Vacinação para COVID-19 em pacientes oncológicos: Risco ou benefício?

Laporte, Bruno Eduardo Pereira; Laporte, Estela Gelain Junges; Aarestrup, Paula Fonseca; Aarestrup, Matheus Fonseca; Aarestrup, Fernando Monteiro

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev Bras Ginecol Obstet. 44 (6) • 2022 • https://doi.org/10.1055/s-0042-1745788 copiar

Vacinação para COVID-19 em pacientes oncológicos: Risco ou benefício?

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

O objetivo do presente estudo é listar os ensaios clínicos publicados sobre as vacinas para coronavirus disease 2019 (COVID-19), descrever seus mecanismos de ação e descrever protocolos sobre segurança, status e priorização de pacientes oncológicos para vacinação.

Métodos

Trata-se de uma revisão sistemática com uma pesquisa bibliográfica limitada conduzida por um especialista em informação; bases de dados como PubMed e sites das principais organizações de câncer foram pesquisados. Os principais termos de pesquisa foram COVID-19, vacinação, câncer e câncer de mama e ginecológico.

Resultados

Pacientes com câncer infectados com o novo coronavírus têm alto risco de complicações e morte, mas ainda sabemos pouco sobre os riscos e benefícios da vacinação para COVID-19 nesses pacientes. Em um cenário ideal, todos os pacientes com câncer deveriam ter seu estado de imunização atualizado antes de iniciar o tratamento, mas nem sempre isso é possível.

Conclusão

Pacientes com câncer de mama ou ginecológico em tratamento ou no período pós-tratamento de 5 anos devem ser incluídos no grupo prioritário para vacinação contra severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2.)

câncer; COVID-19; vacinação; protocolos

Manufacturer	Technology/Platform	Name	Doses	Advantages	Disadvantages	Efficacy
Sinovac Research and Development Co., Ltd.⁴4 Zhang Y, Zeng G, Pan H, Wang H, Yang Y, Gao GF, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine in healthy adults aged 18–59 years: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial. Lancet Infect Dis. 2021;21(02):181–192. Doi: 10.1016/S1473-3099(20)30843-4 https://doi.org/10.1016/S1473-3099(20)30...	Inactivated virus	SARS-CoV-2 vaccine (inactivated) CoronaVac	Day 0 + 28	Safe for cancer patients Known technology Storage from 2 to 8°C	Low immunogenicity	50.36%
Bharat Biotech International Limited.⁵5 Ella R, Reddy S, Jogdand H, Sarangi V, Ganneru B, Prasad S, et al. Safety and immunogenicity clinical trial of an inactivated SARS-CoV-2 vaccine, BBV152 (a phase 2, double-blind, randomised controlled trial) and the persistence of immune responses from a phase 1 follow-up report. medRxiv. [Preprint]. 2020; 152:2020.12.21.20248643 Doi: 10.1101/2020.12.21.20248643 https://doi.org/10.1101/2020.12.21.20248...	Inactivated virus	Whole-virion inactivated SARS-CoV-2 vaccine (BBV152)	Day 0 + 14	Known technology Easy storage	Low immunogenicity	Phase 3 in progress
AstraZeneca + University of Oxford.⁶6 Voysey M, Clemens SA, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99–111. Doi: 10.1016/S0140-6736(20) 32661-1 https://doi.org/10.1016/S0140-6736(20) 3...	Viral vector (non-replicating)	ChAdOx1-S-(AZD1222) (Covishield)	Day 0 + 28 or 3 months	Longer gap between doses. One dose protection		70.4%
Gamaleya Research Institute of Epidemiology and Microbiology, Russia.⁷7 Logunov DY, Dolzhikova IV, Zubkova OV, Tukhvatullin AI, Shcheblyakov DV, Dzharullaeva AS, et al. Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: two open, non-randomised phase 1/2 studies from Russia. Lancet. 2020;396 (10255):887–897. Doi: 10.1016/S0140-6736(20)31866-3 https://doi.org/10.1016/S0140-6736(20)31...	Viral vector (non-replicating	Sputnik V Gam-COVID-Vac (rAd26-S and rAd5-S)	rAd26-S given on day 0 and rAd5-S on day 21	Uses different vectors in two doses		91.6%
Janssen Pharmaceutical.⁸8 Madewell ZJ, Yang Y, Longini IM Jr, Halloran ME, Dean NE. Household transmission of SARS-CoV-2: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2031756. Doi: 10.1001/jamanetworkopen.2020.31756 https://doi.org/10.1001/jamanetworkopen....	Viral vector (non-replicating)	Ad26.COV2.S	Day 0 or Day 0 +56	Possibility of single dose, ongoing studies		Phase 3 in progress
Pfizer/BioNTech + Fosun Pharma.⁹9 Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383(27):2603–2615. Doi: 10.1056/ NEJMoa2034577 https://doi.org/10.1056/ NEJMoa2034577...	RNA-based vaccine	BNT162 (3 LNP-mRNAs)	Day 0 + 21	Promising technology. Easy adaptation in case of viral mutation	Risk of accumulation in solid tumors due to the use of lipid capsule Storage at -70°C	95%
Moderna + National Institute of Allergy and Infectious Diseases (NIAID).¹⁰10 Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(05):403–416. Doi: 10.1056/NEJMoa2035389 https://doi.org/10.1056/NEJMoa2035389...	RNA-based vaccine	mRNA-1273	Day 0 + 28	Promising technology. Easy adaptation in case of viral mutation	Risk of accumulation in solid tumors due to the use of lipid capsule Storage at -20°C	94.1%

