Immunogenicity of SARS-CoV-2 vaccines in patients with breast cancer

Elyssa Denault, Erika Nakajima, Vivek Naranbhai, Jennifer A. Hutchinson, Lindsey Mortensen, Elizabeth Neihoff, Caroline Barabell, Amy Comander, Dejan Juric, Irene Kuter, Theresa Mulvey, Jeffrey Peppercorn, Aron S. Rosenstock, Jennifer Shin, Neelima Vidula, Seth A. Wander, Beverly Moy, Leif W. Ellisen, Steven J. Isakoff, A. John IafrateJustin F. Gainor, Aditya Bardia, Laura M. Spring

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Purpose: To explore the immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with breast cancer based on type of anticancer treatment. Methods: Patients with breast cancer had anti-spike antibody concentrations measured ⩾14 days after receiving a full SARS-CoV-2 vaccination series. The primary endpoint was IgA/G/M anti-spike antibody concentration. Multiple regression analysis was used to analyze log10-transformed antibody titer concentrations. Results: Between 29 April and 20 July 2021, 233 patients with breast cancer were enrolled, of whom 212 were eligible for the current analysis. Patients who received mRNA-1273 (Moderna) had the highest antibody concentrations [geometric mean concentration (GMC) in log10: 3.0 U/mL], compared to patients who received BNT162b2 (Pfizer) (GMC: 2.6 U/mL) (multiple regression adjusted p = 0.013) and Ad26.COV2.S (Johnson & Johnson/Janssen) (GMC: 2.6 U/mL) (p = 0.071). Patients receiving cytotoxic therapy had a significantly lower antibody titer GMC (2.5 U/mL) compared to patients on no therapy or endocrine therapy alone (3.0 U/mL) (p = 0.005). Patients on targeted therapies (GMC: 2.7 U/mL) also had a numerically lower GMC compared to patients not receiving therapy/on endocrine therapy alone, although this result was not significant (p = 0.364). Among patients who received an additional dose of vaccine (n = 31), 28 demonstrated an increased antibody response that ranged from 0.2 to >4.4 U/ mL. Conclusion: Most patients with breast cancer generate detectable anti-spike antibodies following SARS-CoV-2 vaccination, though systemic treatments and vaccine type impact level of response. Further studies are needed to better understand the clinical implications of different antibody levels, the effectiveness of additional SARS-CoV-2 vaccine doses, and the risk of breakthrough infections among patients with breast cancer.

Original languageEnglish
Article number17588359221119370
Number of pages14
JournalTherapeutic Advances in Medical Oncology
Publication statusPublished - Aug 2022
Externally publishedYes


  • breast cancer
  • CDK4/6 inhibitor
  • HER2+ breast cancer
  • hormone receptor-positive breast cancer
  • triple-negative breast cancer

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