Update: COVID boosters: What people with cancer should know

Contents

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.