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  Table of Contents  
NEWS
Year : 2022  |  Volume : 59  |  Issue : 2  |  Page : 304-306
 

News from the world of oncology



Date of Submission29-Jun-2022
Date of Decision02-Jul-2022
Date of Acceptance20-Jul-2022
Date of Web Publication08-Aug-2022

Correspondence Address:
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.ijc_750_22

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How to cite this article:
. News from the world of oncology. Indian J Cancer 2022;59:304-6

How to cite this URL:
. News from the world of oncology. Indian J Cancer [serial online] 2022 [cited 2022 Sep 28];59:304-6. Available from: https://www.indianjcancer.com/text.asp?2022/59/2/304/353600





  Are cancer survivors more prone to COVID-19 vaccine ineffectiveness (breakthrough infections)? Top


As of June 2022, more than 537,591,764 confirmed coronavirus disease (COVID) cases with more than 6,319,395 COVID-attributable deaths have been reported worldwide (https://COVID19.who.int/). The first COVID vaccine was rolled earliest almost a year after the pandemic started. Studies have shown vaccine effectiveness (VE) to be up to 98% in the general population. It would be interesting to understand the differences, if any, in immune response to vaccination between cancer patients and normal individuals.

A population-based study designed as a public health surveillance analysis led by Lennard Y W Lee on VE (Pfizer and AstraZeneca vaccines) against coronavirus disease 2019 (COVID-19) breakthrough infections in cancer patients was published in The Lancet Oncology June 2022 (https://doi.org/10.1016/S1470-2045 (22) 00202-9). The study had a total of 28,388,149 participants, including 377,194 cancer patients and the remaining were controls. The study aimed to look at the influence of the type of cancer, its treatment, and patient demographics on VE, which was calculated between 3 and 6 months of second dose of vaccine.

Gender and ethnicity did not affect VE in either group. Older age groups (>70 years) had reduced number of breakthrough infections and more VE. Authors have attributed this to their reduced contacts traced during this period. Similarly, those with advanced stage cancer were expected to show lesser VE, but, in fact, they had better control due to reasons similar to those of older age groups. Hematological malignancies i ncluding leukemias and lymphoma were most susceptible to have breakthrough infections among t he cancer patients, while among solid malignancies, head and neck cancer patients were the most susceptible. Specifically, in head and neck cancer patients, men had significantly lower VE than women. Interestingly, difference in VE within 3 months of second dose was only 4 percentage points, while it was reduced by 14.4 percentage points between 3 and 6 months. Studies have shown the difference to be as great as 25 percentage points for other diseases such as trisomy, post splenectomy, and cancer. The greatest levels of waning VE were observed in those with a diagnosis of lymphoma or leukemia, in those who were diagnosed within 12 months of data cut-off, and in those who had received chemotherapy or radiotherapy in the past. Helena Linardou (https://doi.org/10.3390/cancers13184621) who studied the vaccine response in cancer patients (on active treatment) found that cancer patients had significant lower antibody titers compared to controls. Age more than 70 years, gender (men), and those in active treatment were the most significant factors affecting the immune response. A meta-analysis by Andrea Becerril-Gaitan (doi: 10.1016/j.ejca. 2021.10.014) looking at 35 studies has shown significantly higher relative risk of 3.21 (95% confidence interval [CI] 0.35–29.04) after partial and 2.04 (95% CI 0.38–11.10) after complete immunization in cancer patients compared to the general population.

This study is not without limitations. It was conducted on cancer survivors, and therefore, the results may not apply to patients actively suffering from cancer or on active treatment. This was done in the UK population, and the results may not reflect similarly for the people of different geographic regions. Only two kinds of vaccine (Pfizer and AstraZeneca) were studied. Immune response to other vaccines may be different. The study was conducted between Dec 8, 2020 and Oct 15, 2021. Whether vaccines remain effective against newer variants of COVID-19 is yet to be known. However, the study does show impaired VE against breakthrough infections in cancer survivors compared to the general population. It lends support to the idea for global prioritization and evaluation of vaccination programs and booster timings for people with cancer. Patients with cancer should be counseled and motivated to continue to follow COVID protocols in spite of complete vaccination, to reduce getting infections. This study certainly helps in understanding the effect of COVID VE in cancer patients and can lead to designing better protocols for global health care and cancer care system to handle COVID-19 pandemic with coexisting cancer epidemic.

