Low booster uptake in cancer patients despite health benefits

Jane C Figueiredo; Julia Levy; So Yung Choi; Alexander M Xu; Noah M Merin; Omid Hamid; Tucker Lemos; Nathalie Nguyen; Maimoona Nadri; Alma Gonzalez; Simeon Mahov; Justin M Darrah; Jun Gong; Ronald L Paquette; Alain C Mita; Robert A Vescio; Sarah J Salvy; Inderjit Mehmi; Andrew E Hendifar; Ronald Natale; Warren G Tourtellotte; V Krishnan Ramanujan; Carissa A Huynh; Kimia Sobhani; Karen L Reckamp; Akil A Merchant

doi:10.1016/j.isci.2024.110596

Low booster uptake in cancer patients despite health benefits

iScience. 2024 Jul 26;27(9):110596. doi: 10.1016/j.isci.2024.110596. eCollection 2024 Sep 20.

Authors

Jane C Figueiredo^{1

2}, Julia Levy¹, So Yung Choi³, Alexander M Xu⁴, Noah M Merin⁵, Omid Hamid^{1

6}, Tucker Lemos⁵, Nathalie Nguyen¹, Maimoona Nadri¹, Alma Gonzalez¹, Simeon Mahov⁵, Justin M Darrah⁵, Jun Gong¹, Ronald L Paquette⁵, Alain C Mita¹, Robert A Vescio⁵, Sarah J Salvy⁷, Inderjit Mehmi⁶, Andrew E Hendifar¹, Ronald Natale¹, Warren G Tourtellotte^{8

9}, V Krishnan Ramanujan⁹, Carissa A Huynh⁹, Kimia Sobhani⁹, Karen L Reckamp¹, Akil A Merchant⁵

Affiliations

¹ Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
² Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
³ Biostatistics Shared Resource, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁴ Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁵ Division of Hematology and Cellular Therapy, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁶ The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, CA 90025, USA.
⁷ Research Center for Health Equity, Department of Biomedical Sciences, Los Angeles, CA 90048, USA.
⁸ Department of Neurology, Neurological Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
⁹ Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Abstract

Patients with cancer are at increased risk of death from COVID-19 and have reduced immune responses to SARS-CoV2 vaccines, necessitating regular boosters. We performed comprehensive chart reviews, surveys of patients attitudes, serology for SARS-CoV-2 antibodies and T cell receptor (TCR) β sequencing for cellular responses on a cohort of 982 cancer patients receiving active cancer therapy accrued between November-3-2020 and Mar-31-2023. We found that 92 · 3% of patients received the primer vaccine, 70 · 8% received one monovalent booster, but only 30 · 1% received a bivalent booster. Booster uptake was lower under age 50, and among African American or Hispanic patients. Nearly all patients seroconverted after 2+ booster vaccinations (>99%) and improved cellular responses, demonstrating that repeated boosters could overcome poor response to vaccination. Receipt of booster vaccinations was associated with a lower risk of all-cause mortality (HR = 0 · 61, p = 0 · 024). Booster uptake in high-risk cancer patients remains low and strategies to encourage booster uptake are needed.

Keywords: Cancer; Disease; Immunity; Patient social context.

Grants and funding

KL2 TR001882/TR/NCATS NIH HHS/United States