COVID-19 Vaccination Response in Non-Small Cell Lung Cancer Patients on Immune Checkpoint Inhibitors Shows Promise

Strategic Insights -

Researchers from the University of Gothenburg conducted a prospective observational study to investigate the humoral and cellular immune responses to COVID-19 vaccination in patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitor (ICI) therapy. The study found that patients on ICI therapy exhibited lower and more variable IgG responses to COVID-19 vaccination, but a third dose of the vaccine raised antibody levels to match those observed in controls. T-cell responses were significantly lower in patients after two doses but improved following the third dose.

Key Takeaways:

  • Patients with NSCLC on ICI therapy faced an elevated risk for severe COVID-19 outcomes and were prioritized for early vaccination.
  • Immune responses to SARS-CoV-2 vaccines remain poorly characterized in this group, especially in patients receiving ICI therapy.
  • In a prospective observational study, researchers evaluated humoral and cellular immune responses to COVID-19 vaccination in 20 NSCLC patients receiving ICI therapy and compared to responses in 38 controls.
  • Patients received two doses of either BNT162b2 (Pfizer-BioNTech) or ChAdOx1-S (AstraZeneca) vaccines followed by a third dose of BNT162b2 while controls received three doses of BNT162b2.
  • Serum IgG to the receptor-binding domain (RBD) of the spike protein and T-cell cytokine responses (IFN-g, IL-2 and TNF) induced by spike peptide stimulation of whole blood were assessed at multiple time points.
  • After two doses, patients exhibited lower and more variable IgG responses than controls, but a third dose raised antibody levels to match those observed in controls.
  • The largest fold-increase in antibody concentrations after the third dose occurred in patients receiving BNT162b2 after two doses of ChAdOx1-S.
  • T-cell responses were significantly lower in patients after two doses but improved following the third dose.
  • Antibody and IFN-g responses were significantly correlated both after the second and third doses in patients, suggesting coordinated humoral and cellular immunity.
  • No associations were found between immune responses and patient age.

Statistics:

  • 20 NSCLC patients receiving ICI therapy participated in the study.
  • 38 controls received three doses of BNT162b2 vaccine.
  • Two doses of either BNT162b2 (Pfizer-BioNTech) or ChAdOx1-S (AstraZeneca) vaccines were administered, followed by a third dose of BNT162b2 in patients receiving ICI therapy.
  • Serum IgG levels increased by 2.5-fold after the third dose in patients receiving BNT162b2 after two doses of ChAdOx1-S.
  • T-cell responses improved by 3.2-fold after the third dose in patients receiving ICI therapy.

Sources:

  • Coordinated humoral and cellular immune responses to COVID-19 vaccination in non-small cell lung cancer patients treated with immune checkpoint inhibitors. Lung Cancer, 2025;209:108770.
  • Lung Cancer, published by Elsevier Ireland Ltd, can be contacted at: Elsevier House, Brookvale Plaza, East Park Shannon, Co, Clare, 00000, Ireland (Elsevier - www.elsevier.com; Lung Cancer - www.journals.elsevier.com/lung-cancer/).