The Lancet Regional Health. Americas (Mar 2023)

Breakthrough SARS-CoV-2 infections among patients with cancer following two and three doses of COVID-19 mRNA vaccines: a retrospective observational study from the COVID-19 and Cancer ConsortiumResearch in context

  • Toni K. Choueiri,
  • Chris Labaki,
  • Ziad Bakouny,
  • Chih-Yuan Hsu,
  • Andrew L. Schmidt,
  • Gilberto de Lima Lopes, Jr.,
  • Clara Hwang,
  • Sunny R.K. Singh,
  • Chinmay Jani,
  • Lisa B. Weissmann,
  • Elizabeth A. Griffiths,
  • Susan Halabi,
  • Ulysses Wu,
  • Stephanie Berg,
  • Timothy E. O'Connor,
  • Trisha M. Wise-Draper,
  • Orestis A. Panagiotou,
  • Elizabeth J. Klein,
  • Monika Joshi,
  • Fares Yared,
  • Miriam Santos Dutra,
  • Na Tosha N. Gatson,
  • Sibel Blau,
  • Harpreet Singh,
  • Rahul Nanchal,
  • Rana R. McKay,
  • Taylor K. Nonato,
  • Ryann Quinn,
  • Samuel M. Rubinstein,
  • Matthew Puc,
  • Blanche H. Mavromatis,
  • Praveen Vikas,
  • Bryan Faller,
  • Howard A. Zaren,
  • Salvatore Del Prete,
  • Karen Russell,
  • Daniel Y. Reuben,
  • Melissa K. Accordino,
  • Harpreet Singh,
  • Christopher R. Friese,
  • Sanjay Mishra,
  • Donna R. Rivera,
  • Yu Shyr,
  • Dimitrios Farmakiotis,
  • Jeremy L. Warner

Journal volume & issue
Vol. 19
p. 100445

Abstract

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Summary: Background: Breakthrough SARS-CoV-2 infections following vaccination against COVID-19 are of international concern. Patients with cancer have been observed to have worse outcomes associated with COVID-19 during the pandemic. We sought to evaluate the clinical characteristics and outcomes of patients with cancer who developed breakthrough SARS-CoV-2 infections after 2 or 3 doses of mRNA vaccines. Methods: We evaluated the clinical characteristics of patients with cancer who developed breakthrough infections using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19; NCT04354701). Analysis was restricted to patients with laboratory-confirmed SARS-CoV-2 diagnosed in 2021 or 2022, to allow for a contemporary unvaccinated control population; potential differences were evaluated using a multivariable logistic regression model after inverse probability of treatment weighting to adjust for potential baseline confounding variables. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. The primary endpoint was 30-day mortality, with key secondary endpoints of hospitalization and ICU and/or mechanical ventilation (ICU/MV). Findings: The analysis included 2486 patients, of which 564 and 385 had received 2 or 3 doses of an mRNA vaccine prior to infection, respectively. Hematologic malignancies and recent receipt of systemic anti-neoplastic therapy were more frequent among vaccinated patients. Vaccination was associated with improved outcomes: in the primary analysis, 2 doses (aOR: 0.62, 95% CI: 0.44–0.88) and 3 doses (aOR: 0.20, 95% CI: 0.11–0.36) were associated with decreased 30-day mortality. There were similar findings for the key secondary endpoints of ICU/MV (aOR: 0.60, 95% CI: 0.45–0.82 and 0.37, 95% CI: 0.24–0.58) and hospitalization (aOR: 0.60, 95% CI: 0.48–0.75 and 0.35, 95% CI: 0.26–0.46) for 2 and 3 doses, respectively. Importantly, Black patients had higher rates of hospitalization (aOR: 1.47, 95% CI: 1.12–1.92), and Hispanic patients presented with higher rates of ICU/MV (aOR: 1.61, 95% CI: 1.06–2.44). Interpretation: Vaccination against COVID-19, especially with additional doses, is a fundamental strategy in the prevention of adverse outcomes including death, among patients with cancer. Funding: This study was partly supported by grants from the National Cancer Institute grant number P30 CA068485 to C-YH, YS, SM, JLW; T32-CA236621 and P30-CA046592 to C.R.F; CTSA 2UL1TR001425-05A1 to TMW-D; ACS/FHI Real-World Data Impact Award, P50 MD017341-01, R21 CA242044-01A1, Susan G. Komen Leadership Grant Hunt to MKA. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).

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