The National Comprehensive Cancer Network (NCCN) has published significant updates to the expert consensus recommendations on vaccination and pre-exposure prophylaxis of COVID-19 in people with cancer.
The NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis meets frequently to review all available research and provide evidence-based best practices for keeping people with cancer as safe as possible during the COVID-19 pandemic.
The updated guidance includes information on the preventive use of human monoclonal antibodies in addition to the following principals:
- Patients with cancer should get fully immunized, including third doses and/or any approved boosters;
- There is a strong preference for mRNA vaccines;
- Vaccination should be delayed for at least 3 months following hematopoietic cell transplantation (HCT) or engineered cellular therapy (e.g. chimeric antigen receptor [CAR] T-cells) to maximize vaccine efficacy. Vaccine delays in patients with cancer should also include those recommended for the general public (e.g. recent exposure to COVID-19, recent monoclonal Ab therapy).
- Full vaccination is also recommended for caregivers, household/close contacts, and the general public;
- The committee strongly supports full vaccination mandates for healthcare workers.
The Food and Drug Administration (FDA) has issued an emergency use authorization for the monoclonal antibody combination of tixagevimab plus cilgavimab for pre-exposure protection from COVID-19 in adults and children starting at age 12 (weighing at least 40 kg) who have moderate to severe immune compromise and may not be responsive to vaccination. Patients with blood cancers (including those receiving stem cell transplantation or engineered cellular therapy) are more likely to have inadequate responses to COVID-19 vaccination and are at highest risk of major COVID-19 complications. The committee states that it is reasonable to prioritize these patients for tixagevimab plus cilgavimab before patients with solid tumor cancers in the event of limited supply.
The committee also supports recommendations from the Centers for Disease Control (CDC), American Society of Transplantation and Cellular Therapy (ASTCT), and the American Society of Hematology (ASH) that previously vaccinated patients completing stem cell transplantation or engineered cellular therapy should receive a repeat vaccination series starting at three months post-treatment.