publication date: Jan. 8, 2021

Cancer groups urge CDC to prioritize cancer patients for COVID-19 vaccination

By Matthew Bin Han Ong

This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage is available here.

The American Cancer Society, the Association of Clinical Oncology, and the American Association for Cancer Research are calling on the Centers for Disease Control and Prevention to give cancer patients a higher priority amid the rollout of vaccines against SARS-CoV-2.

In a Dec. 18 letter to the CDC’s Advisory Council on Immunization Practices, leaders at ACS and ACO cite “compelling data that shows worse COVID-19 outcomes” in patients with cancer and people with a history of cancer.

“We urge the Committee to frequently review the emerging evidence about the impact of COVID-19 on people with cancer and to place these patients in the appropriate tier of allocation based on their risk. Our organizations stand ready to work with you toward a fair and equitable distribution plan during the coming months,” Monica Bertagnolli, chair of the Board Association for Clinical Oncology, and William Cance, chief medical and scientific officer of ACS, wrote in the letter.

AACR’s COVID-19 and Cancer Task Force recommended that patients with cancer should be considered for priority access to COVID-19 vaccines due to their increased risk of mortality from COVID-19 infection. The task force reviewed the available literature on fatality rates of patients with cancer who developed COVID-19 and based their recommendation on 28 publications.

According to the task force’s review—announced Dec. 19 and published in Cancer DiscoveryCOVID-19 fatality rates for patients with cancer were double that of patients without cancer. Even when adjusted for age, sex, and comorbidities, the mortality rates trended upward, indicating a greater risk for severe disease and mortality due to COVID-19 in patients with cancer.

Two mRNA COVID-19 vaccines have received emergency use authorization from FDA—the Pfizer-BioNTech vaccine, for people 16 years of age and older, and the Moderna vaccine, for people 18 years of age and older. Both vaccines have been found to be more than 90% effective at preventing COVID-19 infection in people who receive two doses.

States and other authorities rely on CDC guidelines to inform their own priorities for vaccine distribution, but do not have to comply with those guidelines.

“Individual states have varying plans regarding prioritization of these high-risk patient populations for vaccination, with some states recommending cancer patients be vaccinated early while other states place these patients farther down the priority list,” members of the COVID Lung Cancer Consortium wrote in a Dec. 29 letter to the CDC advisory council.

“Currently, the CLCC recommends specific attention to this vulnerable population(s) and close follow-up of these individuals to ensure the vaccine is effective and there are no unexpected adverse events.”

In a statement Dec. 15, the Association of American Cancer Institutes commended FDA for swiftly granting an EUA to Pfizer for its vaccine.

“Now more than ever, it is critical to ensure that public health recommendations are founded on strong scientific evidence. AACI applauds the rigor with which the current vaccines were evaluated, and its members are thankful for the potential to save lives,” said AACI President Karen E. Knudsen, enterprise director at Sidney Kimmel Cancer Center at Jefferson Health.

“In the coming months, AACI cancer centers will be charged with the important task of boosting public trust in clinical research and educating community members on the importance of vaccination. We stand ready to embrace this challenge and help bring an end to the pandemic.”

The statements from ACS, ACO, CLCC, and AACI follow:

American Cancer Society and Association for Clinical Oncology

Dear Advisory Council Members:

On behalf of the American Cancer Society and the Association for Clinical Oncology, we write to thank you for your dedication to developing carefully considered and data-driven recommendations on how to distribute the COVID-19 vaccines, and to share data on the impact of COVID-19 on cancer patients and survivors.

Together we represent millions of cancer patients and survivors, and the cancer care teams that treat them. As you make recommendations about the distribution of the vaccination, our hope is that you will consider prioritizing cancer patients because of the compelling data that shows worse COVID-19 outcomes for people in active treatment for, or with a history of, cancer.

While evidence is still emerging about the nature and severity of illness caused by this novel virus, there have been numerous studies examining the risk of severe COVID-19 disease or death from COVID-19 infection in individuals with a history of cancer.

One meta-analysis reported that individuals with a history of cancer had 1.35-times higher odds of COVID-related death compared to individuals without cancer (OR=1.35, 95% CI 1.17-1.55) and another meta-analysis reported 2.31-times higher risk of death in those with a cancer history (95% CI 1.80-2.91). Mounting evidence also demonstrates that individuals with any history of cancer are at a higher risk of severe disease compared to the general population. In a recent retrospective analysis of patients in Massachusetts, those with a history of cancer were twice as likely to develop severe COVID-19 disease compared to the general population.

We appreciate the challenge facing the Committee in recommending priorities for COVID-19 vaccination, and respect the thoughtful and transparent way in which you have approached this unprecedented situation.

