NCCN Publishes New Guidance on COVID-19 PrEP and Vaccinations for Those With Cancer

The recommendations include full immunization, including third doses and/or any approved boosters.

The National Comprehensive Cancer Network (NCCN) has published new updates to the expert consensus recommendations on COVID-19 pre-exposure prophylaxis and vaccinations for individuals with cancer.

The NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis meets frequently to review available research and provide evidence-based practices to help keep individuals with cancer as safe as possible during the COVID-19 pandemic and make sure the recommendations are up to date.

“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,” Robert Carlson, MD, CEO at NCCN, said in a statement. “Thankfully, we now have additional tools to help people in active treatment for cancer, solid organ transplant recipients, engineered cellular therapy (eg CAR T-cell) or stem cell transplant recipients [hematopoietic stem cells] and those with other immunodeficiency-causing conditions [such as DiGeorge syndrome, HIV, or Wiskott-Aldrich syndrome],” Carlson said.

The update guidance includes information on the preventive use of human monoclonal antibodies.

In addition, the new guidance suggests that individuals with cancer get fully immunized, including a third and/or any approved boosters; an mRNA vaccine is preferred; and vaccinations should be delayed for at least 3 months following engineered cell therapy or hematopoietic cell transplantation to maximize vaccine efficacy. Full vaccination is also recommended for caregivers, household, individuals in close contact, and the public; vaccine delays in individuals with cancer should also include those recommended for the public; and the committee supports vaccination mandates for health care workers.

The FDA has issued an emergency use authorization for the monoclonal antibody combination of tixagevimab plus cilgavimab for pre-exposure protection from COVID-19 in individuals aged 12 years or older, weighting at least 40 kg, who are moderately to severely immunocompromised and may not be responsive to vaccines.

Individuals with blood cancers, including those receiving engineered cellular therapies or stem cell transplantation, are more likely to have inadequate responses to COVID-19 vaccinations and are at the highest risk of major COVID-19 complications.

It is reasonable for these individuals to be prioritized with tixagevimab plus cilgavimab before individuals with solid tumor cancers, in the event of a limited supply, according to the committee.

The committee also supports recommendations from the American Society of Hematology, the American Society of Transplantation and Cellular Therapy, and the CDC that previously vaccinated individuals who are completing stem cell transplantation or engineered cellular therapy should receive a repeat vaccination, starting 3 months post-treatment.

“Rapid research, thoughtful analyses, and tireless care delivery is allowing us to save so many more people than we could have a year ago. We hope by sharing this simplified guidance highlighting the latest research and approvals, we can help make sure the very latest in evidence-based care reaches as many patients and providers as possible,” Carlson said.

Reference

Protecting people with cancer from COVID-19: New recommendations from cancer guidelines organization. EurekAlert. News release. January 4, 2022. Accessed January 6, 2022. https://www.eurekalert.org/news-releases/939205