Covid-19 immune response varies in cancer patients

CANCER patients with Covid-19 showed varied immune responses depending on disease type in a study funded by Cancer Research UK.

The research found that the immune response to Covid-19 in people with solid tumours was the same compared to those without cancer. However, blood cancer patients varied in their ability to respond to the virus, with many unable to shake off the virus for up to 90 days after the first signs of infection – around five times longer than the average.

Cancer Research UK says the study offers reassurance to many people with cancer but also highlights that patients cannot be grouped together when it comes to delivering cancer care during the pandemic.

The study analysed the blood of 76 cancer patients: 41 with Covid-19 (23 solid tumours; 18 blood cancers) and 35 who had not been exposed to the virus. The samples were compared to the blood of people without cancer. Immune responses to the virus in people with solid tumours were like those of people without cancer – even when patients were in the advanced stages of cancer and undergoing active anti-cancer treatments.

The immune response to Covid-19 in people with certain types of blood cancer was found to be similar but "milder" in the active/early phases of the disease and became stronger over time resembling immune changes often seen in chronic infections. This was especially true for cancers affecting B cells: a type of immune cell that plays an important role in immune memory.

Antibody response to the virus in patients with B-cell-related blood cancers was more diverse compared to people with solid tumours and presented as three distinct groups:

  1. those who developed antibodies and cleared the virus like the solid cancer patients and people without cancer
  2. those who never developed antibodies even more than 75 days after virus exposure and continued to fail to clear the virus
  3. those who despite having developed antibodies against the virus were unable to clear it.

The next phase of the study will be monitoring the immune responses of cancer patients to the COVID-19 vaccine.

Dr Sheeba Irshad, lead researcher on the study and a Cancer Research UK clinician scientist based at King’s College London, said: "Whilst we need to maintain caution, our study provides some confidence and reassurance to care providers that many of our patients with solid cancers will mount a good immune response against the virus, develop antibodies that last and hopefully resume their cancer treatment as soon as possible.

"These conclusions imply that many patients despite being on immunosuppressive therapies will respond satisfactorily to Covid-19 vaccines. For patients with blood cancers, especially those with B-cell malignancies, this may not hold true even in the era of Covid-19 vaccines. Our work suggests that they may be susceptible to persistent infection despite developing antibodies, so the next stage of our study will focus on monitoring their response to the vaccines. At present the best way to protect them may be to vaccinate all the carers to achieve herd immunity in the clinic."

Publication of the study has been fast-tracked online as a preprint in Cancer Cell.

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