SARS-CoV-2 vaccination in patients with GI and hepatobiliary carcinoma: a call for booster vaccination.

Abstract

Bollipo et al presented recommendations for SARSCoV2 infections in patients with chronic liver diseases (CLDs). Since their publication, at least three SARSCoV2 vaccinations are recommended for all persons regardless of comorbidities. Cancer and CLD are associated with impaired immune responses to SARSCoV2 vaccines. However, patients with GI cancer, especially with hepatobilary carcinoma (HBC), are underrepresented in published studies. In this prospective, longitudinal study, 120 patients with GI cancer, including 32.5% HBC, participated (table 1). Patients under anticancer therapy were analysed compared with patients with GI cancer in followup care (≥1 year off anticancer therapy). We present profound data on humoral response rates (SARSCoV2 antispike and surrogate neutralisation antibodies (sNAB) using SARSCoV2 IgG II Quant chemiluminescent microparticle immunoassay (Abbott Laboratories) and cPass SARSCoV2 Neutralization Antibody Detection Kit (GenScript), respectively). Of note, the ELISA analysing levels of sNAB is limited when it comes to current variants of concern (VOCs; BA.1, BA.2, BA.4 and BA.5). Therefore, rates of infections are more important. Cellular response rates were not considered. Linear mixed regression models were used to compare levels of total (log10 transformed) and neutralising antibodies. Four weeks after second vaccination, levels of SARSCoV2 antispike IgG were significantly lower in patients with active GI cancer (2.48 log10 binding antibody unit (BAU)/mL; 95% CI 2.28 to 2.68; p<0.01) and HBC (2.52 log10 BAU/mL; 95% CI 2.25 to 2.78; p<0.01) compared with patients in followup care (3.03 log10 BAU/mL; 95% CI 2.77 to 2.28). Titres decreased overtime, and differences diminished (figure 1). However, patients with HBC still showed significantly lower IgG levels compared with patients in followup care 12 weeks after second vaccination (2.06 log10 BAU/mL; 95% CI 1.79 to 2.33 vs 2.47 log10 BAU/ mL; 95% CI 2.24 to 2.70; p=0.02). Regarding surrogate neutralisation antibody (sNAB) at the same time point, levels were more impaired in patients with HBC (57.80%; 95% CI 47.49 to 68.11; p<0.01) than in patients with GIcancer (67.81%; 95% CI 58.33 to 77.29; p<0.01) compared with patients in followup care (84.88%; 95% CI 76.34 to 93.43) (figure 1). Patients with HBC under chemotherapy showed most extended impairment of SARSCoV2 antispike IgG levels (1.94 log10 BAU/ mL; 95% CI 1.42 to 2.46) 12 weeks after second vaccination in an univariate analysis. While in patients with GI cancer under chemotherapy levels of SARSCoV2 antispike IgG were also lower (2.16 log10 BAU/mL; 95% CI 1.80 to 2.52), patients under therapy with immune checkpoint inhibitors had highest titres (2.27 log10 BAU/mL; 95% CI 1.43 to 3.11) compared with all other types of therapy. Following first booster vaccination, that is, the third vaccination, titers of SARSCoV2 antispike IgG were balanced between patients with GI Letter