Učinkovitost (in varnost) cepljenja onkoloških bolnikov proti covidu-19 med aktivnim zdravljenjem Efficacy (and safety) of vaccination against SARS-CoV-2 in cancer patients on active treatment

Povzetek

Onkološki bolniki so bili že ob začetku pandemije covida-19 prepoznani kot skupina s povečanim tveganjem zapletov ob morebitni okužbi z virusom SARS-CoV-2, vendar so bili izključeni iz registracijskih raziskav cepiv proti covidu-19. Šele v zadnjih mesecih imamo na voljo več raziskav, ki so preučevale učinkovitost cepljenja pri onkoloških bolnikih z različnimi načini zdravljenja. Te so pokazale dobro učinkovitost (tako z razvojem humoralnega kot celičnega odgovora) in varnost cepiv predvsem pri bolnikih s solidnimi raki. Pričakovano slabši humoralni odziv je bil pri hematoloških bolnikih oziroma ga skoraj ni bilo pri bolnikih na terapiji anti-CD20 in terapiji z zaviralci Brutonove kinaze. Vendar je bil pri hematoloških bolnikih ohranjen celični odgovor in tako je smiselno cepljenje tudi pri tej skupini bolnikov, tudi s tretjim odmerkom. Pri bolnikih, ki so predhodno preboleli okužbo s SARS-CoV-2 ter bili nato cepljeni, so ugotavljali bistveno boljši humoralni odgovor kot pri cepljenju neprebolevnikov.

Abstract (Eng)

Since the COVID-19 pandemic, cancer patients have been recognized as a group with an increased risk of complications, if they become infected with the SARS-CoV-2 virus. However, they were not included in registrational trials for COVID-19 vaccines. In the last few months data from studies investigating the efficacy and safety of COVID-19 vaccines in cancer patients receiving systemic treatment have become available. It has been established that the efficacy (regarding humoral and cellular response) and safety of COVID-19 vaccines in solid cancer patients are comparable to that in healthy individuals. On the other side, humoral response is very low or even undeterminable in haematological patients, especially in those receiving anti-CD 20+ targeted therapy or Bruton kinase inhibitors. However, a cellular response is preserved and vaccination, including with a third dose, is reasonable. Cancer patients who were infected with SARS-CoV-2 and then vaccinated developed much better humoral response.