Study: Striking differences seen in COVID-19 responses in cancer patients

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A study funded by Cancer Research UK shows that the immune response to COVID-19 is the same in people with solid tumors compared to those without cancer.

However, blood cancer patients varied in their ability to respond to the virus, with many unable to shake off the virus for up to 90 days after the first signs of infection—around five times longer than the average.

Due to the importance of sharing findings related to the pandemic, the publication has been fast-tracked online as a preprint in Cancer Cell. The study gives reassurance to many people with cancer, but also highlights that patients cannot be grouped together when it comes to delivering cancer care during the pandemic.

The COVID-19 pandemic has led to many challenges for people with cancer, including decisions around shielding and delaying treatment. There is also conflicting evidence around COVID-19 having a more detrimental effect on those with cancer, and there is little insight into how cancer patients’ immune systems respond to the virus.

Researchers led by Sheeba Irshad, a Cancer Research UK clinician scientist based at King’s College London, in collaboration with Professor Adrian Hayday and Piers Patten (consultant hematologist) wanted to address two key questions: 1) Does the immune response to COVID-19 in cancer patients differ to those without cancer; and 2) What is the long-term impact of COVID-19 on the immune system in people with cancer.

The study analysed the blood of 76 cancer patients: 41 of them had COVID-19, and 35 had not been exposed to the virus. The samples were compared to the blood of people who didn’t have cancer, and who had already been recruited to the previously published COVID-IP study led by Professor Adrian Hayday*. Of the 41 people with cancer, 23 had solid tumors, and 18 had blood cancer.

Immune responses to the virus in people with solid tumors were like those of people without cancer. This was the case even where patients were in the advanced stages of cancer and were undergoing active anti-cancer treatments. Both groups were able to mount a strong immune response to the initial COVID-19 infection, and subsequently developed high levels of antibodies to clear the virus from their systems.

This study was the first to show that high levels of COVID-19 antibodies are sustained long-term in patients with solid tumors—up to 78 days after exposure to the virus. The study also found that once patients had recovered from COVID-19, their immune systems returned to normal, pre-COVID functioning.

The immune response to COVID-19 in people with certain types of blood cancer was similar but milder in the active/early phases of the disease and became stronger over time resembling immune changes often seen in chronic infections. This was especially true for cancers affecting B cells: a type of immune cell that plays an important role in immune memory.

In patients with B cell-related blood cancers, the antibody response to the virus was more diverse compared to people with solid tumors and presented as three distinct groups: 1) those who developed antibodies and cleared the virus like the solid cancer patients and people without cancer; 2) those who never developed antibodies even >75 days after virus exposure and continued to fail to clear the virus; and finally, 3) those who despite having developed antibodies against the virus were unable to clear it.

The next phase of the SOAP study will monitor the immune responses of cancer patients to the COVID-19 vaccine.

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