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OA06 IMPACT OF COVID-19 ON CANCER MANAGEMENT AND PROTECTION FROM VACCINES, MONDAY, AUGUST 8, 2022 - 11:00 - 12:10| Volume 17, ISSUE 9, SUPPLEMENT , S17-S18, September 2022

OA06.03 Serological Response to SARS-CoV-2 Vaccination in Patients Lung Cancer: A Mount Sinai-Led Prospective Matched Controlled Study

      Introduction

      Since the onset of the COVID-19 pandemic, patients with lung cancer (LC) are at increased risk of severe outcomes from SARS-CoV-2 infection, prompting efforts to encourage LC patient vaccination. There remains a significant knowledge gap in how LC patient demographics and clinical features impact on the response to SARS-CoV-2 vaccines or infection. Understanding these patient- and cancer-specific factors is essential to providing optimal care.

      Methods

      This ongoing IRB-approved NCI U54/SeroNet-sponsored study, designed to accrue a prospective longitudinal cohort of LC patients, was initiated January 2021 at the Mount Sinai Hospital, NY. The study enrolled LC patients of any stage, histology, SARS-CoV-2 exposure/vaccination or cancer treatment. Demographic, epidemiological, clinical data, and blood specimens for participating patients were collected at the time of enrollment, 3 and 6 months thereafter. Presence of IgG Ab against the SARS-CoV-2 Spike protein was quantitated using a validated enzyme-linked immunosorbent assay (ELISA) established at Mount Sinai. Neutralizing antibody titers (NAbT) against ancestral SARS-CoV-2 and Omicron were quantified in a post-booster subset. For comparison, 114 age-matched cancer-free participants were recruited as controls.

      Results

      Overall, 176 LC patients were recruited (January to December 2021), of which a subset of 114 had two doses of mRNA vaccine (66% PfizerBNT162b2; 34% Moderna1273). Controls were well-matched for age and ethnicity. Analysis of anti-SPIKE Ab titers showed that the vast majority of LC patients mounted a similar response to controls following vaccination - with the exception that 5% of patients presented titers of zero (p<0.0001). Maintenance of titers over time was significantly lower in LC patients than controls (p=0.0018), significantly more intra-patient variance in titers within the cancer group (p=0.002). No relationships were observed by age or smoking status, but treatment effects could not be ruled out as a possible contributor to zero titer cases. Additionally, 35% of patients received a booster (third dose) vaccination, showing significant enhancement of their Ab titers (p<0.001). After their booster, both controls and patients had significantly diminished NAbT against Omicron compared to ancestral variant after the booster, and a sizable proportion of LC patients (21%) had no detectable NAbT against Omicron compared to 3% of controls.

      Conclusions

      Overall, the majority of LC patients mounted a humoral response comparable to that of healthy controls. A small but significant subset of patients failed to mount an Ab response to vaccination, only partially rescued by booster shots. Additionally, post-booster Omicron neutralizing activity was compromised in a subset of LC patients.
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      Keywords

      SARS-CoV-2, Antibody titers, lung cancer