Third COVID-19 Vaccine Dose Effective and Safe in Patients with Lung Cancer


A study in France showed that patients with lung cancer, a population initially excluded from COVID-19 vaccination registration trials, were able to safely receive 3 doses.

Third COVID-19 Vaccine Dose Effective and Safe in Patients with Lung Cancer

Third COVID-19 Vaccine Dose Effective and Safe in Patients with Lung Cancer

Patients with lung cancer, especially patients with minimal serologic response following a second dose of the SAR-SoV2 vaccine, safely experienced seroconversion after receiving a third dose of the vaccine, according to findings from a French study published in the Journal of Thoracic Oncology.1,2

The results showed that most patients were immunized after 2 doses and that a third booster shot given to 11% of patients who had persistent low antibody titers induced an 88% immunization rate.

“Though lung cancer patients were reported at high COVID-19-related mortality risk in published series, lethality systematically exceeding 30% of infected patients, we observed only 8 mild COVID-19 cases among our 306 vaccinated patients (2.6%). Such observation strongly supports the efficacy of mRNA COVID-19 vaccines used in 98.4% of our population,” lead study authorValérie Gounant, MD, of the University Hospital Bichat-Claude Bernard in Paris, France, and coauthors wrote in the study publication.

In January 2021, COVID-19 vaccines were made available in France. To increase access to the first vaccine dose, the French Health authorities recommended a 28-day interval for both mRNA vaccines, with a 42-day interval for healthy individuals.

Despite the high COVID-19 mortality rate among patients with lung cancer, the population was excluded from SARS-CoV2 vaccine registration trials, leaving it unknown whether they could develop a protective anti-spike antibody response after vaccination.

As such, investigators conducted a study to evaluate the humoral responses to SARS-CoV2 vaccines in patients with thoracic malignancies.

The prospective study included patients with thoracic cancers who had been seen in Bichat Hospital from January 26, 2021 to July 28, 2021. Patients who had been diagnosed with thoracic cancer and had no known COVID-19 infection within the past 3 months, a life expectancy greater than 3 months, and no known allergies to prior vaccines were contacted and offered vaccination.

The investigators enrolled and vaccinated 306 patients with lung cancer. Most patients were male (n = 181; 59.2%) and had lung cancer (n = 285; 93.1%); 260 patients (84.9%)

had non–small cell lung cancer and 22 (7.2%) had small cell lung cancer, while 13 patients (4.4%) had pleural malignant mesothelioma. Patients were a median age of 67 years (interquartile range, 58-74), and the majority (n = 283) had received 2 vaccine doses at 28-day intervals.

The last treatment patients received within 3 months before their first vaccine dose was chemotherapy (n = 74; 24.2 %) alone (n = 51; 16.7%), with concurrent radiotherapy (n = 2), or combined with a checkpoint inhibitor (n = 21; 6.9%); 49 patients (16%) received a checkpoint inhibitor alone, and 13.7% were treated with daily TKIs or maintenance bevacizumab (Avastin). The last 141 patients (30.7%) had not received systemic treatment within the last 3 months leading up to vaccination.

The primary end point was the humoral immunity against SARS-CoV-2-spike following the COVID-19 mRNA BNT162b2 vaccine injection and booster dose. Some patients were vaccinated outside the center and received the Moderna mRNA-1273 (n = 1) or AstraZeneca ChAdOx1 nCov-19 (n = 3) vaccines.

SARS-CoV2-spike antibodies were measured with the Abbot ARCHITECT SARS-CoV-2 IgG immunoassay before the first injection of the mRNA vaccine, after the fourth week, and 2 to 16 weeks after second vaccine dose.

After a median follow-up of 6.7 months, 8 patients (2.6%) had developed symptomatic SARS-CoV-2 infection, with a fast-onset evolution. Of 269 serological results that had been collected after 14 days following the second vaccine dose, 17 (6.3%) were still negative (<50 arbitrary units [AU]/mL), and 34 (11%) were less than 300 AU/mL in the 12.5th percentile—the level at which an exact correlation was found between anti-S antibodies and neutralizing antibodies.

Multivariate analysis demonstrated that age, chemotherapy as the last systemic treatment within 3 months, and chronic corticosteroid treatment were significantly associated with a lack of immunization.

Thirty patients received a third vaccine dose, after which 3 patients showed persistent negative serology and the rest seroconversion.

In terms of safety, data were available for most patients (n = 278; 90.1%), without significant safety concerns.

One-third of patients (n = 98) did not report symptoms following their first injection. Reported adverse effects (AEs) included transitory pain, injection-site swelling, or grade 1 injection-site erythema lasting less than 24 hours.

AEs were reported in 201 patients following the second dose and included injection-site erythema, pain, local injection-site swelling, mild fever (< 38.5°C) all lasting less than 36 hours. Flu-like symptoms, chills, and fatigue lasting less than 48 hours were reported in 25 (8%) cases.

Additionally, no anaphylaxis reaction was reported following the administration of 587 vaccine doses.

“Although this report involves, to the best our knowledge, the largest series of patients [with thoracic cancer] receiving anti-SARS-CoV-2 mRNA vaccines that has been published to date, the sample size of the different patient subsets remains limited,” the authors concluded.


  1. Gounant V, Ferre VM, Soussi G, et al. Efficacy of SARS-CoV-2 vaccine in thoracic cancer patients: a prospective study supporting a third dose in patients with minimal serologic response after two vaccine doses. J Thorac Oncol. doi:10.1016/j.jtho.2021.10.015
  2. COVID-19 vaccine effective in patients with lung cancer results from a French study published in the Journal of Thoracic Oncology. News release. IASLC. November 16, 2021. Accessed November 19, 2021.

This article was originally published on OncLive as “Third SARS-CoV2 Vaccine Shows Evidence of Seroconversion in Lung Cancer”

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