For those with cancer, the threat of serious illness from COVID-19 is often a major concern. Cancer treatments can weaken your body’s immune system, increasing your risk of a serious infection.
Immunotherapy is a type of cancer treatment that boosts and supports your immune system in responding against cancer. If you or a loved one is receiving immunotherapy treatment for cancer, you may have concerns about how the COVID vaccine may affect your immune system and your treatment.
This article will answer some common questions about immunotherapy cancer treatment and the COVID vaccines.
How does immunotherapy work?
Doctors use different types of immunotherapy drugs to treat different cancers. Each type of drug affects cancer cells differently. Your oncologist will discuss which type of immunotherapy treatment is best for your diagnosis. Types include:
- Monoclonal antibodies: These are molecules engineered in a laboratory to build a response against a specific disease. The monoclonal antibodies for cancer differ from those engineered to defend against or prevent COVID-19.
- Immune checkpoint inhibitors: These are drugs that block proteins that turn off your immune response. They allow white blood cells called T cells to find and attack cancer cells.
- Chimeric antigen receptor (CAR) T-cell therapy: This is a process that alters the genes inside your T cells. This helps them respond against cancer more effectively. Doctors often use CAR T-cell therapy to treat blood cancers such as leukemia, lymphoma, and multiple myeloma.
People with a weakened immune system due to cancer are at an increased risk for poor outcomes from COVID-19. No matter where you are in your treatment plan, vaccination can reduce your risk of developing severe COVID. Vaccination is important even for those with a robust immune system.
The National Comprehensive Cancer Network (NCCN) and the
- People getting a stem cell transplant should wait at least 3 months after treatment to get vaccinated.
- People getting CAR T-cell therapy or natural killer (NK) cell therapy should wait at least 3 months after treatment to get vaccinated.
- People with cancer who have major surgery should wait several days to 2 weeks after the procedure to get vaccinated.
Since they weaken the immune system, some cancer treatments reduce — but don’t eliminate — vaccine effectiveness. Even if you’re getting one or more of these treatments, you will gain some protection from the vaccine. Treatments include:
Vaccination combined with protective measures, such as wearing a mask and avoiding large crowds, provides you with more protection from COVID than you would have without them. For that reason, experts strongly recommend vaccination for people with cancer or a history of cancer.
But check with your oncologist first about when you should get vaccinated. If you are currently receiving treatment for cancer, it may be best to wait until your immune system recovers from treatment. This will give you the best chance of mounting a strong immune response.
Both the Pfizer BioNTech and the Moderna mRNA vaccines are appropriate for use in people who take immunotherapy drugs. Neither vaccine is known to be better than the other for this population.
A separate 2021 study noted that people with solid tumors who had the Pfizer vaccine had similar antibody levels to those without cancer 6 months after vaccination. In the subgroup of people on immunotherapy, about 87% still had antibodies, compared to about 84% of the control group.
If you cannot get or do not want either of these vaccines, you can also get the Johnson & Johnson (Janssen) vaccine.
Swelling in the lymph nodes under the arm on the same side as the injection site is a potential side effect of vaccination. While temporary, this can be concerning for people with breast cancer and other cancers.
Tenderness and swollen lymph nodes caused by vaccination should subside within a few days to a few weeks. Let a healthcare professional know if the swelling increases or does not go away within this timeframe.
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Some immunotherapy drugs, such as CAR T-cells, may
People with compromised immune systems may find it difficult to generate a robust response to the vaccine, no matter what type of cancer treatment they receive. This may be particularly true for people with blood cancers. For that reason, dosing protocols for
To date, no data indicate that the COVID vaccine reduces the effectiveness of immunotherapy medication. But there may be a
However, the impact of certain immunotherapy treatments on your immune system makes the timing of vaccination important. Talk with your oncologist about when you should schedule your vaccine.
People taking immunotherapy drugs should receive an additional primary dose of the vaccine if they have active cancer or are immunocompromised. You may fall into one of these categories if any of the following situations apply:
- You’re on CAR T-cell therapy.
- You’re taking high dose steroids to treat the side effects of immunotherapy drugs (or for any other reason).
- You’re getting cancer treatments such as chemotherapy in addition to immunotherapy.
- You started cancer treatment within 1 year of your first COVID vaccine dose.
- You’re newly diagnosed with cancer or have recurrent cancer, and receive or will receive cancer treatment.
- You have any type of hematologic (blood) cancer.
- You have an immunocompromising condition, such as HIV, in addition to cancer.
- You had an organ or stem cell transplant.
- You contracted SARS-CoV-2 and developed COVID-19 after getting two vaccine doses.
Yes. Getting COVID does not ensure you will not get it again. In fact, with ever-changing variants continually emerging, contracting the virus more than once has become commonplace.
If you’re on cancer treatments that cause you to be immunocompromised, it is vital to get vaccinated, even if you’ve already had COVID. Talk with your oncologist about when you should get vaccinated after having COVID-19.
If you have cancer, you may be more likely to experience serious complications from COVID-19. Cancer treatments, including certain immunotherapy drugs, may affect your scheduling for vaccination. Talk with your oncologist about when you should schedule your vaccines and how many doses you should get.