Protocol	Cytotoxic chemotherapy	Radiotherapy	Endocrine therapy	Targeted therapy	Corticoids	Immunotherapy	Surgery	Vaccination priority	Observations
AC Camargo Cancer Center.²⁰20 A. C. Camargo Cancer Center Departamento de Infectologia. Recomendações de vacinação para SARS CoV-2 em pacientes tratados no AC. Camargo Cancer Center [Internet]. 2021 [cited 2021 Feb 6]. Available from: https://accamargo.org.br/sites/default/files/2021/01/geral-recomendacoes-de-vacina-para_sars-cov-2-em-pacientes.pdf https://accamargo.org.br/sites/default/f...	When blood counts have recovered to the maximum (end of the cycle). Avoid the day of chemotherapy treatment.		Cleared without restrictions.	Cleared without restrictions, provided blood counts are normal.		Cleared without restriction, provided blood counts are normal.			Information obtained from Pfizer-BioNtech and AstraZeneca-Oxford vaccines
National Comprehensive Cancer Network.²²22 National Comprehensive Cancer Network. NCCN: cancer and COVID-19 vaccination: preliminary recommendations of the NCCN COVID-19 Vaccination Advisory Committee [Internet]. 2021 [cited 2021 Feb 6]. Available from: https://www.nccn.-org/docs/default-source/covid-19/2021_covid-19_vaccination_-guidance_v5-0.pdf https://www.nccn.-org/docs/default-sourc...	Cleared without restrictions. There is no evidence of optimal timing of vaccination during treatment.	Cleared without restrictions	Cleared without restrictions (not a priority when used exclusively by non-metastatic patients)	Cleared without restrictions	May reduce the immune response to vaccination. It is recommended to delay vaccination.	Cleared without restrictions.	Do not vaccinate on the day of the surgery because the vaccine symptoms.	Yes. 1 b/c priority group by CDC. Patients under endocrine therapy are not prioritized.
Memorial Sloan Kettering Cancer Center.²³23 Kamboj MScope of the document In: Memorial Sloan Kettering Cancer Center. MSK COVID-19 vaccine interim guidelines for cancer patients [Internet]. 2021 [cited 2021 Feb 6]. p. 2-3. Available from: https://www.asco.org/sites/new-www.asco.-org/files/content-files/covid-19/2021-MSK-COVID19-VACCINE-GUIDELINES.pdf https://www.asco.org/sites/new-www.asco....	First dose between cycles, far apart from the nadir period, or after the end of the treatment if the latter is near completion.	Cleared without restrictions	Cleared without restrictions	Cleared without restrictions	Cleared without restrictions	If possible, 2 weeks before the start of therapy	Cleared without restrictions. Exceptions in cases of splenectomy	Yes. Prioritize by age not according to location or presence of metastasis.	Avoid immunotherapy or chemotherapy on 2nd or 3rd day after vaccination (period of increased risk vaccine side effects)
European Society for Medical Oncology.²⁴24 European Society for Medical Oncology. Summaries R. COVID-19 and patients with cancer. 2021;(January):1–48.	Cleared without restrictions. There is no evidence of the optimal timing of vaccination during treatment.					Potential reduction in vaccine effectiveness. The benefits outweigh the risk.		Yes, especially in patients with hematologic tumors (receiving chemotherapy or with active disease), advanced solid tumors, or history of solid tumor in the last 5 years.	Protein kinase and PARP inhibitors do not have timing restrictions. Proteasome and CDK4/6 inhibitors should be used preferably at the end of the cycle, avoiding the day of chemotherapy treatment.
