What Cancer Patients Need to Know About COVID-19 Vaccines
Welcome to this bonus episode of Our MBC Life. We are pleased to again highlight a program from our parent non-profit SHARE Cancer Support. We are less than 2 weeks away from Season 2. The premiere episode will drop on March 1. While we do that, we hope you catch up on any episodes you missed from Season 1.
Our MBC Life is a part of the metastatic breast cancer program at SHARE Cancer Support. SHARE has many programs to support women living with MBC including the Talk METS Helpline, several virtual support groups, and educational and wellness programs. We are thrilled to highlight another important program presented by SHARE a few weeks ago. For many of us living with cancer there are numerous questions about COVID-19, the vaccines, and what we need to know to best take care of ourselves. How do we know if the vaccine is effective for cancer patients if we were not included in the trials? Can I continue my treatment while getting the vaccine? What about certain types of chemo and reactions? Should I get the vaccine if I’ve already had Covid? What about my immune system, am I at greater risk?
On February 11 SHARE invited Dr. Joshua Hill from Fred Hutchinson Research Center to discuss the COVID-19 Vaccine in relation to cancer patients and their treatment.
LINKS AND RESOURCES MENTIONED IN THE EPISODE:
Can mRNA vaccines be used in cancer care?
Understanding and Explaining mRNA COVID-19 Vaccines
Lipid nanoparticles in COVID-19 vaccine
The immune system and the antibody response
Difference Between mRNA Vaccine and Traditional Vaccine
COVID-19 Racial and Ethnic Health Disparities
Patients in Cancer Remission at High Risk for Severe COVID-19 Illness
Coronavirus (COVID-19) and cancer
COVID-19 Vaccines
Johnson & Johnson Adenovirus-Based Viral Vector Vaccine
AstraZeneca-Oxford Adenovirus-Based Vaccine
Novavax Recombinant Nanoparticle Vaccine
Sanofi/GSK Protein-based Recombinant Vaccine
OVERVIEW
00:01:30 - Introductions. (Jump to section)
00:03:25- General Remarks about COVID-19 vaccines. (Jump to section)
00:11:36 - Q1. Does each person receive the same dose of vaccine or is it personalized in some way? (Jump to section)
00:12:40 - Q2. Does a strong reaction to the vaccine mean that you have a stronger immune response? (Jump to section)
00:13:56 - Q3. Can you get coronavirus from vaccine? Do these vaccines have traces of SARS and HIV among heavy metals that can weaken a patient who has cancer? (Jump to section)
00:17:19 - Q4. Can the genetic code that's part of this vaccine somehow affect your own DNA or your own genetics? (Jump to section)
00:18:36 - Q5. How long before or after undergoing an invasive procedure should one wait to get vaccinated? (Jump to section)
00:19:48 - Q6. Is there a white cell count you should have before taking the vaccine? (Jump to section)
00:20:46 - Q7. If you have had the virus already, should you take the vaccine? (Jump to section)
00:22:00 - Q8a. Is the second vaccine exactly the same as the first one? (Jump to section)
00:22:00 - Q8b. Can you mix and match vaccines? (Jump to section)
00 -23:05 Q9. Is it okay to get a second vaccine earlier than recommended? (Jump to section)
00:24:00 - Q10. Why does COVID-19 seem to have a more detrimental effect on certain populations? (Jump to section)
00:26:28 - Q11. Why should I, as a cancer patient, get the COVID-19 vaccine? What are some of the pros and what are some of the cons? (Jump to section)
00:29:19- Q12. How long should I wait after the vaccination before resuming any cancer related treatment? (Jump to section)
00:30:38 - Q13. Do you know if there's anything about these vaccines that would encourage cancer to grow or spread? (Jump to section)
00:32:17 - Q14. Is there a risk in taking the vaccine for a person that has a compromised immune system due to chemotherapy? (Jump to section)
00:33:42 - Q15. Should or could cancer patients get the vaccine while they are in active treatment? (Jump to section)
00:35:00 - Q 16. How might COVID vaccine affect your underlying cancer? Do the components of this vaccine interact with cancer? (Jump to section)
00:36:08 - Q17. Why aren't high risk patients who are under 65 being prioritized? (Jump to section)
00:38:27 - Q18. Is it true that people who had allergic reactions to Taxol or Taxotere should not get the vaccine? (Jump to section)
00:39:52 - Q19. How long does immunity last after having the vaccines? (Jump to section)
00:41:00 - Q20. Is there any cancer research that is being done to use mRNA technology to treat cancer? (Jump to section)
00:41:52 - Q21. What is the effect of the COVID-19 vaccine on cancer patients on PARP inhibitors? (Jump to section)
0042:11 - Q22. Is it ok for people who have egg and dairy allergies get a COVID vaccine? (Jump to section)
