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The base of cancer patients in China is huge, and there will be 4.
57 million new cases of malignant tumors in 2020 alone1
.
In the new crown epidemic, cancer patients are at a higher risk of infection than the general population due to their average age, many complications, suppression of immune function due to treatment, and repeated hospital visits
.
Therefore, China's "New Coronavirus Vaccination Technical Guidelines"2 recommends vaccination for the above-mentioned groups
.
In practice, vaccination is usually delayed for patients with unstable or postoperative conditions3
.
Cancer patients are high-risk groups that cannot be ignored in the new crown epidemic and require effective preventive measures
.
This article will combine the latest research data to interpret the vaccination-related issues of cancer patients
.
01 Cancer patients are at high risk of being infected with the new crown.
Due to the disease itself and treatment, cancer patients may be in a state of immunosuppression, so the probability of being infected with the new crown is higher than that of the general population
.
Domestic surveillance data 4 in early 2020 shows that among the 1590 cases of new coronary disease, 1% (n=18) have a history of cancer, which is higher than 0.
29% of the cancer incidence in the total population in China, indicating that cancer patients are more likely to be infected with the new coronavirus And patients with a history of tumors are more likely to have serious consequences after infection
.
The incidence of serious events in different populations after being infected with the new crown virus4 The infection of immunosuppressed patients such as tumor patients may also bring further risks to the epidemic
.
A recently published case report shows that immunosuppressed patients may undergo viral mutations in the body during continuous new crown infection.
Some mutation patterns have key similarities with the currently widely spread variants of concern (VOC), which may lead to immune escape or increase transmission Force
.
Therefore, vaccination of immunosuppressed patients with the new coronavirus vaccine can not only protect the patients themselves from the virus, but also reduce the risk of evolving more dangerous virus strains5
.
The virus detected in immunosuppressive patients with neocoronavirus has a mutation pattern similar to that of VOC5 In view of the infection, severe illness, and the potential risk of mutations in cancer patients, the current authoritative guidelines clearly recommend that all cancer patients should be vaccinated with neocorona vaccine2 ,6
.
China National Health Commission "New Coronavirus Vaccination Technical Guidelines" 2 National Comprehensive Cancer Network (NCCN) New Coronary Vaccination Guidelines for Cancer Patients 602 Existing research data: effectiveness and safety of tumor patients after vaccination, then whether there is currently an assessment of tumors What about research data on the effectiveness and safety of patients after vaccination? 01 Solid tumor research data show that the vast majority of solid tumor patients can obtain an effective immune response after receiving 2 doses of mRNA vaccine, and the antibody titer of a few patients receiving chemotherapy combined with immunotherapy has decreased
.
A UK prospective study7 showed that if patients with solid tumors received only one dose of BNT162b2 vaccine, the antibody response rate was lower than that of the healthy control group, while the immunogenicity was significantly increased after two doses, and the antibody response rate was comparable to that of the healthy control group
.
Anti-S protein IgG positive rates after 1 or 2 doses of vaccine in different populations7 This study also evaluated the T cell immune response after vaccination, and the results showed that the response characteristics are similar to humoral immunity, whether it is a solid tumor or a hematological tumor patient , Two doses of vaccine can significantly increase the T cell response rate
.
T cell response rates after 1 or 2 doses of vaccine in different populations 7 Another prospective Israeli study 8 showed that after 2 doses of BNT162b2 vaccine, 90% of solid tumor patients can obtain sufficient antibody levels (anti-S protein IgG≥50 AU/mL)
.
Multivariate analysis showed that the only variable related to the reduction of IgG titer was chemotherapy combined with immunotherapy
.
In terms of safety, the aforementioned British study 7 showed that the side effects of tumor patients within 30 days after receiving two doses of vaccine were mainly pain at the injection site, and the incidence of side effects was almost lower than that of healthy controls
.
The incidence of adverse reactions after 1 or 2 doses of BNT162b2 vaccine in different groups of people is relatively complicated
.
Compared with the general population, the level of immune response obtained by patients with hematological tumors after vaccination has been reduced, and it is related to the treatment they receive
.
An Israeli study9 showed that after two doses of BNT162b2 mRNA vaccine in patients with B-cell non-Hodgkin lymphoma (B-NHL), the response rate (defined as anti-S protein RBD antibody ≥80 U/mL) was lower than that of healthy controls (49% vs 98.
5%)
.
Another French study10 showed that after two doses of BNT162b2 vaccine in patients with hematological tumors, the proportion of protective responses (defined as anti-S protein IgG level ≥ 3100 UA/mL) was lower than that of healthy controls (47% vs 87%)
.
However, in the above-mentioned Israeli study9, the response rate of untreated B-NHL patients was higher (89.