Cancer Research UK.²⁵25 Cancer Research UK. COVID-19 vaccine and cancer – latest updates [Internet]. 2020 [cited 2021 Jan 26]. Available from: https://scienceblog.cancerresearchuk.org/2020/12/15/covid-19-vaccine-and-cancer-latest-updates/ https://scienceblog.cancerresearchuk.org...	Optimal vaccination timing is before the start of the treatment. If treatment has already started, the patient should discuss the best timing for vaccination with the physician.	Cleared without restrictions.				Cleared without timing restrictions. Benefits are greater than costs.	Vaccination is recommended 2 weeks before surgery.
MD Anderson Cancer Center.²⁶26 The University of Texas MD Anderson Cancer Center. COVID-19 vaccine information [Internet]. 2020 [cited2021 Jan 26]. Available from: https://www.mdanderson.org/patients-family/becoming-our-patient/planning-for-care/coronavirus-protections/covid-19-vaccine-information.html https://www.mdanderson.org/patients-fami...	Cleared. However, the optimal timing for vaccination should be discussed with the physician.					Cleared. However, the optimal timing for vaccination should be discussed with the physician.	Vaccination is recommended 2 weeks after surgery	Yes. Increased COVID-19-related morbidity and mortality in cancer patients.
Cancer Treatment Centers of America.²⁷27 Cancer Treatment Centers of America. What cancer patients need to know about COVID-19 vaccines [Internet]. 2020 [cited 2021 Jan 26]. Available from: https://www.cancercenter.com/community/blog/2020/12/covid-vaccine-cancer-patients https://www.cancercenter.com/community/b...	Safe according to available data. Potential reduction in vaccine effectiveness during cancer treatment. A discussion with the physician is recommended.	Safe according to available data. Potential reduction in vaccine effectiveness.							Use of AstraZeneca Oxford vaccine is restricted in immunocompromised patients.
Sociedade Brasileira de Oncologia Clínica.²⁸28 Sociedade Brasileira de Oncologia Clínica. COVID-19: vacinação de pacientes oncológicos [Internet]. 2020 [cited 2021 Jan 26]. Available from: https://www.sboc.org.br/prevencao/item/2349-covid19-vacinacao-de-pacientes-oncologicos https://www.sboc.org.br/prevencao/item/2...	Cleared, but should be given preferably before the start of the treatment.				Cleared. There is no evidence of the need for a second vaccine dose in immunosuppre-ssed patients.	Cleared. Risk of interference with vaccine response and side effects.		Yes. Increased Covid-19-related morbidity and mortality in cancer patients.

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[1] Address for correspondence Bruno Eduardo Pereira Laporte, MD MSc, Rua Dr. Dirceu de Andrade, 33, 36025-140, Juiz de Fora, MG, Brazil (e-mail: laportebruno@hotmail.com).