Abstract
Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study, integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2 positive, 94 were symptomatic and 2 died of COVID-19. In this cohort, 83% patients had S1-reactive antibodies and 82% had neutralizing antibodies against wild type SARS-CoV-2, whereas neutralizing antibody titers against the Alpha, Beta and Delta variants were substantially reduced. S1-reactive antibody levels decreased in 13% of patients, whereas neutralizing antibody titers remained stable for up to 329 days. Patients also had detectable SARS-CoV-2-specific T cells and CD4+ responses correlating with S1-reactive antibody levels, although patients with hematological malignancies had impaired immune responses that were disease and treatment specific, but presented compensatory cellular responses, further supported by clinical recovery in all but one patient. Overall, these findings advance the understanding of the nature and duration of the immune response to SARS-CoV-2 in patients with cancer.
Highlights
IntroductionPatients with cancer are at increased risk of severe outcomes from coronavirus disease 2019 (COVID-19)[1,2], with risk factors including general features (such as increased age, male sex, obesity and comorbidities) as well as cancer-specific features (such as hematological and thoracic malignancies, progressive cancer and poor performance status)[3,4,5,6,7,8]
Patients with cancer are at increased risk of severe outcomes from coronavirus disease 2019 (COVID-19)[1,2], with risk factors including general features as well as cancer-specific features[3,4,5,6,7,8]
The median SsT cell levels were numerically higher in healthcare workers (HCWs) than in all patients with cancer (Extended Data Fig. 6c,d). Results from this prospective, longitudinal study of 118 patients with cancer and SARS-CoV-2 infection indicated that most patients with solid tumors developed a functional and probably durable humoral immune response to SARS-CoV-2 infection, as well as an anti-SARS-CoV-2-specific T cell response
Summary
Patients with cancer are at increased risk of severe outcomes from coronavirus disease 2019 (COVID-19)[1,2], with risk factors including general features (such as increased age, male sex, obesity and comorbidities) as well as cancer-specific features (such as hematological and thoracic malignancies, progressive cancer and poor performance status)[3,4,5,6,7,8]. Previous studies established the features of the acute immune response to SARS-CoV-2 in patients with cancer: (1) patients with solid tumors show high seroconversion rates; (2) patients with hematological cancer show impaired humoral immunity, especially those on anti-CD20 therapy; and (3) higher CD8+ T cell counts in patients with hematological malignancies are associated with improved survival[11,12,13]. We present an integrated analysis of functional immune response, including SARS-CoV-2-specific T cells and neutralizing antibodies, and cross-protection against emerging variants of concern (VOCs). CAPTURE (COVID-19 antiviral response in a pan-tumor immune monitoring study) is a prospective, longitudinal cohort study initiated in response to the global SARS-CoV-2 pandemic and its impact on patients with cancer[14]. The study aims were to evaluate the impact of cancer and cancer therapies on the immune response to SARS-CoV-2 infection and COVID-19 vaccination. We report findings from the SARS-CoV-2 infection cohort of the CAPTURE study
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