3%), and the response rate of patients receiving anti-CD20 treatment was only 7.
3%, and the time between vaccination and the last anti-CD20 treatment was longer.
Longer, the higher the probability of getting a response
.
B-NHL patients: The longer the time between vaccination and the last anti-CD20 treatment, the higher the likelihood of a response.
9 A Canadian study11 showed that untreated patients with chronic lymphocytic leukemia (CLL) and lymphoma were vaccinated2 28 days after the administration of mRNA vaccine, the level of antibody response was not significantly different from that of the healthy control group
.
S protein antibody response after vaccination in healthy controls and untreated CLL/lymphoma patients11 In patients receiving anti-CD20 treatment, two more doses of vaccine more than 12 months after anti-CD20 treatment can still produce a significant antibody response11
.
The S protein antibody response of patients within 12 months after anti-CD20 treatment and more than 12 months after vaccination11 In addition, an Israeli study12 showed that CLL patients who obtained an antibody response after 2 doses of BNT162b2 vaccine had an antibody response within 100 days after vaccination.
The degree of antibody attenuation is similar to that of the healthy control group, and the antibody titer does not decrease significantly, suggesting that these patients can obtain a sustained immune response
.
All in all, the results of the above-mentioned multiple studies suggest that although the overall antibody response rate of patients with hematological tumors after being vaccinated with the new crown vaccine is lower than that of healthy people, patients who have not received treatment or received anti-CD20 monoclonal antibody treatment for a long time still have the opportunity to obtain Higher response rate
.
In terms of safety, existing research evidence 9 shows that the incidence of pain at the injection site of patients with hematological tumors after inoculation of mRNA vaccine is higher than that of the healthy control group, and the incidence and severity of most of the other adverse events are not significantly different from that of the healthy control group
.
The incidence of adverse reactions in B-NHL patients and healthy control patients 903 Practical operation: How should tumor patients be vaccinated? Finally, it is the most concerned issue of the majority of cancer patients.
Under what circumstances can the vaccine be vaccinated? At present, there are a number of clinical guidelines for vaccinating neocoronavirus vaccines for cancer patients, including NCCN guidelines13, US neocoronavirus disease and tumor clinical trial working group guidelines14, and Peking Union Medical College Hospital expert group preliminary clinical recommendations15
.
The main recommendations are as follows: Recommendations for vaccinating new crown vaccines for cancer patients with different treatment methods and stages.
At present, due to strict epidemic control and control in China, the total number of infected persons is small, so some cancer patients have a certain degree of hesitation about vaccination
.
However, cancer patients are highly susceptible to the new crown.
The existing research data shows that most cancer patients can still obtain effective protection after being vaccinated with mRNA vaccines, and at the same time have good safety.
.
Recent real-world data show that immunocompromised people, including cancer patients, can benefit from vaccination, but the effective rate is reduced16,17, and the risk of breakthrough infection is relatively high16
.
Therefore, at present, many countries have proposed to inoculate an additional dose of vaccine, that is, the third dose of booster immunization, to ensure that this population is fully protected
.
China is also currently studying the feasibility of using the same technical route to strengthen immunization and different technical routes of sequential immunization for high-risk groups, and further suggestions will be made after more data is obtained18
.
Reference 1.
https://gco.
iarc.
fr/today/ (accessed on 9th Sept, 2021) 2.
http:// 3.
http: //wsjkw.
sh.
gov.
cn/yfjz/20210527/6d72dbddf689403f81e94e60d06b0d19.
html4.
Liang WH, et al.
Lancet Oncol.
2020; 21(3): 335–337.
5.
Corey L, et al.
Engl J Med, 385( 6), 562–566.
6.
https:// Monin L, et al.
Lancet Oncol.
2021, 22(6):765-778.
8.
Massarweh A, et al.
JAMA Oncol.
2021, 7(8):1133-11140.
9.
Perry C, et al.
Blood Adv.
2021;5(16):3053 -3061.
10.
Malard F, et al.
Blood Cancer J.
2021;11(8):142.
11.
Crombie JL, et al.
Blood Adv.
2021, 5(16): 3062–3065.
12.
Tadmor T, et al.
Leukemia.
2021;35(9):2727-2730.
13.
https:// Desai, et al.
Nat Rev Clin Oncol.
2021;18(5):313-319.
15.
Wang Luo et al.
Chinese Journal of Lung Cancer, 2021,24(6):377-383.
16.
Tenforde MW, et al.
medRxiv 2021.
07.
08.
21259776; doi: https://doi.
org/10.
1101/2021.
07.
08.
2125977617.
https://khub.
net/documents/135939561/430986542/RCGP+VE+riskgroups+paper.
pdf/a6b54cd9-419d -9b63-e2bf-5dc796f5a91f18.
http://
57 million new cases of malignant tumors in 2020 alone1
.
