Ask The Experts About COVID-19 and Cancer

TraceyS

The Personalized Medicine Foundation and CancerConnect are pleased to provide patients and caregivers the opportunity to ask questions about the management of cancer during COVID-19. We have put together a panel of leading cancer experts to answer questions and publish a forum for the exchange of information.
Dr. Tanios Bekaii-Saab, MD FACP Professor of Gastrointestinal Cancer Mayo Clinics College of Medicine and Science.
Dr. Thomas J. Herzog, MD Paul & Carolyn Flory Professor Deputy Director, UC Cancer Institute Vice Chair Quality & Safety, Dept Ob/Gyn University of Cincinnati.
Diane M. Simeone, M.D. Laura and Isaac Perlmutter Professor of Surgery and Pathology Director, Pancreatic Cancer Center Associate Director of Translational Research NYU Langone Health NYU Perlmutter Cancer Center.
Rami Komrokji, MD Senior Member & Professor of Oncologic Sciences, Section Head- Leukemia and MDS, Vice Chair-Malignant Hematology Department, Moffitt Cancer Center.
Click here to submit your question-if it has not already been answered below- you will be notified when the responses are posted.

Are you recommending the vaccine to your patients with cancer?

Having cancer regardless of treatment status is a risk factor for worse outcome from infections including influenza and COVID-19. The short answer is yes once COVID-19 vaccines become more widely available. In terms of prioritization, and according to CDC guidelines, cancer patients will be part of the phase II wave of vaccination which will occur sometime in February. The vaccine is given in 2 doses at 21 days interval and we expect patients receiving the vaccine to be immune 2-3 weeks after their second dose of vaccine.

Timing of Vaccination

It is recommended that all patients with cancer receive the COVID-19 vaccine, however there are some individuals who may need to wait to ensure that their immune system responds to the vaccine. The NCCN advises patients who have undergone an allogeneic or autologous transplant or chimeric antigen receptor T (CAR-T) cell therapy should wait a minimum of 3 months to receive the vaccine. (1)

What is your approach to timing of the Covid vaccination for patients with cancer who have not have had prior Covid 19, and are about to start chemotherapy?

If possible to delay, is it advised to delay starting chemo until 2 weeks after completing the Covid 19 vaccine series in order to max out the protective benefit from the vaccine.

Can i get the vaccine while receiving chemotherapy?

Yes. Having cancer regardless of treatment status is a risk factor for worse outcome from infections including influenza and COVID-19. Some individuals with suppressed immune systems may not respond to the vaccine as well as others but this is not a reason not to get the vaccine.

Patients who received intensive cytotoxic chemotherapy and experienced a resulting decrease in absolute neutrophil count should wait until the neutrophil count recovers to receive the vaccine. It is also advised that patients who underwent a major surgery wait a few days to be vaccinated. All other patients with cancer, regardless of their type of treatment, should receive the vaccine as soon as it is made available to them, according to the NCCN. (1) The vaccine has not been evaluated in cancer patients specifically at this time.

When should the COVID vaccine be given if I have already started chemotherapy?

My last dose of Taxol is in 2 days. I am 51 yo and a Health Care worker so eligible to receive the vaccine now. When should I get the covid vaccine? and have there been any common side effects noted for cancer/chemo patients since we have started vaccination

The vaccines are approved for general use and you should get the vaccine. The vaccines however were not evaluated in patients with blood disorders or cancers and compromised immune systems so we are not certain how effective they will be - the CDC is recommending cancer patients should get the vaccine. You should however discuss vaccination with the doctor managing your cancer.

Thus far the reported side effects in patients with cancer are no different than the general population.

Can I have the covid-19 vaccine if i am taking letrozole as maintenance therapy for cancer?

Yes, the vaccine can be given with most drugs used to treat cancer. It might be advisable to hold certain medications that suppress the immune system for a few weeks to give your immune system the best chance to generate a full immune response. Make sure you discuss with your oncologist before changing any of your meds.

