As of December 18, the United States Food and Drug Administration (FDA) issued emergency use authorization of two approved COVID-19 vaccines, developed by Pfizer and Moderna. Preliminary findings from their vaccine trials demonstrated that these vaccines were more than 90% effective in preventing symptomatic COVID-19. Dr. Gary Schwartz, deputy director of the Herbert Irving Comprehensive Cancer Center (HICCC) and chief of the Division of Hematology and Oncology at NewYork-Presbyterian/Columbia University Irving Medical Center, addresses what patients, particularly cancer patients, should know about the new vaccine.
How does the COVID-19 vaccine work?
As noted, there are two FDA approved COVID-19 vaccines in the United States at this time, one from Pfizer and the other from Moderna. Both are RNA based. RNA is the template by which cells make proteins. These RNA templates are used by the normal cellular machinery to make proteins that are similar to but not identical to the viral proteins made by the COVID-19 virus. By making proteins that mimic the virus, the body then generates antibodies against them such that if the body is ever infected by the actual virus these antibodies are rapidly generated and they neutralize the virus. This is a process called “humoral immunity” and comes from the B cells of the immune system. The vaccine also elicits a process called “cell-mediated” immunity. These comes from the T cells of the immune system and this also elicits a very strong anti-viral response. Collectively by generating both “humoral” and “cellular” immunity these RNA-based vaccines represent a very potent means to neutralize or kill the COVID-19 virus.
How safe is the vaccine for cancer patients?
The science clearly shows that the COVID-19 vaccines are safe, and there is no data saying that there's any increased risk for cancer patients. Patients should discuss their concerns about the new vaccines with their treating oncologist, but I can’t think of a reason why cancer patients should not take the vaccine. There have been reports of rare allergic reactions but these have only been in people with known severe allergic reaction to other vaccines or foods. If this should develop there are rapid ways to reverse it. In fact, patients are now monitored for up to 15 minutes, post-vaccination to observe for this possibility, and if this does develop, medications are administered to rapidly reverse it.
Cancer patients are generally immunosuppressed and they represent an especially vulnerable population that would benefit from the protection the vaccine offers. Our patient population at NewYork-Presbyterian/Columbia includes a large number of Hispanic and Black cancer patients who appear particularly susceptible to dying from this disease. Up to this point, the only protection we have had are masks, social distancing, and frequent hand-washing. With the vaccine, we now have something that can finally turn the tide.
When will the COVID-19 vaccine become available to cancer patients?
There is no timeline for this yet, but we expect this will start happening soon. In mid-December, our emergency room physicians at NewYork-Presbyterian/Columbia started getting the vaccine. This has now moved to all health care workers who have direct patient interactions. My hope is that once all of our health care providers are vaccinated we will move onto our cancer population.
Should cancer patients on active treatment get vaccinated?
Every adult patient with cancer should talk with their oncologist about taking this vaccine, whether they are on active treatment or completed treatment in the past. In fact, cancer patients should be moved to the front of the line because they are immunosuppressed and they are more susceptible to dying from COVID.
What are some key insights that have been uncovered so far about COVID-19 and patients with cancer?
COVID-19 is a deadly disease. For many of our patients the chance of dying from COVID, if infected, is greater than the chance from dying of cancer. We’ve just submitted updated data to a prospective study—Red Cap—that is investigating what happens to cancer patients with COVID over time. Red Cap is the largest collection of cancer patients in the country that involves multiple cancer centers across the country, called the COVID-19 and Cancer Consortium, and Columbia is one of the largest contributors to it. I’m co-leading it on this campus with Jessica Hawley, MD. We enrolled numerous patients into this prospective study, and found that patients with lymphoma, in particular, have had a very high death rate. This may be related to the fact that they often receive, as part of their chemotherapy, drugs that suppress their immune system. This concern for greatly increased susceptibility to COVID-19 can be extended to other cancer patients, including those with leukemia, or to patients undergoing bone marrow transplant. So, we know that cancer patients receiving certain types of chemotherapy, especially in combination with immunosuppressive therapy, when infected with COVID-19 have exceptionally high death rates, which have exceeded anything we've ever seen before. Yet these therapies are needed to treat and cure these diseases.
During the height of the COVID epidemic in New York City in March and April of 2020, there were cancer patients who refused to come in for treatment because of fear of COVID-19. Retrospectively, we have determined that for patients who deferred chemotherapy for fear of getting the virus or for concern that the immunosuppressive effects of chemotherapy would make them more susceptible to the virus, the death rates for these patients were higher than we would have predicted if they had come in for their treatments. This makes the need for the vaccine now more urgent than ever. In fact, during this current resurgence, we are telling all of our patients to come in for treatment. All patients receiving chemotherapy are being tested for COVID-19.
If they are determined to be COVID positive and are asymptomatic from the illness, we are finding every means to treat them safely. Since last spring, we’ve learned a lot about cancer and COVID-19. We’re telling our patients not to be afraid to come to the hospital for their treatments. We have created an absolutely safe environment here.
Are the side effects from the vaccine different for cancer patients?
We don’t yet have that data. With an impaired immune system there could actually be fewer side effects in a cancer patient, since the potential immune response to the vaccine could be more muted. The major side effect is pain at the injection site. With all the thousands of patients that have been vaccinated to date, the extent of the side effects has been muscle aches, a fever, and fatigue that may last 24 to 48 hours and goes away. These later side effects are more apparent with the second injection, as the vaccine does require a second injection 3 to 4 weeks after the first to achieve maximum immunity. We have to weigh the pros and cons. I think the pros greatly outweigh the cons. We must make every effort to protect our cancer patients from getting COVID, who remain at increased risk of death from this disease.
Is the protection of this vaccine equivalent in a cancer patient as a non-cancer patient?
This is something we are thinking about and will closely monitor--will our cancer patients have enough immunity intact to mount a sufficient humoral and cellular response to the virus when exposed? Is the second boost going to give the same 95% protection to our patients, or will it be different for a patient with cancer? If this vaccine even gives a cancer patient 60% protection from COVID-19 then this is better than zero protection from a disease that can otherwise be lethal to patients with cancer.
Given the choice between having COVID or receiving a vaccine that offers you protection from contracting this disease, the data clearly indicates that patients with cancer should receive this COVID-19 vaccine. In fact, I would say that's true for our entire population, cancer and non-cancer. Only when we get to the point in which 80 to 90% of the American population is vaccinated will we all be safe from contracting this virus.
-Interview by Melanie A. Farmer