A disclaimer: I write this both as a pediatric oncologist who has focused on childhood brain tumors for over 30 years, as well as an individual currently undergoing chronic immune suppressive anti-cancer chemotherapy for multiple myeloma (an adults-only disease, fortunately!).
Around 600,000 individuals in the U.S.—adults and children—are currently under treatment for cancer with various degrees of immune-suppressive chemotherapy. Such therapies can blunt an individual’s ability to respond to all kinds of vaccinations against viral infections, be it COVID-19 or influenza.
Studies have been published that address this problem for influenza vaccination. Children with cancer, in particular, are uniformly recommended to undergo influenza vaccine because of its safety and ability to reduce the severity of influenza disease.
Since children and adolescents are only nearing eligibility for the COVID-19 vaccination, we have no idea how individuals with cancer in this age bracket will benefit from the vaccine. It is most reasonable that they receive the vaccine, given that some children, even in the absence of immune-suppressive chemotherapy, experience severe and even fatal COVID-19 infection. However, even after the COVID-19 vaccination, children and adolescents on cancer therapy should continue with standard practices of masking, social distancing, and handwashing.
In the coming months, researchers must address several questions for children, adolescents, and adults undergoing cancer chemotherapy:
(1) Can the timing of COVID-19 vaccination around drug-therapy cycles help some patients?
It depends on the patient’s stage of treatment. Having a plan of action is essential in case patients on immune-suppressive chemotherapy become infected with COVID-19. Parents should have their children and adolescents undergo testing immediately if they have had possible exposure or show any symptoms, no matter how mild.
If the patient tests positive for COVID-19, the designated provider should know how to refer that individual to receive FDA-approved monoclonal antibodies for treatment as soon as possible—ideally within a matter of days.
(2) Should individuals undergoing chronic cancer chemotherapy, who develop no immunity to vaccination or are considered unsuitable for vaccination, receive monoclonal antibodies prophylactically (to prevent illness)?
Some cancer patients undergoing chemotherapy receive FDA-approved monoclonal antibodies in frequent intervals (say, every 1 to 3 months). This treatment, known as passive immunization, can serve as a “bridge” to vaccination. Recent studies of households with confirmed COVID-19 have shown that receiving monoclonal antibodies in an out-patient setting is very effective in preventing infection overall and results in only mild or asymptomatic disease in those who do become infected. However, this treatment is not yet approved for routine prevention—it is only approved for high-risk individuals who have been exposed to someone with COVID-19 within 48 hours.
(3) Should children and adolescents receiving cancer chemotherapy undergo a blood test post-vaccination to document the development of immunity?
Some patients undergo testing roughly 2-4 weeks after receiving the COVID-19 vaccination to document the development of immunity (antibodies against COVID-19). Health care providers, patients, and their parents need to be aware that authorized vaccines—as well as vaccines likely to be approved in the near future—all induce the production of antibodies to the spike protein alone and not to other parts of the virus. Many of the antibody tests available for detecting COVID-19 antibodies do not detect the spike protein. Therefore, if your physician recommends such testing, it must be specifically to detect the antibody against the spike protein.
I hope this blog will serve to sensitize health care providers, as well as patients and their parents, to the need for COVID-19 vaccination and other preventative measures. The ongoing risk for COVID-19 infection, despite vaccination, is a concern. Hopefully, current ongoing clinical trials will soon provide answers for our children and adolescents, as well as for adults.
About the Author
Jonathan Finlay, MD, ChB, FRCP is the Pediatrician-in-Chief of MORE Health for Kids. He is an Emeritus Professor of Pediatrics at The Ohio State University College of Medicine and is Principal Investigator of NEXT / Head Start 4 Consortium Trial at Nationwide Children’s Hospital. Among his many awards, he is the first pediatric specialist to receive a Lifetime Achievement Award from the Society of Neuro-Oncology.