NCCN Update on COVID-19 Prevention Gives “Strong Preference” for mRNA Vaccines in Patients With Cancer

The update recommends that patients who receive CAR T-cell therapy wait 3 months before getting a COVID-19 vaccine.

The National Comprehensive Cancer Network (NCCN) today published major updates to its expert consensus recommendations on vaccination and prevention of COVID-19 in people with cancer, expressing a preference for mRNA-based vaccines and calling for patients and caregivers alike to receive boosters.

NCCN’s Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis “endorses vaccination for all eligible persons based on FDA-approved indications or emergency use authorization,” and emphasized the need for everyone to be fully vaccinated—including third doses.

Caregivers and close contacts of persons with cancer—along with the public—should also be fully vaccinated to offer the best possible protection for those who are immunocompromised, the experts recommend.

Vaccination should be delayed for at least 3 months following hematopoietic cell transplantation (HCT) or engineered cellular therapy, such as chimeric antigen receptor (CAR) T-cell therapy, to ensure the best possible vaccine efficacy. These are the same recommendations given to the public who have been exposed to COVID-19 or received recent monoclonal antibody therapy.

While the committee supports any of the possible FDA-approved vaccines, it expressed “strong preference” for the mRNA vaccines—Pfizer/BioNTech, which has full FDA approval in adults, or Moderna.

The committee also “strongly supports mandates for healthcare worker vaccination.”

“All of us are called to do everything we can to save as many lives as possible during the ongoing pandemic,” Robert W. Carlson, MD, chief executive officer, NCCN, said in a statement. “Vaccination is our most effective approach for avoiding serious COVID-19 complications, including hospitalization and death. However, research shows many immunocompromised people develop inadequate immune responses from vaccines. Thankfully, we now have additional tools to help people in active treatment for cancer, solid organ transplant recipients, engineered cellular therapy (e.g., CAR T-cell) or stem cell transplant recipients (a.k.a. hematopoietic stem cells), and those with other immunodeficiency-causing conditions (such as HIV, DiGeorge syndrome, or Wiskott-Aldrich syndrome).”

“We have new agents to prevent and treat COVID-19 that will benefit patients with cancer,” said Brahm Segal, MD, Roswell Park Comprehensive Cancer Center, co-leader of the NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis. “An important challenge on a national level is to ensure drug availability to patients with cancer and others at high risk for COVID-19. The revised recommendations from the NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis will provide guidance on the use of these agents for patients with cancer, including prioritization when supplies are limited.”

In its statement, the committee said it also supports recommendations from the CDC, the 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.

The statement follows a series of presentations during last month’s meeting of the American Society of Hematology regarding the effectiveness of COVID-19 vaccines in patients with blood cancers and disorders. Of note, data presented by the Leukemia and the Lymphoma Society demonstrated that getting the third shot, or booster, was particularly important for these patients.

The LLS data showed that 43% of patients with blood cancers produced antibodies after receiving the third dose of mRNA vaccine. This is the “booster” shot that for most patients comes 6 months after the initial 2 doses, which are given 3 or 4 weeks apart, depending on the vaccine.