Rapid access to COVID-19 vaccination for cancer patients
09.02.2021 08:55
The number of people worldwide suffering from the new coronavirus SARS-CoV-2 continues to rise. People with active cancer are among the groups of people at increased risk of a severe course of COVID-19. The double threat leads to uncertainty and fear. Patients are advised to be particularly careful and follow the recommendations of the health authorities, especially regarding voluntary quarantine. At the same time, the fear of infection with the coronavirus must not affect the fight against an existing, life-threatening disease such as cancer. We demand that people with active cancer have rapid access to COVID-19 vaccinations.
Great uncertainty among patients
Hedy Kerek-Bodden and Werner Kubitza, managing directors of the House of Cancer Self-Help - Federal Association, make it clear that they support the call for higher priority for people with cancer for COVID-19 vaccination: “From the perspective of the organizations We support the joint proposal for cancer self-help. We know from our members that they are very uncertain about rapid access to the COVID-19 vaccination. In addition to the great uncertainty regarding the course of their cancer, many now have to live with a second major uncertainty - namely: 'When will I receive the COVID-19 vaccination?'" In this context, Kerek-Bodden and Kubitza encourage themselves to consult with the treating doctor to certify the urgency of a COVID-19 vaccination due to the cancer.
Need for a differentiated view
At the end of last year, the DGHO had already published a proposed change with a view to the current classification of all people with cancer in the third level, i.e. with “increased priority”, and called for a differentiated assessment of the activity of cancer diseases. Prof. Dr. med. Lorenz Trümper, Executive Chairman of the DGHO and Director of the Clinic for Hematology and Medical Oncology at the University Medical Center Göttingen, emphasizes that the current classification is based on studies in which the entire population of people diagnosed with cancer was considered. “This comprehensive classification does not do justice to the very different illness situations of our patients, so we as a scientific medical society advocate a more differentiated approach,” says Trümper. In this context, he refers to studies that have demonstrated the particular vulnerability and increased mortality of patients with cancer.
Mortality among cancer patients is increased - especially when the disease is active
Various studies have shown, among other things, that people with cancer make up a relevant proportion of those who have COVID-19. In addition, cancer is one of the comorbidities relevant to prognosis, especially when the disease is active. Numerous international registry analyzes have described significantly higher mortality in people with cancer compared to people without cancer. “In this context, we have to take the activity of cancer into account,” says Trümper. “A current analysis from the USA with data from almost 30,000 patients confirms the unfavorable prognosis for active cancer.” The study shows that mortality, at 24.7 percent, is highest among people with active, progressive cancer, while patients and patients in remission “only” had a mortality rate of 11.6 percent.
Urgency of a COVID-19 vaccination
Prof. Dr. med. Hermann Einsele, Chairman of the DGHO and Director of the Second Medical Clinic at the University Hospital of Würzburg, makes the priority of COVID-19 vaccination for patients with cancer clear: “Based on the current data, we see a high priority for COVID-19 -Protective vaccination of patients with hematological diseases and those with solid tumors and active cancer who are under systemic therapy.” This includes patients with malignant hematological diseases and in particular patients with acute and chronic leukemias, malignant lymphomas and Multiple myeloma. The same applies to patients with advanced solid tumors and active disease.
Particular risk for young cancer patients
In addition, the analyzes show that the risk factor cancer has a negative impact on the prognosis, particularly in younger age groups. The relative increase in mortality from COVID-19 is highest in the patient group under 50 years of age. Prof. Dr. med. Mathias Freund, Chairman of the Board of Trustees of the German Foundation for Young Adults with Cancer, emphasizes the urgency of COVID-19 vaccination, especially for young patients: “For people with cancer in this age group, the risk of dying from COVID-19 is four times higher than in people without cancer. That is why the German Foundation for Young Adults with Cancer also advocates for priority access for cancer patients to the COVID-19 vaccination.”
Vaccination Yes or No: Joint decision by patient and doctor
To date, there is almost no data from clinical studies available to help decide on the vaccination itself, the optimal timing and the most suitable vaccine. Only very few cancer patients were included in the approval studies.
Prof. Dr. med. Lorenz Trümper explains: “The basics of shared decision making between doctor and patient when making patient-specific decisions about whether to have a COVID-19 vaccination are essential. Our basic position is: Get vaccinated now, unless there are valid reasons against it.”
New medicines to treat COVID-19
Despite numerous experimental approaches and clinical studies initiated very quickly, current therapy for COVID-19 disease is largely supportive and is not based on clinical studies in this specific disease. As new antiviral drugs become available, it will also be necessary to discuss in the foreseeable future whether early use of monoclonal antibodies, kinase inhibitors and/or convalescent plasma in people with active cancer suffering from COVID-19 makes sense. Such a therapy could also reduce the currently increasing number of those affected with prolonged shedding of SARS-CoV-2 (shedding) - which is also associated with the risk of mutations forming - after a COVID-19 infection.
Neutralizing, monoclonal anti-SARS-CoV-2 antibodies can reduce the viral load. The combination of bamlanivimab with the second, non-competitive antibody etesevimab increased the effectiveness in reducing viral load. This observation is confirmed by the data on the antibody combination casivirimab plus imdevimab. “The potential clinical benefit of the antibodies is currently difficult to assess because the data available to date on clinical effectiveness are not very reliable. The clinical effectiveness can be assumed particularly in the early, asymptomatic or oligosymptomatic phase of the disease, in which virus replication plays a dominant role. In any case, we need rapid clinical studies on the effectiveness of the new drugs,” said Trümper.