Hitesh Rajendra Singhavi

ORCID ID: https://orcid.org/0000-0001-8191-0951


  Increased risk of cardiovascular disease in breast cancer survivors Top


Breast cancer (BC) remains the commonest cause of cancer in women today worldwide as well as in India. With the continued advances in treatment, increasing awareness among women, and screening programs, the BC-related mortality has decreased over the past few decades. More and more women are getting cured and living longer, although they suffer from the aftereffects of treatment in the long run. The ongoing Pathways Heart study published recently by Greenlee et al. in the Journal of Clinical Oncology (https://doi.org/10. 1200/JCO.21.01736) aimed to look at the risk of cardiovascular disease (CVD) and mortality in BC survivors based on treatment received compared to that in those without BC.

The study population included members of the Kaiser Permanente Northern California (KPNC). Electronic health records of women patients, at least 21 years of age, diagnosed with BC (stage I–IV) from November 2005 to March 2013 enrolled in a KPNC health plan for at least 12 months before their BC diagnosis date, with a history of chemotherapy, radiation therapy (RT), or endocrine therapy were individually matched 5:1 to controls on birth year, race, and ethnicity. There were 13,642 in the BC cohort and 68,202 in the control group. Women receiving chemotherapy were younger, with a higher proportion of women of color, never smokers, and having stage II–IV disease, compared to women who received endocrine therapy or RT. More women getting endocrine therapy had diabetes, dyslipidemia, and hypertension, compared to those receiving chemotherapy.

With a median follow-up of 7 years, risk of developing heart failure (HF), cardiomyopathy, stroke, arrhythmia, cardiac arrest, venous thromboembolism (VTE), or dying from a CVD-related event was increased in BC survivors, which was affected by the type of treatment. Multivariate analysis showed the lowest HF and cardiomyopathy risk in women receiving anthracyclines without trastuzumab, followed by those receiving trastuzumab without anthracyclines, while the highest risk was seen with the use of both drugs, as has been seen in previous studies. Higher risk of arrhythmia was noted with anthracycline use, whereas increased risk of VTE was noted in all chemotherapy groups, with the highest risk being in women not exposed to anthracycline or trastuzumab. Risk of CVD-related and all-cause mortality was less in women receiving anthracyclines and trastuzumab, although this could have been due to the lowest numbers in this group. Women receiving cyclophosphamide, fluoropyrimidine, and/or taxane had almost threefold and twofold risk of CVD-related and all-cause mortality, respectively, which could be related to the higher incidence of VTE in this group. RT was associated with higher risk of cardiovascular events, irrespective of the side of RT, with more HF and cardiomyopathy, cardiac arrest, valvular disease, VTE, and CVD-related death occurring in women getting left-sided RT. Tamoxifen use correlated with increased risk of CVD-related death, but no other outcomes. In contrast to previous studies, no difference in VTE risk was noted between tamoxifen and aromatase inhibitor (AI) use, although AI was linked to higher risk of HF and/or cardiomyopathy, stroke, arrhythmia, cardiac arrest, CVD-related death, and all-cause death compared to tamoxifen.

Large sample size with racially and ethnically diverse patient population from an integrated health-care system with robust EHR data and a large pool of matched controls are the strengths of this study. However, limitations are that the study did not include data about treatment combinations across different therapy types, dosage, and duration, which may be analyzed in the future. The population mainly included women with higher household median incomes and education levels, which may not be applicable to the general population.

This study does go on to show the increased CVD risk in women treated for BC, with the risk varying according to the type of treatment given. It emphasizes the need to develop effective clinical strategies to reduce CVD incidence in BC survivors.

Uma Dangi

ORCID iD: https://orcid.org/0000-0001-5973-6379

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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