Determinants of humoral immune response to SARS-CoV-2 vaccines in solid cancer patients: A systematic review and meta-analysis. Issue 11 (10th March 2023)

• Record Type: Journal Article
• Authors: Wankhede, Durgesh; Grover, Sandeep; Hofman, Paul
• Is Part Of: Vaccine. Volume 41:Issue 11(2023)
• Page Start: 1791
• Page End: 1798
• Publication Date: 2023-03-10
• Subjects: COVID-19 -- COVID-19 vaccines -- Cancer -- Seroconversion; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2023.01.072
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Solid cancer patients are more likely to mount an inadequate response to COVID-19 vaccines, however, evidence suggests that these differences may be restricted to certain risk groups. Our study indicated that males, aged over 65 years and with recent chemotherapy are associated with lower seroconversion, whereas patients under follow-up, immune or targeted therapy have a better immune response. These risk factors may aid in altering the current COVID-19 immunization schedule for cancer patients and provide a benchmark for future studies to study the clinical efficacy of COVID-19 vaccines in these patients. Abstract: Importance: Solid cancer patients following SARS-CoV-2 vaccination are likely to have a lower seroconversion rate than healthy adults. Seroconversion between those with and without cancer is likely to vary moderately or to be restricted to specific subgroups. Therefore, we sought to conduct a systematic review and meta-analysis to identify risk factors for diminished humoral immune responses in solid cancer patients. Methods: MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were used to search literature through May 1, 2022. Prospective or retrospective studies comparing responders with non-responders against SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) following COVID-19 vaccination were included. Pooled Odds Ratios (pORs) with 95% CIs for binary variables and differences in means (with SDs) for continuous variables were calculated to determine the pooled effect estimates of risk factors for poor antibody response. Results: Fifteen studies enrolling 3593 patients were included in the analysis. Seroconversion was seen in 84% of the pooled study population. Male gender, age >65 years, and recent chemotherapy were all factors in a poor immune response. Patients under follow-up, those who received immunotherapy or targeted therapy, were more likely to be seropositive. Cancer subtypes, vaccine types, and timing of antibody testing from the 2nd dose of vaccine did not correlate with seroconversion. Conclusion: Cytotoxic therapy for solid cancer may portend poor immune response following 2 doses of COVID-19 vaccines suggesting a need for booster doses in these patients. Immunotherapy and targeted therapy are likely to be associated with seropositive status, and thus can be considered as an alternative to cytotoxic agents in cases where both therapies are equally efficacious.