mRNA COVID-19 Vaccines Safe for Cancer Patients Receiving Immunotherapy
The mRNA COVID-19 vaccines — Pfizer-BioNtech and Moderna — are safe for people diagnosed with several types of cancer who are receiving immunotherapy, according to a Memorial Sloan Kettering Cancer Center study.
The research was published online on Oct. 17, 2022, in the Journal of the National Comprehensive Cancer Network. Read “Immune-Related Adverse Events Among COVID-19-Vaccinated Patients With Cancer Receiving Immune Checkpoint Blockade.”
What is immunotherapy?
Immunotherapy medicines use the power of your body’s immune system to attack cancer cells.
There are several immunotherapy medicines approved by the U.S. Food and Drug Administration (FDA) to treat breast cancer.
Immune checkpoint inhibitors are one type of immunotherapy. Immune checkpoint inhibitors help the immune system recognize and attack cancer cells.
Immune checkpoint inhibitors approved by the FDA to treat breast cancer are:
Jemperli (chemical name: dostarlimab-gxly)
Keytruda (chemical name: pembrolizumab)
Jemperli is used to treat mismatch repair deficient (dMMR) advanced-stage breast cancer that has grown during or after treatment if no other treatment options are available. Less than 1% of breast cancers have the dMMR biomarker.
Keytruda is used in combination with chemotherapy to treat unresectable locally advanced or metastatic triple-negative, PD-L1-positive breast cancer. Unresectable means that the cancer can’t be removed with surgery.
Keytruda also is used in combination with chemotherapy before surgery, and then on its own after surgery to treat early-stage triple-negative breast cancer with a high risk of recurrence (the cancer coming back).
mRNA vaccines
The Pfizer and Moderna vaccines work by using genetic material called messenger RNA (mRNA). The mRNA vaccines contain a small piece of the virus’s mRNA, which tells your body to make copies of a protein in the virus called the spike protein. Your immune system then builds up immune cells and special proteins (antibodies) to fight the spike protein. So, if you’re ever exposed to the COVID-19 virus, your immune system is ready to recognize the virus and protect you from infection.
About the study
People receiving cancer treatment have a higher risk of developing severe COVID-19 if they are infected, so experts recommend that most people diagnosed with cancer should get a COVID-19 vaccine. Still, because the mRNA COVID-19 vaccines may cause side effects, doctors have been concerned about immune system-related side effects in people receiving immunotherapy for cancer. It’s also important to know that people receiving cancer treatment weren’t allowed to be part of key COVID-19 vaccine trials.
In this study, the researchers wanted to document the rates of immune system-related side effects in people who received an mRNA COVID-19 vaccine within 90 days of receiving an immune checkpoint inhibitor.
The study included 408 people diagnosed with cancer who received the first dose of an mRNA vaccine in the 90 days before or after receiving an immune checkpoint inhibitor.
The people in the study ranged in age from 55 to 93 years; 217 people were men and 191 were women.
Overall, 11 different cancers were represented in the study:
30% of the people had thoracic cancer (lung, thymic, and windpipe cancers)
21% of the people had genitourinary cancer (urinary cancers, prostate, and testicular cancer)
12% of the people had upper gastrointestinal cancer
12% of the people had melanoma (the most serious type of skin cancer)
10% of the people had gynecologic cancer (cervical, ovarian, uterine, vaginal, and vulvar cancers)
5% of the people had sarcoma (bone and soft tissue cancers)
5% of the people had head and neck cancer
3% of the people had lower gastrointestinal cancer
1% of the people had glioblastoma (brain and spinal cord cancer)
1% of the people had lymphoma (lymph system cancer)
1% of the people had breast cancer
The people in the study received one or a combination of three immune checkpoint inhibitors:
65% of the people received Keytruda alone
24% of the people received Opdivo (chemical name: nivolumab) alone
10% of the people received a combination of Opdivo and Yervoy (chemical name: ipilimumab)
0.7% of the people received Yervoy alone
0.3% of the people received a combination of Keytruda, Opdivo, and Yervoy
Opdivo and Yervoy are not approved by the FDA to treat breast cancer, but studies are looking at whether they may be effective.
More than 95% of the people in the study received the Pfizer COVID-19 vaccine.
Overall, 7% of the people in the study had an immune system-related side effect within 90 days of receiving the vaccine.
Among the 54 people who had a history of immune system-related side effects before receiving the vaccine, 6% had an immune system-related side effect within 90 days of receiving the vaccine.
Most — 78% — of the immune system-related side effects that people had after receiving the vaccine were mild.
Four people had a severe immune system-related side effect and these were all either colitis or diarrhea. Three of these people were receiving a combination of Opdivo and Yervoy and one was receiving Keytruda alone.
None of the people in the study had a flare-up of an earlier immune system-related side effect after being vaccinated.
“We see no evidence to suggest that taking the COVID-19 vaccine increases the risk of immune-related adverse events in newly or previously [immune checkpoint inhibitor]-treated patients,” senior author Mini Kamboj, MD, chief medical epidemiologist and infectious disease specialist at Memorial Sloan Kettering Cancer Center, said in a statement. “Also, the vaccine will not disrupt treatment or lead to early discontinuation. Vaccines continue to offer strong protection from severe COVID-19 for all variants, and patients are highly encouraged to stay up-to-date on their COVID-19 vaccination.”
What this means for you
If you’re receiving immunotherapy for breast cancer, the results of this study are reassuring.
Other research shows that the mRNA COVID-19 vaccines help keep immunocompromised people from being hospitalized with COVID.
According to the U.S. Centers for Disease Control and Prevention (CDC), immunocompromised people age 18 and older should receive the mRNA vaccines as follows:
the first dose of the primary series of the vaccine.
the second dose of the primary series of the vaccine three or four weeks after the first dose
a third dose of the primary series of the vaccine at least four weeks after the second dose
a fourth dose — the updated bivalent booster — at least two months after the third dose or the last booster
Still, each person’s health situation is unique. So it makes sense to talk to your doctor about whether a COVID-19 vaccine and booster shots are right for you.
Learn more about COVID-19 vaccines for people with breast cancer.
Learn more about immunotherapy for breast cancer.
— Last updated on January 19, 2023 at 6:10 PM