Prophylactic Monoclonal Antibodies Recommended to Protect Certain Patients With Cancer From COVID-19

The National Comprehensive Cancer Network now recommends prophylactic monoclonal antibodies for immunosuppressed individuals, such as certain patients with cancer.

Patients with cancer should talk with their doctor to determine if they would be sufficiently protected by any of the available COVID-19 vaccines or if they would be eligible for, and better off, receiving a prophylactic (preventive) combination of monoclonal antibodies that were recently granted emergency use authorization by the Food and Drug Administration (FDA), according to an expert.

“We know that patients who have undergone transplantation such as solid organ transplants, bone marrow transplants CAR-T cell therapy, certain malignancies like lymphoid malignancies, lymphoma, (chronic lymphocytic leukemia), that their response to the (COVID-19) vaccine could be quite poor, based upon the treatment that they’ve been receiving,” Dr. Sanjeet Dadwal, a clinical professor of infectious diseases at City of Hope in Duarte, Calif, said in an interview with CURE®. (The monoclonal antibody combination) is particularly for that group, who are considered to be immunocompromised and are unlikely to respond to the vaccine.”.

Dadwal, who is also a member of the Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis and the National Comprehensive Cancer Network (NCCN) Guidelines Panel for Prevention and Treatment of Cancer-Related Infections, recently spoke with CURE® about the NCCN’s updated COVID-19 guidance for patients with cancer.

The new guidelines were crafted after the FDA issued an emergency use authorization for the drug duo — tixagevimab plus cilgavimab — for the pre-exposure protection for COVID-19 in individuals aged 12 or older who are moderately to severely immune compromised.

Prioritizing Who Receives Preventive Monoclonal Antibodies

Currently, the drugs that are used to prevent exposure to COVID-19 are very scarce, and as Dadwal noted, should be reserved for the patients who need them most, such as those who recently underwent a solid organ transplantation, received a hematopoietic stem cell transplantation or have blood cancer and have been shown to be less likely to develop immunity from the vaccine.

“If somebody is eligible for vaccination, that’s the route to go,” Dadwal said. “If they are ineligible for the vaccine, (per) the guidance which we have at the NCCN, then they can go this route (of the prophylactic monoclonal antibody).”

Repeat Vaccination After Certain Cancer Treatments

The updated NCCN guidelines also advocate that patients get vaccinated again after they have undergone a stem cell transplant, CAR-T cell therapy or other chemotherapy and radiation treatments. This is the case for other vaccines that were given before treatment, too.

“That’s nothing new (with) other vaccines, also. So let’s say that people got the polio vaccine, or hepatitis A, B (vaccine) prior to transplant when they were kids or young adults. After you give the transplant or CAR-T (therapy), that immunity is lost,” Dadwal said. “And the same thing holds for the COVID-19 vaccine, too.”

Dadwal explained that now the NCCN recommends that patients wait at least three months after transplantation to get re-vaccinated against COVID-19.

Still Take Other Precautions

Even with the promise of new treatments and preventive strategies for COVID-19, patients with cancer should still be careful to protect themselves from infection — especially as omicron variant cases continue to rise.

“I do understand and emphasize, we cannot be isolating ourselves forever,” Dadwal said. “But getting into larger groups is not advised, especially now when the surge is going up. Stay away, because we do not know how (well) you may have responded to the vaccine. So it is very important to do your due diligence and be careful with masking. If you’re meeting with somebody, maybe even get your eye protection and stay away from them and not mingle very closely.”

Additionally, he said that vaccination for those eligible is still essential.

“Vaccination is still the key, and it has shown that it reduces the severity of illness and hospitalization, so we still recommend getting vaccinated,” Dadwal concluded.

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