Covid-19: Just a third of blood cancer patients had antibodies against delta variant after two vaccine doses, study finds #Covid19RftLks

Fendler, A., et al. | 2021| Adaptive immunity and neutralizing antibodies against SARS-CoV-2 variants of concern following vaccination in patients with cancer: the CAPTURE study| Nat Cancer | https://doi.org/10.1038/s43018-021-00274-w

The Capture study, conducted by the Francis Crick Institute and the Royal Marsden NHS Foundation Trust, analysed the immune responses of 585 patients with different types of cancer after they received two doses of the Pfizer-BioNTech or Oxford-AstraZeneca covid-19 vaccine.

This article in the BMJ summarises the findings of the recent study which reported that fully vaccinated people with cancer who have no history of SARS-CoV-2 infection have much lower levels of neutralising antibodies against the delta variant (54 per cent) than against the original SARS-CoV-2 virus (83 per cent) (Source: BMJ)

Primary paper

Fendler, A. et al | 2021| Adaptive immunity and neutralizing antibodies against SARS-CoV-2 variants of concern following vaccination in patients with cancer: the CAPTURE study | Nature Cancer |

Abstract

Coronavirus disease 2019 (COVID-19) antiviral response in a pan-tumor immune monitoring (CAPTURE) (NCT03226886) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after two doses were 85% and 59% in patients with solid and hematological malignancies, respectively. A lower proportion of patients had detectable titers of neutralizing antibodies (NAbT) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOC) versus wild-type (WT) SARS-CoV-2. Patients with hematological malignancies were more likely to have undetectable NAbT and had lower median NAbT than those with solid cancers against both SARS-CoV-2 WT and VOC. By comparison with individuals without cancer, patients with hematological, but not solid, malignancies had reduced neutralizing antibody (NAb) responses. Seroconversion showed poor concordance with NAbT against VOC. Previous SARS-CoV-2 infection boosted the NAb response including against VOC, and anti-CD20 treatment was associated with undetectable NAbT. Vaccine-induced T cell responses were detected in 80% of patients and were comparable between vaccines or cancer types. Our results have implications for the management of patients with cancer during the ongoing COVID-19 pandemic.

Adaptive immunity and neutralizing antibodies against SARS-CoV-2 variants of concern following vaccination in patients with cancer: the CAPTURE study [paper]

BMJ article Covid-19: Just a third of blood cancer patients had antibodies against delta variant after two vaccine doses, study finds

HSIB: Missed detection of lung cancer on chest X-rays of patients being seen in primary care

Healthcare Safety Investigation Branch | October 2021 | Missed detection of lung cancer on chest X-rays of patients being seen in primary care

The Healthcare Safety Investigation Branch‘s (HSIB) investigation reviewed the experience of a patient who saw their GP on multiple occasions and had three chest X-rays where the possible cancer was not identified. This resulted in an eight-month delay in diagnosis and potentially limited the patient’s treatment options.

Image is an x-ray of the lungs. Image source: HSIB

This investigation:

• Sought to nderstand the context and contributory factors influencing a delay in lung cancer diagnosis in a patient repeatedly attending primary care with non-specific symptoms.
• Identified the systemic factors that help or hinder the detection of lung cancer on chest X-rays.
• Considered the utility of chest X-ray to assess for lung cancer in symptomatic patients being seen in primary care.
• Identified the implications of the findings for mitigating the risk of delayed diagnosis of lung cancer.

The HSIB makes three recommendations as a result of this investigation, one to NHS England and NHS Improvement, one to the one to NHSX, and one to the National Institute for Health and Care Excellence. The HSIB expect a response to our safety recommendations within 90 days of publication of the investigation report. The responses will be shared here when it’s available.

The full investigation report is available from HSIB

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study #Covid19RftLks

COVIDSurg Collaborative | 2021| Effect of Covid-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study | The Lancet Oncology | https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00493-9/fulltext

This international study prospectively enrolled patients with a decision for curative surgery awaiting surgery during the SARS-CoV-2 pandemic and tracked their care pathways prospectively. It included data from the 15 most common solid cancer types across all country-income settings, providing wide generalisability to global policy. The analysis allowed a direct comparison of full and moderate lockdowns to light restrictions, accounting for their dynamic nature, where different patients from the same country were exposed to different lockdown states.

Their findings indicate that during full lockdowns, one in seven patients did not receive their planned operation, all of whom had a pandemic-related reason for non-operation. This finding was robust, and consistent in sensitivity analyses. In a secondary analysis, awaiting surgery in a full lockdown for greater than 6 weeks was associated with an increased likelihood of non-operation (Source: COVIDSurg Collaborative).

Summary

Background

Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.

Methods

This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.

Findings

Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays.

Interpretation

Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.

Funding

National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an interrnational, prospective, cohort study [primary paper]