Response Rate of the Third and Fourth Doses of the BNT162b2 Vaccine Administered to Cancer Patients Undergoing Active Anti-Neoplastic Treatments.

The BNT162b2 vaccine is globally used for preventing morbidity and mortality related to COVID-19. Cancer patients have had priority for receiving the vaccine due to their diminished immunity. This study reports the response rate of administering the third and fourth vaccine doses to cancer patients receiving active anti-neoplastic treatment. A total of 142 patients received two doses of the mRNA-based BNT162b2 COVID-19 vaccine, while 76 and 25 patients received three and four doses, respectively. The efficacy of the humoral response following two vaccine doses was diminished in cancer patients, especially in the group of patients receiving chemotherapy. In a multivariate analysis, patients who received three and four BNT162b2 vaccine doses were more likely to have antibody titers in the upper tertile compared to patients who received two doses of the vaccine (odds ratio (OR) 7.62 (95% CI 1.38-42.12), p = 0.02 and 17.15 (95% CI 5.01-58.7), p < 0.01, respectively). Unlike the response after two doses, the third and fourth BNT162b2 vaccine booster doses had an increased efficacy of 95-100% in cancer patients while undergoing active treatment. This result could be explained by different mechanisms including the development of memory B cells.

Efficacy of the mRNA-Based BNT162b2 COVID-19 Vaccine in Patients with Solid Malignancies Treated with Anti-Neoplastic Drugs.

The BNT162b2 vaccine was shown to be highly effective in reducing the risk of COVID-19 infection in healthy individuals and patients with chronic disease. However, there are little data regarding its efficacy in patients treated for cancer. We analyzed the humoral response following vaccination with the second dose of BNT162b2 in 140 patients with solid malignancies who were receiving anti-cancer therapy at the time of vaccination and 215 participants who had not been diagnosed with cancer. Multivariate analysis was performed, followed by matching the two groups by age, gender and days from vaccination. The humoral response in the cancer patient group was significantly lower than in the non-cancer group: 20/140 seronegative (14.3%) vs. 3/215 (1.4%), p < 0.001; median IgG levels 2231 AU/mL (IQR 445-8023) vs. 4100 (IQR 2231-6774) p = 0.001 respectively. The odds ratio for negative serology results in cancer patients adjusted by age and gender was 7.35 compared to participants without cancer. This effect was observed only in chemotherapy treated patients: 17/73 seronegative (23.3%) vs. 3/215 (1.4%), p < 0.001; median IgG 1361 AU/mL vs. 4100, p < 0.001 but not in patients treated with non-chemotherapeutic drugs. Reduced immunogenicity to COVID-19 vaccine among chemotherapy-treated cancer patients, raises the need to continue exercising protective measures after vaccination in these patients.

Treatment of Rare Mutations in Patients with Lung Cancer.

Lung cancer is a worldwide prevalent malignancy. This disease has a low survival rate due to diagnosis at a late stage challenged by the involvement of metastatic sites. Non-small-cell lung cancer (NSCLC) is presented in 85% of cases. The last decade has experienced substantial advancements in scientific research, leading to a novel targeted therapeutic approach. The newly developed pharmaceutical agents are aimed towards specific mutations, detected in individual patients inflicted by lung cancer. These drugs have longer and improved response rates compared to traditional chemotherapy. Recent studies were able to identify rare mutations found in pulmonary tumors. Among the gene alterations detected were mesenchymal epithelial transition factor (MET), human epidermal growth factor 2 (HER2), B-type Raf kinase (BRAF), c-ROS proto-oncogene (ROS1), rearranged during transfection (RET) and neurotrophic tyrosine kinase (NTRK). Ongoing clinical trials are gaining insight onto possible first and second lines of medical treatment options intended to enable progression-free survival to lung cancer patients.

Encephalitis Induced by Durvalumab During Treatment of Metastatic Small-Cell Lung Cancer: Illustrative Case and Review of the Literature.

The immune checkpoint inhibitors have improved the standards of care in cancer treatment and have dramatically improved patient prognoses. These new antibodies turned to be an integral part of the standard of care for metastatic small-cell lung cancer. Platinum-based chemotherapy combined with checkpoint inhibitors, resulted in statistically significant improvement of progression free survival and overall survival. Immune checkpoint inhibitors immune-related adverse events have been observed and reported as a consequence of administering these innovative treatment drugs. Neurological immune-related adverse events are rare complications; however, they can be potentially fatal, particularly encephalitis. This report describes a 66-year-old female who received Durvalumab for metastatic small-cell lung cancer. Following 3 cycles of treatment, she developed encephalitis.

[TREATMENT OF ONCOLOGY PATIENTS DURING THE CORONA VIRUS ERA].

BACKGROUND: Cancer patients are more at risk to contract SARS-CoV-2 and may develop many more severe complications, along with high mortality rates relative to the cancer-free population. The outbreak of the epidemic was characterized by a high rate of infection from person to person, however medical systems remained fully functional. Following most international guidelines, adaptations were made to the performance level of oncology treatments, and the service was to continue as usual. Moreover, the corona virus epidemic era was characterized by new challenges such as emergency work schedules, additional hygiene measures and social distancing. Furthermore, the medical staff used Personal Protection Equipment and resource preparedness for a larger outbreak and probable collapse of the health system. Therefore, changes have been made in the form and delivery of patient care and treatments. This article presents the work format employed in the Oncology Unit at Bnai Zion Medical Center during the COVID-19 epidemic. The newly adjusted protocol included four areas: staff, patients, infrastructure and malignant disease types.

[MANAGING LUNG CANCER PATIENTS' CARE DURING THE COVID-19 PANDEMIC].

BACKGROUND: Lung cancer patients who contract the new coronavirus, appear to have a greater risk for severe COVID-19 illness along with early deterioration and death. However, the prognosis may depend on the cancer stage and the type of treatment administered. OBJECTIVES: Establishing updated treatments and care management regulations for lung cancer patients during the COVID-19 pandemic, based on worldwide clinical experience. METHODS: This article reviews the main recommendations described by the American and European Oncology Societies managing lung cancer patients infected by COVID-19. RESULTS: In the current pandemic setting, attempts should be made to avoid jeopardizing the prognosis of lung cancer patients, by maintaining current guidelines in oncology practice. In cases of patients with active infection, the recommendation is to hold treatment until recovery. For other patients, due to the aggressive nature of lung cancer, the guidelines suggest not to delay curative treatments in non-metastatic disease and provide palliative treatment in shortened protocols. CONCLUSIONS: The present summary of guideline recommendations provides different management strategies for patients with lung cancer. These care approaches attempt to solve new challenges raised by the COVID-19 pandemic. Each specific case must be considered individually.