Update: COVID boosters: What people with cancer should know

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Contents

At a glance Limitations
Who should get a booster? What does this mean for me?
When should you get a booster? Questions for your doctor
After a booster Resources

 

UPDATE AT A GLANCE

 

What is this update about?

This update is about recent changes to the National Comprehensive Cancer Network (NCCN) COVID-19 vaccination guidelines. The NCCN now recommends a booster (a third dose) of the mRNA COVID-19 vaccines for people with a new or recurring cancer as well as those who are currently in treatment.
 

Why is this update important?

Studies show that cancer patients are at high risk for COVID-19-associated complications. Because of this, there is a clear need for vaccination for cancer patients. While several studies have shown a reduced response to COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) in cancer patients after the first dose, response improves after the second dose. Emerging data now suggests that a third dose of an mRNA vaccine safely improves immunity against COVID-19 for patients with cancer, including those undergoing active treatment.
 

Who should receive a vaccine booster?

  • Patients who have received cancer treatment within 1-year of their initial vaccination or are actively being treated, including those undergoing chemotherapy, targeted therapy, hormonal therapy, surgery, radiation or treatment with therapy that is currently used only in an experimental setting (e.g., a clinical trial).
  • Patients with newly diagnosed cancer or recurrent cancer who will receive cancer treatment in the future.
  • Patients with cancer of the blood regardless of whether they are currently receiving treatment.
  • Patients who have received a stem cell transplant or engineered cellular therapy (e.g., CART cells).

When should a booster be given?

  • Boosters should be given at least four weeks after the second dose of an mRNA vaccine.
  • The booster should be the same as the initial vaccine (Pfizer-BioNTech or Moderna) if possible.
    • If the same mRNA vaccine is not available for the booster, then either may be used.
  • Patients who have had COVID-19 after their initial vaccine series should also get a booster (delayed more than 28 days after completion of the first series and documented clearance of the virus).

The third vaccine dose preferably should be administered to cancer patients in a healthcare setting (e.g., a doctor’s office) rather than a public vaccination clinic or a pharmacy to minimize exposure to COVID-19.
 

After a booster

Emerging data suggest that most patients with cancer are likely to have improved antibody levels to COVID-19 after a booster. However, cancer patients are still at higher risk for COVID-19 complications. Because of this, the NCCN recommends that cancer patients continue public masking (especially indoors) and avoid large crowds and public gatherings, limit contact with people outside their immediate household and avoid unmasked interactions with unvaccinated people.
 

Limitations of this update

This guideline update does not address people who received the one-shot Johnson & Johnson COVID-19 vaccine despite evidence that the efficacy of the vaccine decreases over time and that immunocompromised people who received J&J may benefit from a booster with a Moderna or Pfizer booster.
 

What does this mean for me?

To date, there are no reports of an increased risk for side effects from COVID-19 mRNA vaccines in patients with cancer as compared to the general population. Early data suggests that this is true for COVID-19 boosters as well.

Although the new NCCN guidelines do not specifically address recommendations for people who have had a J&J vaccine, the CDC did approve a booster for people in the general population who received this vaccine.

If you have been diagnosed with cancer, ask your healthcare provider about a COVID-19 booster, even if you are currently in active treatment and/or received the J&J vaccine. Because people around cancer patients (spouses, household members, etc.) are the most likely to be sources of transmission, they should also be vaccinated and consider getting a booster when available.
 

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posted 11/16/2021

 

Reference

NCCN COVID-19 vaccination guide for people with cancer

 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board before publication to assure scientific integrity.

This article is relevant for:

People with cancer considering a COVID-19 booster

This article is also relevant for:

People with metastatic or advanced cancer

People newly diagnosed with cancer

People with breast cancer

People with colorectal cancer

People with endometrial cancer

People with ovarian cancer

People with pancreatic cancer

People with prostate cancer

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Expert Guidelines

CDC COVID-19 initial vaccination guidelines

  • All people ages 5-17 should be vaccinated with the Pfizer vaccine and people 18 and older should be vaccinated with a Moderna, Pfizer or Johnson & Johnson vaccines unless contraindicated (e.g., known allergic reaction to a vaccine component). 
  • People should be vaccinated even if they have already had a COVID-19 infection.
  • COVID-19 vaccination is recommended for people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future.
  • People ages 5 or older with a weakened immune system, should get a COVID-19 vaccination (if they have no other contraindications). People with a weakened immune system may have a reduced immune response.
  • People with an autoimmune condition, may receive an mRNA COVID-19 vaccine. 

CDC COVID-19 booster recommendations  

  • The following people who received Pfizer or Moderna vaccines for their initial shot series should receive a booster at least 6 months after receiving their 2nd dose:
    • All people age 50 and older.
    • People who are 18 and older who live in a long-term care facility. 
  • The following people who received Pfizer or Moderna vaccines for their initial shot series may receive a booster at least 6 months after receiving their 2nd dose:  
    •   People who are 18 and older. 
  • People who received Johnson & Johnson for their initial shot series should receive a booster at least 2 months after receiving their initial dose. 
  • Moderately to severely immunocompromised people ages 12 years and older who completed their Pfizer vaccine primary series and ages 18 years or older who complete their Moderna COVID-19 vaccine primary series should plan to get an additional primary dose followed by a booster dose.

NCCN booster recommendations for people diagnosed with cancer

NCCN released recommendations for the following people diagnosed with cancer to receive COVID-19 boosters at least four weeks after their second dose of Pfizer or Moderna.  

  • Patients who have received cancer treatment within 1-year of their initial vaccination or are actively being treated, including those undergoing chemotherapy, targeted therapy, hormonal therapy, surgery, radiation or treatment with therapy that is currently used only in an experimental setting (e.g., a clinical trial).
  • Patients with newly diagnosed cancer or recurrent cancer who will receive cancer treatment in the future.
  • Patients with cancer of the blood regardless of whether they are currently receiving treatment.
  • Patients who have received a stem cell transplant or engineered cellular therapy (e.g., CART cells).
  • Patients who have had COVID-19 after their initial vaccine series should also get a booster (delayed more than 28 days after completion of the first series and documented clearance of the virus).

The NCCN guideline update did not address people who received the one-shot Johnson & Johnson COVID-19 vaccine.

Updated: 11/28/2021

Questions to Ask Your Doctor

  • Am I eligible to receive a COVID-19 booster?
  • Should I receive a COVID-19 booster?
  • Which booster should I get?
  • What else can I do to reduce my risk of getting COVID-19?

Open Clinical Trials

The following are studies on COVID and cancer:

 

 

 

 

 

Updated: 11/30/2021

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