What Patients With Cancer, Survivors Need to Know About the Emergency Use Authorization of COVID-19 Vaccine

If a patient with cancer is no longer receiving active treatment and there are no signs of active disease, an expert from The University of Texas MD Anderson Cancer Center suggests they should have a good response to the COVID-19 vaccine, but direct data on this are not yet available.

Following the Food and Drug Administration (FDA)’s emergency use authorization of the Pfizer-BioNTech COVID-19 Vaccine on Friday, many patients with cancer who are actively receiving treatment, and those who no longer have signs of active disease, are sure to have questions as to what they should know about the vaccine.

In fact, Dr. Debu Tripathy, chair of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center and editor in chief of CURE®, said he and his colleagues were getting questions about the distribution of the vaccine prior to its authorization by the FDA and Centers for Disease Control and Prevention.

“We have been getting questions more and more frequently; all our patients want to know what the schedule is for when they might get a vaccine,” said Tripathy in an interview with CURE®.

To address any questions patients with cancer and survivors may have regarding the vaccine, CURE® recently spoke with Drs. Debu Tripathy and Roy Chemaly, chief infection control officer and a professor in the department of infectious diseases, infection control and employee health at The University of Texas MD Anderson Cancer Center.

Administering the vaccine to patients with cancer

On Monday, the first of many high-risk health care workers started receiving the vaccine across the United States. Many frontline workers will continue to receive it over the next several weeks, including those who work directly with patients with cancer who are at a high risk for infection.

After those frontline workers, there is a process for which patients will begin to receive the vaccine, according to Tripathy.

Patients with underlying conditions at high risk for complications of COVID-19 infection will likely be a top priority to receive the vaccine. However, for patients with cancer receiving therapy, in particular, those receiving more intensive therapies like a stem cell transplant, there are still some details that need to be ironed out.

“We haven't gotten into the nitty gritty in terms of how we're going to divide (the vaccine) to some extent,” said Tripathy. “We're going to have the physicians be involved in prioritizing this based on their knowledge because they're the ones who know the patients the best.”

Chemaly also noted that the vaccine will likely be administered to patients on a case-by-case basis.

“Now for cancer patients who are still under active treatment with chemo or radiation, or early after stem cell transplantation, there is no data on how effective the vaccine is, and should it be used,” he said. “So we're going to be a little bit more cautious and take it case by case to recommend these vaccines to our cancer patients, as we wait for more data to come out from the general population, then see how safe it is and how effective (it is) in order to really extrapolate to our cancer patients.”

If a patient is no longer receiving active treatment and there are no signs of active cancer, Chemaly said, they should have a good response to the vaccine, and it will likely be safe for them to receive it as well.

“Now, for other patients who (are) still in the follow-up period, not really called ‘survivors’ of cancer, we're going to probably provide some guidance, for example, for recipients of a stem cell transplantation. If it's been six months from allogeneic transplantation, they're stable and recovering well from after transplant, then it is probably be safe to give it to these patients,” he said. “Autologous transplant could be three months from the transplantation if they have no active issues, if they are still in remission and they're stable enough to receive a vaccine.”

Potential side effects associated with the vaccine

As with any vaccine, Tripathy said, some people will have reactions, but at least there are data from healthy individuals that can be shared with patients with cancer. When those data are shared with patients with cancer, however, there will be some unknowns. For instance, will patients with cancer be able to generate antibodies and develop the same protection, and might there be unique side effects that this patient population will experience.

“These are things that we will have to learn as we go, and we will,” Tripathy said. “As the cancer centers and practices start immunizing their patients, we’re going to be tracking their outcomes.”

In fact, just like with any drug that receives FDA approval, there will be a process for reporting and compiling any side effects that occur when a patient receives the vaccine.

As for the individuals who developed severe allergic reactions to the vaccine in the United Kingdom, Chemaly noted that those individuals had a history of anaphylaxis, or severe allergic reactions to different antigens. And two out of those three individuals who experienced the severe reactions were already carrying an EpiPen (epinephrine), which helps to combat serious allergic reactions.

And we're prepared to intervene if someone develop(s) this kind of reaction when we give the vaccine,” Chemaly said.

Social distancing, masking practices to continue

Everyone —not just patients with cancer — should expect to follow all the public health measures from wearing a mask to social distancing and frequent hand hygiene for at least another six months to one year even if vaccinated, according to Chemaly.

“We need to create herd immunity (because) without herd immunity, we're not going to eliminate this virus,” he said. “Second, even if (you) get (a) vaccine, (it) doesn't mean (you’re) not going to be exposed to the virus in the community or in your workplace. At that point, you may carry the virus and not getting sick from it or get admitted to the hospital … but (you) can still transmit the virus to other people. This why masking is still so important.”

Nothing to hide

Chemaly said he’s received questions from patients and employees every day about their worry of receiving the vaccine. And while he said it’s understandable, he assures the public that the trials have been conducted under a microscope, meaning so many eyes have been watching everything that has happened.

“No one is hiding anything,” he said. “Based on that, I advise my patients, my colleagues (and) other health care workers in the health care setting, that, what we know is (the vaccine is) safe and is effective … there is no long-term side effect up to two or three months from receiving the vaccine. I, myself, feel very comfortable taking it, and I'm going to be lining up to get the vaccine as soon as it is available.”

‘Witnessing an incredible moment’

“I think that we are witnessing an incredible moment in history where we rallied to do something that had never been done, and that is to get a vaccine from scratch in less than one year,” Tripathy said. “That is a pretty astounding technologic feat that not many people would have believed it was possible when all this started — that in this short period of time; we did it.”

Now, it’s up to patients to make an informed decision as to whether to get the vaccine, although the available data point to its potential effectiveness.

“Nothing works unless you get the vaccine,” he said. “If you don't get the vaccine, all of this was for nothing.”

However, Tripathy acknowledged why some people may be concerned and reluctant to receive the vaccine.

“Things have happened in medical history where that might give some people pause,” he said. “There's a lot of concern about people that are underserved and minorities because there is a history of them not receiving fair treatment when it comes to medicine and clinical trials. And so, we have to go the extra mile to reassure patients. But we can't pretend that we can reassure people 100%. Just like many other decisions you make in life, you take the best information you have and you make a recommendation for other people or for yourself. All we can do is be truthful, present our recommendations and hope that a majority of people do get vaccinated.”

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