In the new crown epidemic, cancer patients are at a higher risk of infection than the general population due to their average age, many complications, suppression of immune function due to treatment, and repeated hospital visits
.
Therefore, China's "New Coronavirus Vaccination Technical Guidelines"2 recommends vaccination for the above-mentioned groups
.
In practice, vaccination is usually delayed for patients with unstable or postoperative conditions3
.
Cancer patients are high-risk groups that cannot be ignored in the new crown epidemic and require effective preventive measures
.
This article will combine the latest research data to interpret the vaccination-related issues of cancer patients
.
01 Cancer patients are at high risk of being infected with the new crown.
Due to the disease itself and treatment, cancer patients may be in a state of immunosuppression, so the probability of being infected with the new crown is higher than that of the general population
.
Domestic surveillance data 4 in early 2020 shows that among the 1590 cases of new coronary disease, 1% (n=18) have a history of cancer, which is higher than 0.
29% of the cancer incidence in the total population in China, indicating that cancer patients are more likely to be infected with the new coronavirus And patients with a history of tumors are more likely to have serious consequences after infection
.
The incidence of serious events in different populations after being infected with the new crown virus4 The infection of immunosuppressed patients such as tumor patients may also bring further risks to the epidemic
.
A recently published case report shows that immunosuppressed patients may undergo viral mutations in the body during continuous new crown infection.
Some mutation patterns have key similarities with the currently widely spread variants of concern (VOC), which may lead to immune escape or increase transmission Force
.
Therefore, vaccination of immunosuppressed patients with the new coronavirus vaccine can not only protect the patients themselves from the virus, but also reduce the risk of evolving more dangerous virus strains5
.
The virus detected in immunosuppressive patients with neocoronavirus has a mutation pattern similar to that of VOC5 In view of the infection, severe illness, and the potential risk of mutations in cancer patients, the current authoritative guidelines clearly recommend that all cancer patients should be vaccinated with neocorona vaccine2 ,6
.
China National Health Commission "New Coronavirus Vaccination Technical Guidelines" 2 National Comprehensive Cancer Network (NCCN) New Coronary Vaccination Guidelines for Cancer Patients 602 Existing research data: effectiveness and safety of tumor patients after vaccination, then whether there is currently an assessment of tumors What about research data on the effectiveness and safety of patients after vaccination? 01 Solid tumor research data show that the vast majority of solid tumor patients can obtain an effective immune response after receiving 2 doses of mRNA vaccine, and the antibody titer of a few patients receiving chemotherapy combined with immunotherapy has decreased
.
A UK prospective study7 showed that if patients with solid tumors received only one dose of BNT162b2 vaccine, the antibody response rate was lower than that of the healthy control group, while the immunogenicity was significantly increased after two doses, and the antibody response rate was comparable to that of the healthy control group
.
Anti-S protein IgG positive rates after 1 or 2 doses of vaccine in different populations7 This study also evaluated the T cell immune response after vaccination, and the results showed that the response characteristics are similar to humoral immunity, whether it is a solid tumor or a hematological tumor patient , Two doses of vaccine can significantly increase the T cell response rate
.
T cell response rates after 1 or 2 doses of vaccine in different populations 7 Another prospective Israeli study 8 showed that after 2 doses of BNT162b2 vaccine, 90% of solid tumor patients can obtain sufficient antibody levels (anti-S protein IgG≥50 AU/mL)
.
Multivariate analysis showed that the only variable related to the reduction of IgG titer was chemotherapy combined with immunotherapy
.
In terms of safety, the aforementioned British study 7 showed that the side effects of tumor patients within 30 days after receiving two doses of vaccine were mainly pain at the injection site, and the incidence of side effects was almost lower than that of healthy controls
.
The incidence of adverse reactions after 1 or 2 doses of BNT162b2 vaccine in different groups of people is relatively complicated
.
Compared with the general population, the level of immune response obtained by patients with hematological tumors after vaccination has been reduced, and it is related to the treatment they receive
.
An Israeli study9 showed that after two doses of BNT162b2 mRNA vaccine in patients with B-cell non-Hodgkin lymphoma (B-NHL), the response rate (defined as anti-S protein RBD antibody ≥80 U/mL) was lower than that of healthy controls (49% vs 98.
5%)
.
Another French study10 showed that after two doses of BNT162b2 vaccine in patients with hematological tumors, the proportion of protective responses (defined as anti-S protein IgG level ≥ 3100 UA/mL) was lower than that of healthy controls (47% vs 87%)
.
However, in the above-mentioned Israeli study9, the response rate of untreated B-NHL patients was higher (89.
3%), and the response rate of patients receiving anti-CD20 treatment was only 7.