00:42:49 - Q23. What happens when antibodies start to wane? (Jump to section)
00:44:07 - Q24. Is the vaccine recommended for people undergoing immunotherapy treatment for cancer? (Jump to section)
00:45:07 - Q25. Do we know what groups are at higher risk for severe illness from COVID-19? And do we know what some of those long-term serious complications associated with COVID-19 are? (Jump to section)
00:47:14 - Q26. When do you achieve the maximum immune response after the second vaccine? How long before the vaccine becomes most effective? (Jump to section)
00:48:04 - Q27. Can you take Tylenol or any general pain reliever after the vaccination, if you're experiencing side effects?? (Jump to section)
00:49:04 - Q28. Must you get the vaccine in your arm? Can you get it anywhere else? (Jump to section)
00:49:59 - Q29. Why have these vaccines not been FDA approved yet? (Jump to section)
Dominique Bethea:
Hello everyone. I am Dominique Bethea. I'm the Outreach Manager here at SHARE. I would like to introduce our speaker. Dr. Joshua Hill is an Assistant Professor at Fred Hutch and the University of Washington. His research program is focused on clinical and translational studies to improve preventative and treatment strategies for infections in patients receiving transplantations and CAR T cell therapies. Dr. Hill trained in transplant, infectious diseases at Fred Hutch and epidemiology/biostatistics at the Harvard School of Public Health. He serves as an Attending Physician on the Immunocompromised Host Infectious Diseases service at the Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, and University of Washington Medical Center. Dr. Hill, please take it away.
Joshua Hill, M.D.:
Thanks so much. I appreciate the introduction and thanks again to SHARE and all the work that you do to support your community in these efforts and an educational outreach like this. So it's my absolute pleasure and privilege to have the opportunity to spend an hour with you all today to talk a little bit about what we know about the COVID-19 vaccines that are currently available, and the ones that are in the pipeline, and how to think about it from the perspective of being a cancer patient, whether you have an active cancer that's being treated now, or whether you've been treated one year ago or even 10 or 20 years ago. So I'm happy to talk about these different issues and questions as they come up. This will mainly be a session in which we're focusing on questions from the community and from the people that are listening here.
Joshua Hill, M.D.:
So I think the first big disclaimer to make in this conversation is that we basically have no data right now about the specific vaccines that are available for COVID-19 in patients with cancer from the clinical trials that have been done having an active cancer or an active condition that required therapies that suppress your immune system.
Those were exclusion criteria for the clinical trial, because we really wanted to initially understand how these vaccines work in a broader more healthy population. So that's just the nature of how these trials were done. So we really don't know what the vaccine responses look like in cancer patients. That being said,
we have lots of data about lots of other vaccines in cancer patients. And we've been doing this for decades now. So we've got a lot of other data from other contexts that we can use to understand it and have a pretty good sense of what this would look like in patients with cancer, whether they've previously had cancer or getting therapy right now.
What I'll be talking about today is based on what we've learned in other contexts, so maybe briefly set the stage here, talk about what's currently available. What you might be hearing about from within your community or from your physicians, is that there are two vaccines that were given an Emergency Use Approval by the FDA, which means they've made it available, but it's not officially formally FDA approved yet at this time, but they are being made available for people to get vaccinated.
One of the vaccines is made by a company called Moderna, we're calling it the Moderna vaccine. And the other vaccine is by a company named Pfizer, which we'll call the Pfizer vaccine. So those are the two vaccines that you could get access to, and some of you may have already been vaccinated with. Those are the vaccines that are currently being rolled out.
And so what's interesting about these two vaccines is first of all, the first two that have been approved now are actually extremely similar in the nature of what type of vaccine they are and the specific way that they work. But what's also unique about them is that there are no other commercially approved vaccines for anything else that work just like these vaccines.
