COVID-19 vaccine and cancer – latest updates – Cancer Research UK
Ever since the coronavirus pandemic brought the world to a standstill back in March, there’s been talk of a vaccine.
COVID-19 vaccines have been badged as our biggest opportunity to control the virus and return to normal. And for the last 8 months, researchers and scientists across the world have been racing to make that a reality. There are now more than 300 different potential vaccines in development, many in the final stages of testing.
Now, as initial data is being released from different trials, anticipation is rising. With vaccine news coming thick and fast, we want to make sure everyone has access to information about the COVID-19 vaccine and what it could mean for people with cancer, so we’ll be updating this blog post as new data and information emerges.
15 December – Latest vaccine trial data published
Results from the clinical trial of the vaccine developed by Pfizer/BioNTech – which is currently being rolled out across the country –have been published in The New England Journal of Medicine, showing that the vaccine may provide protection as early as 12 days after the first dose.
The phase 3 trial involved 42,000 people, with around half receiving the vaccine and the others a dummy vaccine (placebo). 170 people developed COVID-19, with 8 cases in the vaccinated group and 162 in the placebo group, demonstrating that the vaccine has an overall efficacy of 95%.
Efficacy or effectiveness – what do we mean?
Efficacy looks at whether an intervention (e.g. a drug or a vaccine) works under optimal conditions (such as a clinical trial). As an example, some of the COVID-19 vaccines are being tested in healthy participants or in people who are at higher risk of catching the virus because of their job, rather than being tested in the whole population.
Effectiveness looks at whether an intervention works in the ‘real world’. Vaccines will continue to be monitored after they’ve been rolled out. The data collected helps experts understand how well they work in different groups of people (looking at factors such as age, ethnicity, people with health conditions, etc) and how long the protection given by the vaccine lasts.
The AstraZeneca Oxford vaccine have also been published, this time in The Lancet, with data suggesting that the vaccine is safe and offers protection against COVID-19. The results are a combination of 2 clinical trials in the UK and Brazil. When the interim trial results were released a few weeks ago, the vaccine had an efficacy between 62 and 90% depending on how doses were administered.
This paper shows that the vaccine offers protection against symptomatic COVID-19 when the 2 doses are administered with a 6-week gap between them. This could mean that this vaccine could take longer to roll out than others, with the Pfizer vaccine being given in 2 doses spaced as little as 3 weeks apart. However, it doesn’t need to be stored at –70 degrees, meaning that it might be easier (and perhaps cheaper) to deliver.
11 December – Progress of COVID-19 vaccine vs cancer research
The development of multiple COVID-19 vaccines over an extraordinary 10-month period has brought up some questions about why there haven’t been similar transformative leaps in treating cancer.
Cancer is a highly complex disease, with over 200 different types that vary in biology, genetic make-up and behaviour. Not only that, but each person’s cancer is unique with its own set of challenges, so it’s very unlikely there will ever be one single cure that can be applied to everyone.
One of the biggest challenges our researchers face is that cancer can evolve, adapt and diversify and eventually outwit the immune system. For now, COIVD-19 doesn’t appear to rapidly change its make-up like cancer. And with COVID-19, researchers have been able to define specific targets that are found on the virus, which makes it much easier to treat than cancer.
Much of the science behind the development of the recent COVID-19 vaccines have been underpinned by previous research to understand the body’s immune system for other diseases, including cancer. And the extraordinary progress of the COVID-19 vaccine is in part because scientists, governments, industry and academic institutes around the world turned their focus to this one goal. To further accelerate development, different phases of vaccine trials and production have overlapped.
Although progress against cancer might not look as quick or dramatic as that against COVID-19, we have made great strides. Thanks to our research, we’ve helped cancer survival double over the last 40 years.
But there’s still more to do, and the technologies and insights that have come from the COVID-19 vaccine work could help us with future advancements in cancer research. We are relentless in our ambition to beat cancer and will continue to fund ground-breaking research to find new ways to prevent, diagnose and treat cancer.
8 December – Vaccine rollout begins across the UK
90-year-old Margaret Keenan has become the first person to receive the Pfizer-BioNTech COVID-19 vaccine, as mass rollout begins across the UK. BBC News has the latest.
Healthcare workers, care home workers and the over 80s will be prioritised to receive the vaccine, after it was approved for use last week.
50 hospitals in England have been selected to receive the first doses of the vaccine and deliver the first rounds of the vaccination programme. Scotland, Wales, and Northern Ireland are also set to begin their vaccination programmes from hospitals today.
