New COVID-19 vaccine booster guidelines for cancer patients

Last month, the National Comprehensive Cancer Network (NCCN) — an alliance of leading cancer centers, including Roswell Park Comprehensive Cancer Center — released updated recommendations from the NCCN Advisory Committee on COVID-19 vaccination and pre-exposure protection against infection.

Significant revisions include new recommendations for the recently approved bivalent vaccines (which protect against both the original SARS-CoV-2 virus and the Omicron variant) and advice on protecting children with cancer. The updated guidance also features comprehensive explanations for who should be considered “immunocompromised” and what that means for booster eligibility and scheduling.

The NCCN committee of leading experts meets frequently to examine all the latest research, says Brahm Segal, MD, Chief of Infectious Disease at Roswell Park and co-leader of the NCCN COVID-19 vaccine advisory committee. “We organize it into a reliable and easy-to-understand source for people with cancer and their families, as well as for their providers.”

Who is immunocompromised?

According to the new guidance, you are considered immunocompromised if you:

• Are being treated for tumors or blood cancer, or you have received cancer treatment in the past year.
• Had an organ or stem cell transplant, or you take medicine to suppress your immune system for another condition.
• Have an immunodeficiency condition or an advanced or untreated HIV infection.
• Take high-dose corticosteroids or other drugs that suppress your immune response.

Booster guidance for immunosuppressed people

Cancer patients who have previously received a two-dose or three-dose primary series and boosting through prior recommendations are now eligible to receive one of the bivalent boosters if:

• They are 12 years old or older for Pfizer.
• At least 18 years old for Moderna.

These boosters have been shown to improve immune response against Omicron strains in people with full immune system capacity. The committee supports this recent approval but cautions they are still awaiting data on bivalent booster effectiveness in immunocompromised people.

Guidance for pediatric immunosuppressed patients

The committee prefers the Moderna mRNA vaccine for pediatric immunosuppressed patients ages 6 months to 17 years. Preliminary data show that cases of myocarditis (inflamed heart muscle) are very rare, although relatively more frequent in adolescent and young adult males 16 and older. Most patients fully recover.

It is extremely important to protect children, which is why the committee recommends COVID-19 vaccination for anyone over 6 months of age, especially infants, children and adolescents who are immunocompromised. It is also very important for household members and caregivers to get vaccinated as well, since immunocompromised children under age 12 or weighing less than about 90 pounds are unable to receive monoclonal antibodies, a protective treatment for those who have been infected by the virus.

Booster clinics at Roswell Park during October

Patients, caregivers and community members, age 15 and older, can receive their COVID-19 booster at our Community Vaccine Clinic by appointment on the ground floor of the hospital near the Pediatric Clinic every Thursday during the month of October. Advance appointments are required. Clinic dates and hours are:

• Thursday, October 6 – 9 a.m.-12 noon
• Thursday, October 13 – 1 p.m.-4 p.m.
• Thursday, October 20 – 9 a.m - 12 noon
• Thursday, October 27 – 1 p.m.-4 p.m.

Patients must schedule their booster through their primary treatment clinic. Caregivers and community members must call 716-845-V4Me (716-845-8463). This phone number is for community members only and should not be used to schedule COVID-19 vaccines or boosters for current Roswell Park patients. Additional considerations:

• This booster is recommended 2 months after having received last COVID vaccine.
• If you have had COVID recently (or tested positive) you’re eligible to receive the booster if your symptoms have been resolved AND it has been at least 10 days since your diagnosis.
• Patients who receive the vaccine must wait 2 weeks after the vaccine to receive Evulshed
• Patients who are receiving Paxlovid should complete the Paxlovid regimen before receiving the booster.

Overcoming vaccine hesitancy

The guidelines also stress that vaccine hesitancy in the general population gets in the way of developing herd (community) immunity, which leaves people with cancer at higher risk. “Reducing community spread is really dependent on good vaccine uptake in the general community. Optimizing vaccine mediated plus herd immunity will limit the ability for the virus to spread widely and thus lessens the chance that people living with cancer, who are at higher risk of COVID-19 complications and may have less ability to attain vaccine related protection, will be exposed to COVID-19 in the first place,” said Katherine Mullin, MD, former Director of Infection Control and Prevention.

Other recommendations

Patients should continue to wear masks, maintain social distancing, avoid crowds and follow other non-pharmacologic recommendations for Covid-19 prevention even after receiving their booster shots. The updated guidance restates previous recommendations and statements, such as:

• Not recommending antibody testing, outside of a research study.
• Recommending boosters for everyone with a hematologic malignancy regardless of whether they are in active treatment.
• Preferring mRNA vaccination in most situations.
• Endorsing the option of mix-and-matching the two mRNA vaccines.
• Re-vaccinating after a patient undergoes hematopoietic cell transplantation or engineered cellular therapy (e.g., chimeric antigen receptor [CAR] T-cell therapy).
• Vaccines are considered safe for people undergoing immunotherapy.
• Vaccination status shouldn’t impact participation in clinical trials.
• Using monoclonal antibodies (tixagevimab plus cilgavimab) as prophylaxis (in addition to vaccination) in selected immunocompromised patients at risk for Covid-19 complications.

Societal concerns

An existing section called “Societal Considerations” says, “It is imperative that all patients have equitable access to the vaccines.” The section features recommendations for the incorporation of social vulnerability awareness to help address health disparities, including tracking racial/ethnic and socioeconomic data for vaccine distribution wherever possible.

The guidance also continues to stress that the timing for COVID-19 vaccination will not interfere with most other vaccines, such as the annual flu shot, but different vaccines should be administered at separate injection sites. To view the full list of recommendations, explanations, and peer-reviewed research citations, visit NCCN.org/COVID-19. The committee plans to continue to update the clinical recommendations and the corresponding patient guide (featuring simplified questions-and-answers) as needed. “We recommend all patients speak with their care team to decide how best to take advantage of the new COVID-19 booster shots,” Dr. Mullin said.