Survival and Incidence of COVID-19 After SARS-CoV-2 Vaccination in a Series of 2391 Cancer Patients

Rationale: Patients with cancer are at high risk for severe or lethal CoVID-19. The impact of SARS-COV-2 vaccination on the risk of developing COVID-19 was investigated in an exhaustive series of patients from a comprehensive cancer center. Methods: This is a study of the exhaustive population of 2391 cancer patients who were prescribed SARS-COV-2 vaccination until 09/21. Patient characteristics, documented SARS-COV-2 infection with RT-PCR, and survival were collected. The primary endpoint was the rate of COVID-19 after vaccination. Secondary endpoints included risk factors to develop COVID-19 after vaccination, with a comparison with the cohort of vaccinated health care workers (HCW), and risk factors for death. Findings: From Jan to Sept 2021, among 2391 patients with cancer under active treatment prescribed a SARS-COV-2 vaccine, 659 (28%), 1498 (63%) and 139 (6%) received 1, 2 and 3 doses respectively. 95 patients received a single dose of vaccine after a previous COVID-19. 2285 health care workers (HCW) received one (N=17, 0.7%), 2-3 (N=2026, 88.7%) vaccine doses and one dose after COVID-19 (N=242, 10.6%). With a median follow-up of 142 days and 199 for patients and HCW respectively, 39 (1.6%) patients and 35 (1.5%) HCW developed COVID-19 after vaccination. 6 of 39 cancer patients and no HCW died of COVID-19 within 50 days after diagnosis. Independent risk factors for COVID-19 in vaccinated patients were age, single dose of vaccine and anti-CD20 treatment in the last 3 months. Independent risk factors for any cause of death included metastatic disease, gender, cancer type, but also documented COVID-19 before vaccination. Interpretation: Patients receiving two or more doses of COVID-19 vaccine have reduced risk of COVID-19. The risk of death of vaccinated cancer patients presenting COVID-19 remains high. COVID-19 before vaccination is associated with an increased overall risk of death. Funding Information: LYRICAN (INCA-DGOS-INSERM 12563), NetSARC (INCA & DGOS), InterSARC (INCA), LabEx DEvweCAN (ANR-10-LABX 0061), PIA Institut Convergence Francois Rabelais PLAsCAN (PLASCAN, 17-CONV-0002), Fondation ARC contre le Cancer, La Ligue contre le Cancer (Canopee), EURACAN (EC 739521) contributed to fund this study. Declaration of Interests: The authors have declared no conflicts of interest Ethics Approval Statement: The study was approved by the Institutional review board of the Centre Leon Berard on March 2021.