NCCN Releases Initial Guidance for COVID-19 Vaccine Administration in Patients With Cancer

The National Comprehensive Cancer Network (NCCN) released guidance information regarding coronavirus disease 2019 (COVID-19) vaccinations in people with cancer, recommending that this patient group be prioritized for immunization.

Preliminary recommendations from the NCCN Vaccination Advisory Committee indicate that immunization is recommended in all patients on active therapy, with the understanding that limited safety and efficacy data related to its use exist in this subgroup.¹ According to the document, patients with cancer fall under the Centers for Disease Control and Prevention priority groups 1b/c, which includes non–health cancer essential workers, patients aged 65 years or older, and those with high-risk medical conditions.²

“Right now, there is urgent need and limited data,” explained Steve Pergam, MD, MPH, who is an associate professor in the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center, Infection Prevention Director at Seattle Cancer Care Alliance, and co-leader of the NCCN COVID-19 Vaccine Committee.³ “Our number one goal is helping to get the vaccine to as many people as we can. That means following existing national and regional directions for prioritizing people who are more likely to face death or severe illness from COVID-19. The evidence we have shown that people receiving active cancer treatment are at greater risk for worse outcomes from COVID-19, particularly if they are older and have additional comorbidities, like immunosuppression.”

Further, reasons for delaying vaccine administration are the same as those for the general population, such as recent exposure to COVID-19, in addition to cancer-specific factors. It is recommended that caregivers and those in close contact with patients, such as household family members, also receive the vaccine.

Cancer-specific instances where a delay in administration is necessary include patients who allogeneic and autologous stem cell transplants or cellular therapy within the last 3 months. Additionally, certain conditions in patients with hematologic malignancies, such as the receipt of cytotoxic chemotherapy for acute myeloid leukemia where the patient has impaired absolute neutrophil count, warrant delay. Major oncologic surgery should be on a separate date from surgery by at least a few days.

In the case of limited vaccine supply, prioritization may need to be considered based on the following criteria outlined by the NCCN:

• Prioritize patients with active cancer and who are planned for treatment or who have just completed treatment, with the exception of those on hormonal therapy only.
• Additional risk factors linked to adverse COVID-19 complications can be considered such as advanced age, comorbidities, and social and demographic factors

“My philosophy is don’t waste a dose and keep it simple,” committee co-leader Lindsey Baden, MD, who is an associate professor of medicine, Infectious Disease, at Brigham and Women’s Hospital and Dana-Farber Cancer Institute, said in a press release. “Too many caveats can lead to confusion. Of course, if strong new evidence comes out to support prioritizing certain groups over others, we can always adjust.”

Counseling for patients with cancer should include a discussion of supporting clinical data regarding safety of the vaccine in the general population. Although data for the cancer population is lacking, the NCCN noted that available mRNA vaccines do not pose an immediate safety risk for immunosuppressed patients. Moreover, vaccination does not supersede the need to continue using general precautions, such as wearing masks and avoiding large gatherings.

“The medical community is rising to one of the biggest challenges we have ever faced,” Robert W. Carlson, MD, chief executive officer of the NCCN, said in a statement. “The COVID-19 vaccines exemplify the heights of scientific achievement. Now we have to distribute them quickly, equitably, safely and, efficiently, using clearly defined and transparent principles.”

The new guidance builds off of existing recommendations for flu vaccinations in the indicated patient population. The panel will continue to refine the recommendations as data become available.

References:

1. Preliminary recommendations of the NCCN COVID-19 Vaccination Advisory Committee. National Comprehensive Cancer Network. January 22, 2021. Accessed January 22, 2021. https://www.nccn.org/covid-19/pdf/COVID-19_Vaccination_Guidance_V1.0.pdf

2. Evidence table for COVID-19 vaccines allocation in phases 1b and 1c of the vaccination program. Centers for Disease Control and Prevention. December 22, 2020. Accessed January 22, 2021. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19/evidence-table-phase-1b-1c.html

3. NCCN shares new guidance principles for vaccinating people with cancer against COVID-19. News release. National Comprehensive Cancer Network. January 22, 2021. Accessed January 22, 2021. https://www.prnewswire.com/news-releases/nccn-shares-new-guidance-principles-for-vaccinating-people-with-cancer-against-covid-19-301213154.html