So they're unique in the way that they work, but they're also very similar to each other. So that's kind of interesting. These two vaccines are what we call mRNA vaccine. That stands for messenger RNA. RNA is a component of our cellular makeup, kind of like our DNA, that is used to encode different proteins.
And so what these vaccines are, is essentially a small piece of genetic code that codes specifically for a part of the Coronavirus that we're being exposed to right now. So it encodes a specific part of it that is good to stimulate our immune system to generate an immune response to, so that if we ever see the actual infectious complete virus, we would already have an immune response that's able to protect us from it. So specifically the way that these vaccines work is, that this genetic code that makes this part of the virus protein, is put inside of a little, what's called lipid capsule. It's kind of like a drop of oil that protects that genetic code that is given to you and into your arm intramuscularly. It's taken up by cells in that location because that little oil droplet or lipid particle on the outside of it, lets it bind and release that mRNA into the cell. And then your own cells will actually read that genetic code, make that one specific protein from the virus, which your cells sense as foreign or something that shouldn't be there.
So they present that to the immune system, which then starts an antibody response. Normal other vaccines that were typically given, just give you the protein directly from whether it's tetanus or measles or mumps that specifically you get parts of the virus or a whole virus, and then your immune system response to that.
In this case, we're giving the code to make a part of the virus and then you respond to it. So it cuts a step out of the process there. So both of the vaccines work that way. One important thing to know about it is that messenger RNA once it's released into your cell, it's very short-lived, it's rapidly broken up by enzymes within the body. So there's no way that it can linger. It doesn't integrate, it doesn't affect your own DNA in any way, shape or form . It's quickly destroyed by the cells, so there's no residual toxins or anything like that left over by this.
There's really absolutely no way that this could affect your own DNA or your own genes or anything like that. That's an important thing to understand. So both vaccines are given in two different doses, so there's your initial dose and then a booster dose.
There's no real magic in how they came up with those numbers other than what we know from other vaccines. And so the Pfizer vaccine is given a second dose three weeks after the first. The Moderna vaccine is given four weeks after the first. I know that there's been some vaccine shortages and delays around the country and getting access.
So if your second shot for some reason is delayed, that's okay. I don't think that that would reduce your immune response at all. The key is to wait at least three to four weeks in between vaccines, but anything after that is still going to work just fine. So I don't have any concerns if you're delayed by a day or a week, or two to three weeks, or whatever it might be in between vaccine doses. So that should all be fine whenever you can get it. And then, obviously, the big questions are -- when do we give this to people who might have active cancer and might be getting chemotherapy. We don't know, if you're on a certain types of chemotherapy that suppresses your immune system, it might also suppress your ability to make a very strong antibody response.
So it might lower the total number of antibodies that you have in your system. How much it lowers that and how this varies by different types of chemotherapy, different types of cancers, that stuff that we're all working out now, as these vaccines are given to more patients with cancer. Those studies are ongoing and that's an important thing for us to know, but we know from other vaccines that the majority of people will still respond,
Most people will have some response. And then it's just a matter of how big that response is. And even if you don't have a full response, you're still likely to benefit from this vaccine. So it's similar to the flu vaccine.
We always give the annual influenza vaccine to all of our patients undergoing cancer. We always offer it and encourage people to get it because even if you don't have a complete response, we know that even a little bit of response can prevent you from getting sicker. If you actually still get the flu, despite getting the vaccine, we know that people that got the vaccine have less severity of symptoms and overall have better outcomes.
So even if you don't have a huge robust response, like a normal healthy person might, there's still a lot of potential benefit from getting this vaccine. There are lots of other vaccines that are in the pipeline.
The next one that's going to the FDA for consideration is a vaccine made by Johnson & Johnson. It has a similar type of mechanism or approach. And then there's a variety of other vaccines that are in different stages as well. And really just to say it upfront from a high level, whatever vaccine you can get access to, I would get it and would take it basically whenever you can. Our understanding of this vaccine is that we don't think you would have any more side effects than anyone else that's been studied so far. So I don't think, having cancer or getting chemotherapy, changes the side effect profile of the vaccine.