We urge the Committee to frequently review the emerging evidence about the impact of COVID-19 on people with cancer and to place these patients in the appropriate tier of allocation based on their risk. Our organizations stand ready to work with you toward a fair and equitable distribution plan during the coming months.

Sincerely,

Monica Bertagnolli, MD, FACS, FASCO

Chair of the Board Association for Clinical Oncology

William G. Cance, MD FACS

Chief Medical and Scientific Officer American Cancer Society

COVID-Lung Cancer Consortium

Dear Advisory Council Members:

Individuals with cancer are at increased risk of severe COVID-19 disease and severe manifestations of the disease including death. Of particular concern, patients with lung cancer have increased mortality rates of ~32% from COVID-19 infection, which calls for specific prevention measures.

Currently, individual states have varying plans regarding prioritization of these high-risk patient populations for vaccination, with some states recommending cancer patients be vaccinated early while other states place these patients farther down the priority list.

The COVID- Lung Cancer Consortium meets on a regular basis to monitor ongoing impacts of the pandemic on patients with lung cancer and is comprised of a global assembly of thought leaders in thoracic oncology, virology, immunology, vaccines and patient advocacy. CLCC recommends that national and state level policies for vaccine administration should strongly consider a high priority for vaccination of all cancer patients and especially lung cancer patients.

Thus, as more vaccine doses are made available, these patients will have early access should they choose to be vaccinated after discussion with their healthcare providers of the associated risks and benefits.

Clearly, we still do not yet have enough information about the effectiveness and any additional side effects of such vaccines in cancer patients depending on their cancer type, stage, treatments, and other medical conditions. As such key information becomes available, such as that from current NCI sponsored research, including SeroNet studies, adjusted recommendations based on scientific knowledge can be made.

Currently, the CLCC recommends specific attention to this vulnerable population(s) and close follow-up of these individuals to ensure the vaccine is effective and there are no unexpected adverse events.

Sincerely,

Fred R. Hirsch, MD, PhD

Executive Director,
Center for Thoracic Oncology.
Mount Sinai Cancer, Mount Sinai Health System.
Professor of Medicine and Pathology, Icahn School of Medicine.
Joe Lowe and Louis Price Professor of Medicine.
Associate Director, Tisch Cancer Institute

Amy Moore, PhD

GO2 Foundation for Lung Cancer
Director, Science and Research

Paul A. Bunn, MD

Distinguished Professor and Dudley Lung Cancer Chair
Univ. of Colorado Cancer Center

John Minna, MD

Professor and Director
Max L. Thomas Chair in Molecular Pulmonary Oncology
Sarah M. and Charles E. Seay Distinguished Chair in Cancer Research UT Southwestern Medical Center

Association of American Cancer Institutes

The Association of American Cancer Institutes commends the U.S. Food and Drug Administration for its swift action to grant Emergency Use Authorization to Pfizer’s COVID-19 vaccine.

As an association representing 102 leading academic and freestanding cancer centers in North America, AACI thanks the scientists, researchers, and clinical trial participants who contributed to the development of a safe, effective vaccine for people 16 and older. We also commend the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices for its efforts to ensure equitable distribution of the vaccine, particularly to underserved communities that have been disproportionately affected by the coronavirus pandemic.

Health care providers at AACI cancer centers care for a particularly vulnerable patient population: many patients with cancer are immunosuppressed, and most have serious co-morbidities that increase their risk of contracting COVID-19. Cancer patients also experience poor outcomes after infection with the virus. This vaccine—and others that may receive EUA from the FDA—represents a major step forward in protecting these patients from another devastating illness.

“Though the approval of the first COVID-19 vaccine represents a ‘light at the end of the tunnel’ of the coronavirus pandemic, AACI leadership recognizes that challenges still lie ahead. Widespread, equitable uptake of vaccines is imperative to the success of any COVID-19 vaccination effort,” said AACI Executive Director Jennifer W. Pegher.

“Now more than ever, it is critical to ensure that public health recommendations are founded on strong scientific evidence. AACI applauds the rigor with which the current vaccines were evaluated, and its members are thankful for the potential to save lives,” added AACI President Karen E. Knudsen, MBA, PhD, enterprise director at Sidney Kimmel Cancer Center at Jefferson Health in Philadelphia. “In the coming months, AACI cancer centers will be charged with the important task of boosting public trust in clinical research and educating community members on the importance of vaccination. We stand ready to embrace this challenge and help bring an end to the pandemic.”

Correction: This article has been updated to include AACR’s recommendation.

Copyright (c) 2020 The Cancer Letter Inc.