3%, and the time between vaccination and the last anti-CD20 treatment was longer.
Longer, the higher the probability of getting a response
.
B-NHL patients: The longer the time between vaccination and the last anti-CD20 treatment, the higher the likelihood of a response.
9 A Canadian study11 showed that untreated patients with chronic lymphocytic leukemia (CLL) and lymphoma were vaccinated2 28 days after the administration of mRNA vaccine, the level of antibody response was not significantly different from that of the healthy control group
.
S protein antibody response after vaccination in healthy controls and untreated CLL/lymphoma patients11 In patients receiving anti-CD20 treatment, two more doses of vaccine more than 12 months after anti-CD20 treatment can still produce a significant antibody response11
.
The S protein antibody response of patients within 12 months after anti-CD20 treatment and more than 12 months after vaccination11 In addition, an Israeli study12 showed that CLL patients who obtained an antibody response after 2 doses of BNT162b2 vaccine had an antibody response within 100 days after vaccination.
The degree of antibody attenuation is similar to that of the healthy control group, and the antibody titer does not decrease significantly, suggesting that these patients can obtain a sustained immune response
.
All in all, the results of the above-mentioned multiple studies suggest that although the overall antibody response rate of patients with hematological tumors after being vaccinated with the new crown vaccine is lower than that of healthy people, patients who have not received treatment or received anti-CD20 monoclonal antibody treatment for a long time still have the opportunity to obtain Higher response rate
.
In terms of safety, existing research evidence 9 shows that the incidence of pain at the injection site of patients with hematological tumors after inoculation of mRNA vaccine is higher than that of the healthy control group, and the incidence and severity of most of the other adverse events are not significantly different from that of the healthy control group
.
The incidence of adverse reactions in B-NHL patients and healthy control patients 903 Practical operation: How should tumor patients be vaccinated? Finally, it is the most concerned issue of the majority of cancer patients.
Under what circumstances can the vaccine be vaccinated? At present, there are a number of clinical guidelines for vaccinating neocoronavirus vaccines for cancer patients, including NCCN guidelines13, US neocoronavirus disease and tumor clinical trial working group guidelines14, and Peking Union Medical College Hospital expert group preliminary clinical recommendations15
.
The main recommendations are as follows: Recommendations for vaccinating new crown vaccines for cancer patients with different treatment methods and stages.
At present, due to strict epidemic control and control in China, the total number of infected persons is small, so some cancer patients have a certain degree of hesitation about vaccination
.
However, cancer patients are highly susceptible to the new crown.
The existing research data shows that most cancer patients can still obtain effective protection after being vaccinated with mRNA vaccines, and at the same time have good safety.
.
Recent real-world data show that immunocompromised people, including cancer patients, can benefit from vaccination, but the effective rate is reduced16,17, and the risk of breakthrough infection is relatively high16
.
Therefore, at present, many countries have proposed to inoculate an additional dose of vaccine, that is, the third dose of booster immunization, to ensure that this population is fully protected
.
China is also currently studying the feasibility of using the same technical route to strengthen immunization and different technical routes of sequential immunization for high-risk groups, and further suggestions will be made after more data is obtained18
.
Reference 1.
https://gco.
iarc.
fr/today/ (accessed on 9th Sept, 2021) 2.
http:// 3.
http: //wsjkw.
sh.
gov.
cn/yfjz/20210527/6d72dbddf689403f81e94e60d06b0d19.
html4.
Liang WH, et al.
Lancet Oncol.
2020; 21(3): 335–337.
5.
Corey L, et al.
Engl J Med, 385( 6), 562–566.
6.
https:// Monin L, et al.
Lancet Oncol.
2021, 22(6):765-778.
8.
Massarweh A, et al.
JAMA Oncol.
2021, 7(8):1133-11140.
9.
Perry C, et al.
Blood Adv.
2021;5(16):3053 -3061.
10.
Malard F, et al.
Blood Cancer J.
2021;11(8):142.
11.
Crombie JL, et al.
Blood Adv.
2021, 5(16): 3062–3065.
12.
Tadmor T, et al.
Leukemia.
2021;35(9):2727-2730.
13.
https:// Desai, et al.
Nat Rev Clin Oncol.
2021;18(5):313-319.
15.
Wang Luo et al.
Chinese Journal of Lung Cancer, 2021,24(6):377-383.
16.
Tenforde MW, et al.
medRxiv 2021.
07.
08.
21259776; doi: https://doi.
org/10.
1101/2021.
07.
08.
2125977617.
https://khub.
net/documents/135939561/430986542/RCGP+VE+riskgroups+paper.
pdf/a6b54cd9-419d -9b63-e2bf-5dc796f5a91f18.
http://