So we think, it would be just as safe in someone with cancer as someone without cancer. We recommend getting it, and there are recent guidelines that have come out from different professional organizations that suggest that to do this. The exact timing of either between chemotherapy cycles or right before chemotherapy cycle, we really don't know, and we wish we had enough data and flexibility to make those specific decisions. But for now , we're recommending that you get the vaccine whenever you can. And there's no reason to think that one of the vaccines will be better for you than another.
So whatever vaccine is available and offered, is a reasonable option. That's a lot of information there upfront. I thought I would just address some of the big questions that are out there then I'd be happy to have Dominique take us through some of the other questions that we've received.
Dominique Bethea:
Thank you doctor Hill for that, that answers a lot of the questions that we did have, but we have so many other good questions. So, I would like to start with the question. Does each person receive the same dose of vaccine or is it personalized in some way, say by weight, gender age?
Joshua Hill, M.D.:
Yeah, no, that's a great question right now. It's standardized. So the vaccines that are out there, Moderna and Phizer are currently approved for adults aged 18 and older, even as young as 16 have been studied in the trials.
And the dose is standardized regardless of your weight or your gender or your underlying conditions. So that is all standardized. There are trials going on right now in pediatric patients and children. And likely the dose will be lower there. There are some medications that we do as weight-based medications. Typically for vaccines that isn't done.
So right now it is a standard dose.
Dominique Bethea:
Great. Another question and something also that I have heard going around. Does a strong reaction to the vaccine, for example, having a high fever, headache, fatigue mean that you have a stronger immune response?
Joshua Hill, M.D.:
Yeah. That's a great question.
And I don't think I have specific data to answer that. The intuitive answer to that is yes. We think that if you're having a response like that, it means that your body is having a good immune response. So that's clearly a sign that the vaccine is being active and naturally one would think that that means that you're having a good antibody response. Whether or not that's entirely true, I don't know. But if you were getting vaccinated with something that your immune system didn't respond to at all, you wouldn't be expected to have any symptoms. If I injected you with just saline or just water or something like that you wouldn't have symptoms like that. So typically, that means you're having a good antibody response.
That's not something that you should necessarily rely on, but I think it's safe to assume that most people that get the vaccine are going to have a response regardless of whether you have symptoms or not. And so the flip side of that is, if you're not having any symptoms and you feel totally fine, I wouldn't be concerned that that means, that it didn't work for you.
Dominique Bethea:
Okay. Great. Another question that a person wrote, "I have read that these vaccines can have traces of SARS and HIV among heavy metals that can weaken a patient who has cancer."
Joshua Hill, M.D.:
Yeah, thanks for bringing up that question. I think that's a really important one that we should talk about and address.
And so this is a concern and a question that's been around in the online articles and in various media and press. That's been around for decades for any number of different vaccines that have been developed. And what I can categorically say upfront, for this vaccine and for all other vaccines that are in circulation right now is, that that's not the case.
And so there is no component of HIV in any way, shape or form that's involved in any step of any process here for the manufacturer of any of these vaccines, so that I can definitively take off the table, and that's the case for all vaccines. So there's no usage of HIV or parts of HIV in any of these vaccines.
So that certainly is not a concern for this vaccine. Typically, the FDA for most products that are released, requires screening for things like this and requires all of those tests to be negative.
Hopefully, you can take that to heart and feel reassured by that. The question about whether there's any SARS in this vaccine. If by SARS you mean the name of the coronavirus that we're talking about here, so, no, there's not. There's the genetic code that's used that will produce one part of the SARS virus, essentially. But I think, what the question is getting at, can you get infected with coronavirus from this vaccine? And the answer to that also is no.
So there are some vaccines we use that are with live viruses. For instance, the measles vaccine is a live virus. And so we don't recommend that vaccine in patients that have a compromised immune system and suppressed immune system, or who are getting chemotherapy or who live with someone getting chemotherapy.
So that is true for certain live virus vaccines. This vaccine that we're talking about right now, again, it was just a single protein that cannot cause infection. So you can't get infected by it and you can't give it to anyone, which is great. The other vaccines that are coming out, are also just components or pieces of the virus that are not infectious.