For those with cancer, are they in line to receive the vaccine sooner? Are they more susceptible to getting sick/die from COVID19?

Having cancer regardless of treatment status is a risk factor for worse outcome from infections including influenza and COVID-19. In terms of prioritization, and according to CDC guidelines, cancer patients will be part of the phase II wave of vaccination which will occur sometime in February. The vaccine is given in 2 doses at 21 days interval and we expect patients receiving the vaccine to be immune 2-3 weeks after their second dose of vaccine.

Vaccine Safety

I am concerned about the safety of the two RNA vaccines in general. Are they continued to be studied for safety even as people are getting them. Are there any studies on the safety and efficacy of multiple myeloma patients and these vaccines. I have low risk smoldering myeloma.

Is it safe for an 80 year old mother on 10 mg revlimid daily , with low antibodies, multiple myeloma to get the COVID vaccine.

The vaccines have not been evaluated in patients with blood disorders or cancers and compromised immune systems so we are not certain how effective they will be - the CDC is recommending cancer patients should get the vaccine. You should however discuss vaccination with the doctor managing your cancer.

Thus far the reported side effects in patients with cancer are no different than the general population.

The most common side effects reported in the clinical trials were pain at the injection site, fatigue, and fever. Serious side effects were rare and long-term side effects have not yet been well defined for SARS-CoV-2 vaccines and will be available once phase 3 trials have been followed longer. A national monitoring system exists for reporting vaccine-related adverse events. There are currently no studies defining vaccine effectiveness in patients with myeloma or other cancers. Answers to more questions about vaccination specifically in cancer patients here.

Risk of Anaphylaxis: Anaphylaxis is a life-threatening allergic reaction that occurs rarely after vaccination, with onset typically within minutes to hours. After administration of a reported 1 893 360 first doses of Pfizer-BioNTech COVID-19 vaccine the CDC estimates a rate of 11.1 cases of anaphylaxis per million doses administered. No deaths from anaphylaxis were reported. https://jamanetwork.com/journals/jama/fullarticle/2775646

I have neutropenia. Is the covid vaccine effective and safe for me? If yes, what would be the best choice of the currently approved vaccines? Is it better to wait until more data is collected since the vaccines were tested on healthy individuals?

The clinical trials suggest that the vaccine appears safe to take, there is however no data on efficacy in patients with neutropenia and both the Pfizer and Moderna vaccines appear to have similar effectiveness but they have not been directly compared.

Is it safe to get the vaccine during radiation therapy ?

Radiation therapy in patients with myeloproliferative neoplasms is extremely rarely used, and this would be in myelofibrosis patients that have terribly enlarged spleen not responding to any other therapy, in which case radiation is given over limited number of days (e.g. 7-10 days) to the spleen specifically (not to the whole body). while there is no experience giving vaccine to such patients while receiving radiation, one may wait for 10 days and provide vaccine once radiation has been done.

My friend says that the Pfizer mRNA vaccine may cause covid19 illness in some people, is it true?

Absolutely not , there is no virus in the vaccine​.

Can SARS Pfizer vaccination potentially exacerbate undiagnosed or newly Chronic Myeloproliferative disorders in elderly patients ? or this is purely coincidental.

There is no scientific possibility for a vaccine to cause a neoplasm of the bone marrow. This is therefore purely coincidental.

The "Ask The Experts About COVID-19 and Cancer" Series

References

  1. Preliminary Recommendations of the NCCN COVID-19 Vaccination Advisory Committee, version 1.0. National Comprehensive Cancer Network. Published January 22, 2021. Accessed February 22, 2021.
The Ask The Expert Series is made possible by support from The Personalized Medicine Foundation, Incyte Oncology, Abbvie, and CancerConnect. The "Ask The Expert" series is not medical advice nor is it a substitute for your doctor. It should serve as a guide to facilitate access to additional information and enhancement of a shared decision making process with your treating physician.
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