With the first 800,000 doses arriving this week, limited quantities will be available until further doses arrive. To begin, elderly people who are hospital outpatients, as well as those who are being discharged after a stay in hospital, will be among the first to be offered the vaccine. Each individual will require two jabs, administered within 21 days of each other, so the initial 800,000 doses will vaccinate 400,000 people.
Prioritisation groups are based on who has the greatest risk of becoming seriously ill or dying from the virus.
Others over the age of 80 will be invited to attend the hospital to receive a jab, and care home providers will be able to book their staff into vaccination clinics. Any appointments not used for these priority groups will be given to healthcare workers who are at greatest risk of serious illness from COVID-19.
Chris Hopson, chief executive of NHS Providers, has added that those over 80 should not be worried if they have not yet received a letter or phone call from the NHS asking them to be vaccinated this month, as the “vast majority” of over 80s will have to wait until early next year.
“I’m sure there will be communications over the next few weeks that will tell people how quickly we are getting through the over-80s, and there will be plenty of communications to say, at the right point, if you haven’t had a letter then you should talk to your GP, but we are many weeks away from that,” Hopson added.
2 December – Pfizer–BioNTech vaccine approved for use in the UK and to be rolled out next week
The UK has become the first country to approve the Pfizer–BioNTech vaccine for widespread use, after the Medicines and Healthcare products Regulatory Agency (MHRA) confirmed that the vaccine is safe for rollout across the country.
The chairman and chief executive officer of Pfizer, Albert Bourla, has called this a “historic moment in the fight against COVID-19“. The good news comes after the vaccine has been turned around in just 10 months, a huge improvement on previous efforts, which typically have spanned a decade or more.
The mRNA vaccine, which trials suggest offers up to 95% protection against COVID-19, should be available to those who need it most, including elderly and care home patients and staff, within the week. Protection from the vaccine should stop people from becoming ill with the virus. So far, the UK has ordered 40 million doses, enough to vaccinate 20 million people, with the first 800,000 doses arriving early next week.
The Joint Committee on Vaccination and Immunisation (JCVI), who created the preliminary priority list, have released updated advice on priority groups for vaccination, which you can read here. The list remains the same since it was announced that the “clinically extremely vulnerable” will be placed alongside people over 70.
The JCVI outlined that many people who are “clinically extremely vulnerable” will have some degree of immunosuppression or be immunocompromised and may not respond as well to the vaccine. Based on this information, those who are “clinically extremely vulnerable” should continue to follow Government advice on reducing their risk of infection. There are conversations about increasing the priority of those who live with immunosuppressed individuals, however there’s currently no data on the extent to which COVID-19 vaccines can prevent transmission.
The vaccine will be distributed from Pfizer centres in Germany, Belgium and the USA. Approximately 50 hospitals across the country have been prepared to deliver the first of the vaccination programme. Specialist vaccination units in spaces such as conference centres are also being set up and some GPs and pharmacists may have access to vaccines, if they have the available cold storage facilities required to store the jab.
To find out more, head to BBC News.
30 November – Final results from Moderna confirm vaccine is 94% effective
The final results from Moderna’s vaccine trials have confirmed that their vaccine showed 94% efficacy against COVID-19, and nobody who received the vaccination developed a severe case of the virus.
The latest news has initiated an approval process with regulators around the world who will study the trial data for the vaccine and decide if the data on its safety and effectiveness are robust enough to be recommend for roll out.
The UK has now bought 7 million doses of the vaccine, which are expected to arrive in the UK in March. On top of that, the UK has pre-ordered 40 million of the Pfizer/BioNTech vaccine and 100 million of the AstraZeneca Oxford vaccine. Full trial data has not yet been released but you can read more about the Moderna vaccine at BBC News and The Guardian.
28 November – Extremely vulnerable given high priority for COVID-19 vaccine in UK
The provisional priority list published by Public Health England has listed people aged 18 years and over who are deemed “clinically extremely vulnerable” as the same priority as the over-70s to receive a COVID-19 vaccine.