There may be some trials out there of some live, but attenuated, meaning that there is reduced infectivity of the virus as part of the vaccine. I'm not aware of any of those though. So that's not something that I would be concerned about at this point. And then the other question about the heavy metals or trace metals that are potentially in the product formulation. And that's again something that's been highly scrutinized over the decades and has really been looked at very carefully by the FDA and different regulatory bodies. And those have been removed from all currently licensed vaccines that are out there for other pathogens as well.
And certainly from these specific formulations, there are no heavy metals that could in any way, shape or form affect you. And again, we're talking about such tiny doses of two vaccines that are given, that the exposure is minuscule and there aren't those types of materials that would have any negative health effects.
So those are all really important questions and sometimes it's hard to sort out what's true and what's not from things that we see online or in the media. I just would like to reassure everyone that I would not have those concerns with this vaccines.
Dominique Bethea:
Okay. This next question that we have kind of leads into it.
Someone is asking. Is a COVID vaccination able to trigger genes such as late onset Parkinson's or other types of genes like that?
Joshua Hill, M.D.:
Yeah. And so I briefly touched on this earlier in my introductory comments about this. More broadly, the question is, can the small genetic code that's part of this vaccine somehow affect your own DNA or your own genetics, or how your body turns on or off certain genes that could potentially trigger something or worse than an underlying condition? As I mentioned, it gets quickly destroyed within cells, so it doesn't persist. It doesn't actually interact at all with our DNA in our cells in our body. It's really just read by different machinery. So it doesn't engage or interact with our own DNA in any way. So there's no reason to think that it would affect expression of genes or other parts of our own genetic code or DNA to prompt or trigger or affect any sort of underlying diseases.
So yeah, my answer to that would be no.
Dominique Bethea:
The next question we have is - how long before or after undergoing an invasive procedure should one wait to get vaccinated?
Joshua Hill, M.D.:
Yeah, that's a great question, because life goes on, and we have lots of other things happening. And so the general recommendation here is, if you're going to have surgery or some other major procedure, give yourself a few days on either end, either before or after you get the vaccine.
And mainly that's because you might have some side effects from the vaccine. You could have a low grade fever or you could feel poorly. And so we just don't want to have that complicate your ability to go and get your procedure done or interpreting whether there's complications from the procedure.
So I would just give a window of about 72 hours on either end of that, either before or after, just to avoid kind of knowing what's what, and what's contributing to different symptoms that you might be having. So that's one comment. And then as far as other vaccines that you might need, or that might come up, the general recommendation here is to wait two weeks before getting another vaccine.
Dominique Bethea:
Okay, great. Another question. Is there a white cell count you should have before taking the vaccine?
Joshua Hill, M.D.:
Right. And that's a million dollar question there, that we would like to know - at what point is your immune system thought to be ready to respond to this vaccine or not?
And as I mentioned, unfortunately, we don't have that level of detailed knowledge yet with this vaccine because it really hasn't been given to people that have low white blood cell counts. What I can say is that your total white blood cell count is not a great predictor of whether or not you'll respond to any given vaccine.
And I think that'll be the same case with this. It's more of a marker of your overall kind of immune function, but it really doesn't predict very well. So even if you have a low white blood cell count, you might have a perfectly normal response to this vaccine. And we see that for our cancer patients with other vaccines, we don't have a threshold below, which we say -- you can't get it.
So I don't think you necessarily need to worry about that. Our current recommendation is to take it anyway, regardless of what your white blood cell count is.
Dominique Bethea:
Okay, great. Now we have another million dollar question here. If you have had the virus already, should you take the vaccine?
Joshua Hill, M.D.:
Yeah, that's a great question. And that's an important one. And the answer to that is yes. And that's definitely the guidance that we're giving to our patients and to the community. You should still get the vaccine. We're saying to wait about three months or so to get the vaccine, if you've been previously infected.
But the reason for that is because of what we've actually seen. We can potentially improve upon nature, which is amazing, in that this vaccine can actually give you a better response then the natural infection can. That's important because we've seen now, as we've cared for more and more patients, that people can get re-infected.
It has been well documented that people can develop it again, whether it's from a new strain or the same strain. That's being described now more and more. And so I would encourage people to still get the vaccine, even if you've previously been infected because that will boost your response and give you additional protection, especially if there are new strains or other variants that are coming through. So I think that's still something that's important to do.
Dominique Bethea:
Okay, great. