these medications.
Jamie DePolo: Okay, so I just want to reiterate because we’ve been getting a lot of questions about this, that the current Centers for Disease Control recommendation is that people with a polysorbate allergy should not get the J&J vaccine and should ask their doctors if they can get either the Pfizer or the Moderna vaccine, and people with a polyethylene glycol allergy should not get the Pfizer or Moderna vaccines and should ask their doctor if they can get the J&J vaccine instead. So, I know you mentioned talking to an allergist, but how are you talking to your patients who have these allergies about vaccines?
Dr. Halle Moore: Well, first of all, fortunately, having known allergies to these compounds is not that common, but we do see both polyethylene glycol and polysorbate is present in some of our chemotherapy drugs that we administer. For instance, we may have a patient who’s had a severe, immediate reaction to a chemotherapy medication that contains one or both of these ingredients. And in that situation we would definitely want that patient to see an allergist and try to determine the exact source of the allergy before making a decision about vaccination.
Jamie DePolo: Okay. Okay, thank you. Now, I do want to ask, too, because you mentioned treatment. So, I’ve read some studies showing that people who’ve been diagnosed with cancer have a higher risk of being diagnosed with COVID, and then they also have a higher risk of having serious complications if they are infected with COVID. So, if somebody’s currently in treatment or getting ready to start treatment for breast cancer, does it make sense for them to get the vaccine first and delay treatment a little bit? Can they get the vaccine if they’re currently getting treatment? Should they wait to get the vaccine until they’re done with treatment? How are you advising your patients?
Dr. Halle Moore: These are issues that we face every day in the clinic, and really these have to be individualized. If the treatment is surgery, radiation, anti-estrogen treatments, all of those treatments can be done on schedule regardless of the timing of the vaccine. The only issue is perhaps you would want to not schedule your vaccine the day before surgery because if you had a fever or other adverse reactions to the vaccine, that might end up delaying your surgery. But many of the treatments that we give do not need to be interrupted for vaccinations.
Chemotherapy is a little bit trickier, and some of the new targeted treatments that can also suppress the immune system are a little trickier. Some treatments are ongoing and are not going to be completed anytime soon, and in those situations it may often be best to go ahead with the vaccination, which should still be safe. But there’s a potential for loss of effectiveness if the immune system isn’t responding as robustly. So, for that reason, if chemotherapy is not time-sensitive — perhaps somebody’s had surgery and is planning to start chemotherapy, and we have a window in which it should start — it would be great if one could be vaccinated before. But again, with the limited availability of these vaccines, that’s not always an option. And so we don’t recommend necessarily delaying important cancer treatments to wait for a vaccine if you don’t have an appointment already scheduled.
And then there may be some people who are very close to finishing planned chemotherapy regimens, in which case it may make sense to try to time things after or toward the end of completion in order to try to have a better immune response. But for most cases, partial protection, even if it’s not full protection, from the vaccine may be desirable, especially at a time when cases are still very high and we want to avoid serious infection.
Jamie DePolo: Okay, thank you. So, it sounds like the bottom line, as you said, it’s very individualized, and if somebody is currently in treatment they should probably talk to their doctor about the appropriate time to get the vaccine. Does that make sense?
Dr. Halle Moore: That’s correct.
Jamie DePolo: Okay, perfect. I do want to talk a little bit, too, about the armpit lymph node swelling that the vaccines may cause. That’s been in the media quite a lot. I’m assuming the Johnson & Johnson vaccine causes this as well?
Dr. Halle Moore: Well, many vaccines can cause lymph node enlargement. I know we’ve seen that commonly with the mRNA vaccines. I don’t know what the incidence is with the Johnson & Johnson vaccine, so we’ll have to see as more people receive that vaccine.
Jamie DePolo: Okay. And there’s been a little bit of conflicting advice, but experts seem to be recommending that you schedule your mammogram before getting the vaccine or waiting 4 to 6 weeks after you get the vaccine to have a mammogram. But then I’ve seen some other advice saying, “Well, you don’t really have to wait, you just need to tell your doctor and your mammogram technician that you had the vaccine.” So, could I ask you how you’re advising your patients?
Dr. Halle Moore: So, a lot of our patients are coming in for their scheduled mammogram and have just had their vaccine. And we’re not necessarily canceling the mammogram because of that. However, I would say for the general public, if you have the choice, it’s preferable to schedule the mammogram either before you get your vaccine or a month or so after the final dose. And simply because there is a pretty good chance that if they see enlarged lymph nodes, you’re going to get additional imaging and other tests that may not be necessary, whereas if you allow for that lymph node to have time to resolve itself, then we can get a mammogram without being confused by another finding.
Jamie DePolo: Okay, thank you. And I guess I’m wondering, too, say I’ve had my vaccine, it’s been 4 to 6 weeks after, and I’m getting my mammogram. Does it make sense for me to still mention something to the mammogram technician that I have had the vaccine, or is that not important anymore?
Dr. Halle Moore: I think after 4 to 6 weeks it’s less important for the mammography providers to know.
Jamie DePolo: Okay. And then I know we said this is individualized, but I guess I’m wondering if there are any real specific questions that somebody who’s currently in breast cancer treatment or somebody, say, who’s diagnosed with metastatic disease who is always going to be in treatment, are there specific questions that those people should ask their doctors before getting vaccinated?
Dr. Halle Moore: Again, I think for people who are on chronic treatment, just checking with the doctor about the timing of vaccinations. And the other thing that’s important for our breast cancer patients is that it’s possible if they get lymph node enlargement in the underarm area that it could exacerbate issues with lymphedema if they have the vaccine in the side of their lymph node surgery. So in general, we’ve been recommending — when there’s an option — to use the arm where they have not had surgery. Of course, some patients may have had surgery on both sides, and in that case they might want to discuss with their oncology provider which side might be the lower risk should lymph node enlargement occur.
Jamie DePolo: Okay, because you have to get the shot in your upper arm, right? Like you couldn’t get it in your leg or your hip or someplace else.
Dr. Halle Moore: Potentially you could, although most centers are most comfortable giving it in the upper arm.
Jamie DePolo: Okay. Okay. Thank you very much. Do you think there’s anything else that people who’ve been diagnosed with breast cancer need to know about these vaccines?
Dr. Halle Moore: I think the important thing is that for the vast majority of people, these vaccines are safe and highly effective. In spite of that, of course, until the rates get down in the general public, we need to continue the precautions recommended by the CDC of wearing a mask, social distancing, avoiding crowds, washing hands, and hopefully as more and more people get vaccinated these numbers will come down.
Jamie DePolo: Dr. Moore, thank you so much. I very much appreciate your insights today.
Dr. Halle Moore: You’re welcome.