People considered “clinically extremely vulnerable” are those who were asked to shield during the pandemic, and include:
- People with cancer who are undergoing active chemotherapy
- People with lung cancer who are undergoing radical radiotherapy
- People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- People having immunotherapy or other continuing antibody treatments for cancer
- People having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- People who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs
Although this prioritisation list is subject to further potential changes as the vaccine is still waiting approval from the Medicines and Healthcare products Regulatory Agency (MHRA), those considered “clinically extremely vulnerable” have now been placed in priority group 4 of 9. Based on these changes, the interim guidance, advised by the Joint Committee on Vaccination and Immunisation (JCVI), says the order of priority should be:
- Older adults in a care home and care home workers
- All those 80 years of age and over and health and social care workers
- All those 75 years of age and over
- All those 70 years of age and over and the clinically extremely vulnerable individuals, excluding pregnant women and those under 18 years of age
- All those 65 years of age and over
- Adults aged 18 to 65 years in an at-risk group
- All those aged 60 and over
- All those 55 and over
- All those aged 50 and over
23 November – Initial results of AstraZeneca-Oxford vaccine announced
The day’s big news was of results from clinical trials in Britain and Brazil of the vaccine led by drug company AstraZeneca and researchers in Oxford. The trials involved over 20,000 individuals and showed differing levels of protectivity depending on how the doses were administered (between 62 and 90%). Like all the recent results, these findings were announced in a press release and have not yet been independently verified.
COVID-19 vaccines in development
There are more than 300 vaccines in developments, many in the final stages of testing. The vaccines are all aiming to protect people against developing COVID-19, but they’re produced in different ways.
The main vaccines that have reported results so far are:
- The Pfizer-BioNTech vaccine: Contains a tiny fragment of the virus’s genetic code made in the lab – called RNA – that codes for a part of the virus called the ‘spike protein’, which sits on the outside of the virus. When the RNA is injected into the body it can instruct cells to produce these proteins, priming the immune system to be able to recognise and destroy the coronavirus, without exposing the body to the virus itself. This vaccine must be stored at -70°C.
- Moderna vaccine: Like the Pfizer-BioNTech vaccine, the Moderna vaccine contains RNA that codes for the virus’s spike protein. It can be stored at –20°C (normal freezer temperature) for up to 6 months.
- Oxford-AstraZeneca vaccine: Contains a weakened form of a harmless virus that usually causes the common cold in chimpanzees but doesn’t grow in humans. The virus has been modified to include the gene for the coronavirus spike protein protein. Injecting this virus aims to prime the immune system to attack without exposing the body to the full virus. The vaccine can be stored at fridge temperature.
The trials explicitly excluded people with a history of cancer apart from a few exceptions; those with localised prostate cancer (where the cancer is contained in the prostate and has not spread to anywhere else), non-melanoma skin cancer that has been treated, cervical carcinoma in situ (pre-cancer) that has been treated, or those with a low risk of either their cancer coming back, or spreading to other parts of the body.
So far, we haven’t seen any data about how effective the vaccine was in these people, nor how many were on the trials – we’ll be looking out for this information as it emerges.
The UK government has already pre-ordered 100 million doses of this vaccine.
23 November – Last trials of COVID-19 ‘antibody cocktail’ treatment begin
In addition to vaccine development, AstraZeneca have started large-scale trials of an “antibody cocktail” aimed at providing short-term protection to people with a weakened immune system, who would be unlikely to develop immunity after a vaccine. Antibodies form a key part of the immune system’s response to infection and it’s hoped that these antibodies developed in the lab will help the immune system to fight off the virus. AstraZeneca have described it as “almost like a passive vaccination.”
5,000 people around the world will be taking part in the trial of this treatment that scientists hope could give individuals immediate protection lasting up to 1 year. If successful, this may make up part of the UK’s wider COVID-19 treatment portfolio and be available to people whose immune systems are compromised.
Experts react to COVID-19 vaccine news
Like most of us, Cancer Research UK-funded experts have been following the news closely and have called the progress ‘exceptional’.
News of an effective COVID vaccine is great to hear. Having a vaccine will make the world safer, which means it will be safer for people with cancer too and it will become much easier for cancer treatments to continue.
We look forward to getting a better understanding of the best time to give the vaccine to cancer patients to give them the best level of protection.
– Martin Ledwick, Cancer Research UK’s head information nurse
Normal drug or vaccine development would take in the range of 5-10 years, sometimes much longer, so these developments have been extraordinary.
But experts have been keen to emphasise that the rapid turnaround of the COVID-19 vaccines isn’t because standards have dropped. In fact, the COVID-19 trials have involved more people than standard vaccine trials and have been able to draw on cutting-edge developments in technology and data analysis.
The extraordinary progress is in part because scientists, governments, industry and academic institutes around the world have turned their focus to this one goal. And to further accelerate development, different phases of vaccine trials and production have overlapped.
Finally, while the initial results are extremely promising, it’s early days yet. Preliminary data from one vaccine trial led by Pfizer suggested the vaccine offered 90% protection against developing COVID-19, whilst more recent data revealed the vaccine was 94% effective in over-65s. Initial reports from a second vaccine trial made by Moderna disclosed similar figures.
Experts expect more results – including important safety data – to materialise in the next 4 to 6 weeks. Vaccination will only be approved once it has passed the usual high standards set by the Medical and Healthcare products Regulatory Agency (MHRA) in the UK.
You can read more about the various COVID-19 vaccines in this piece by journalist Tom Chivers, who’s taking part in the Oxford-AstraZeneca vaccine trial.
What could a COVID-19 vaccine mean for people with cancer?
We’ll be following COVID-19 vaccine developments closely to help us understand a range of things including:
- Whether treatment could affect the timing of vaccination in people with cancer and when’s the best time to give people with cancer the vaccine to give them the best level of protection.
- If people with cancer could respond to the vaccine differently.
- Whether people with cancer will be protected by others being protected (known as ‘herd immunity’)
- When people with cancer will be offered the vaccine in the UK.
- How the different types of vaccine work.
Please comment below if there are any other questions you have about the vaccine.
At this early stage, there isn’t a huge amount of information about how effective the different vaccines are specifically for people with cancer.
Why may vaccines be less effective for some people with cancer? Cancer and its treatment can weaken the immune system, making it harder to fight infections like COVID-19. It can also affect the way someone’s immune system responds to a vaccine – altering how effective it may be in preventing or reducing the severity of an infection like COVID-19.
It should become clearer how the vaccine may work for people with cancer as full results from clinical trials begin to emerge.
Who’s taken part in COVID-19 vaccine trials?
We don’t have information on how many people living with cancer, or with a history of cancer, have been involved in COVID-19 vaccine trials so far. But some people with cancer have been able to take part in these trials, although who can take part varies from trial to trial.
For example, the earliest phase of the Pfizer trial involved healthy people aged 18 to 55 or 65 to 85. People with pre-existing conditions were able to take part as long as they didn’t require a significant change in therapy or hospitalisation for worsening disease in the 6 weeks prior to enrolment.
In later phases of the trial (phases 2 and 3) the lower age limit was reduced to 16 years old and individuals identified as being in a ‘high-risk’ group based on their use of public transport, being a frontline essential worker or other factors were included. Although people with cancer weren’t explicitly excluded from this list, those who are immunocompromised or receiving immunosuppressive therapy were not able to take part, and anyone taking part needed to have stable disease prior to enrolment.
For the late phase trials of the Oxford vaccine, anyone over the age of 18 who’s considered to be ‘medically stable’ – someone who’s not expected to be hospitalised or change their therapy less than 3 months before enrolment – could enrol in the trial. The criteria for the Oxford trial explicitly excludes anyone with a history of cancer, apart from a few cancer types, or those with a low risk of either their cancer coming back following curative treatment or spreading to other parts of the body.
Another vaccine that’s hit the news recently is the Moderna vaccine. Similar to the Oxford vaccine trial, medically stable people aged 18 or over were able to take part in the Moderna vaccine trials. However, those who are immunocompromised or have taken immunosuppressive treatments in the 6 months before the trial were not able to enrol.
Beyond vaccine trials, studies looking at how people with cancer’s immune systems respond to COVID-19 may also provide useful information on if the vaccine will be effective for people with specific types of cancer.
Who will be prioritised to receive the vaccine in the UK?
It’s vital that as vaccines begin to become available, there’s a clear approach to prioritise their use. This is particularly important as there won’t be enough doses available for everyone to be vaccinated initially.
Although at this stage there has been no formal prioritisation, interim advice from the Joint Committee on Vaccination and Immunisation (JCVI), published in September 2020, provide a provisional prioritisation list.
At the top of the list are older adults living in care homes and care home workers, followed by all those aged 80 and over as well as health and social care workers. Priority groups then follow in age order, in line with announcements made in the last week following initial vaccine trial results.
While the approach is largely age based, the prioritisation also includes ‘at risk’ adults, a broad term that will need clarifying. The JCVI – which advises UK health departments – acknowledge that some underlying health conditions may result in a higher risk of serious disease and death from COVID-19 infection, including some blood cancers.
There will likely be more information on the prioritisation criteria in the coming weeks as governments prepare for vaccine roll out – we will update as soon as it’s released.
Lilly, Katie, Angs and Lyndsy