NCCN Releases COVID-19 Vaccination Guidance for Patients With Cancer

All patients with active cancer, or with active, recent, or planned cancer treatment, should be considered highest priority to receive one of the coronavirus disease 2019 (COVID-19) vaccines that have been granted emergency use authorization from the FDA, according to guidance released by the National Comprehensive Cancer Network (NCCN).¹

The NCCN’s COVID-19 Vaccine Committee, which is comprised of hematology and oncology experts who specialize in infectious diseases, vaccine development and delivery, medical ethics, and health information technology, released these recommendations to assist cancer care providers in making more informed decisions to better protect their patients from the virus. The recommendations decided upon were based on all available evidence and expert consensus.

Among the network’s top recommendations are:

• Patients with cancer should be prioritized for vaccination, as they are CDC priority group 1b or 1c, and they should be immunized once the vaccine is available.
• Immunization is recommended for all patients on active therapy, with the understanding that limited safety and efficacy data are available.
• Reasons for delay of vaccines in this population are comparable to the general public, such as recent exposure to the virus, as well as other cancer-specific factors. Immunization should be delayed for at least 3 months after hematopoietic cell transplantation (HCT) or engineered cellular therapy, such as CAR-T cell therapy, to maximize the effectiveness of the vaccine.

• All caregivers and household contacts of patients with cancer should also be vaccinated when the option is available to them.

“One of our primary goals is reducing morbidity and mortality,” Sirisha Narayana, MD, associate professor of medicine and chair of the UCSF Ethics Committee at University of California San Francisco Health, stated in a press release. “We also have to take social determinants of health into account and make special efforts for people in high-risk communities.”

In the event of limited vaccine supply, the NCCN specified in their guidance that patients with active cancer on treatment, including those on hematopoietic and cellular therapy; those planning to begin treatment; and those who received treatment less than 6 months ago, should be among the first to be immunized. Patients receiving hormonal therapy are the only exception to this.

The guidance also recommended that cancer-care providers consider additional risk factors in patients that could put them at higher risk for COVID-19 infection, such as advanced age, namely those 65 years and older; other comorbidities, such as chronic pulmonary, cardiovascular or renal disease; as well as social and demographic factors, including poverty, limited access to healthcare, and underrepresented minorities.

“Right now, there is urgent need and limited data,” Steve Pergam, MD, MPH, associate professor in the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center; infection prevention director at Seattle Cancer Care Alliance; and co-leader of the NCCN COVID-19 Vaccine Committee, added in the release . “Our number one goal is helping to get the vaccine to as many people as we can. That means following existing national and regional directions for prioritizing people who are more likely to face death or severe illness from COVID- 19. The evidence we have shows that people receiving active cancer treatment are at greater risk for worse outcomes from COVID-19, particularly if they are older and have additional comorbidities, like immunosuppression.”

The guidance from the NCCNalso acknowledges that, although trial data have demonstrated that the COVID-19 vaccine is safe and effective amongst the general population, the efficacy of these vaccines in patients with cancer specifically, is still relatively unknown.

Vaccine trials have shown data indicating a decrease in the incidence of COVID-19 infection and complications, but whether these vaccines fully prevent infection and subsequent transmission is still unclear. As such, it is recommended by the NCCN that patients with cancer, as well as their caregivers and household contacts, continue to wear masks and that they maintain social distancing and follow other COVID-19 preventative measures, even after vaccination.

“The medical community is rising to one of the biggest challenges we have ever faced,” Robert W. Carlson, MD, chief executive officer of the NCCN, added in the release. “The COVID-19 vaccines exemplify the heights of scientific achievement. Now we have to distribute them quickly, equitably, safely and, efficiently, using clearly defined and transparent principles.”

The NCCN COVID-19 Vaccine Committee will continue to meet regularly to refine the recommendations for these and other issues.

References

1. NCCN shares new guidance principles for vaccinating people with cancer against COVID-19. News release. National Comprehensive Cancer Network. January 22, 2021. Accessed January 22, 2021. https://www.nccn.org/about/news/newsinfo.aspx?NewsID=2552
2. NCCN. Preliminary recommendations of the NCCN COVID-19 vaccination advisory committee, version 1.0. Accessed January 22, 2021. https://www.nccn.org/covid-19/pdf/COVID-19_Vaccination_Guidance_V1.0.pdf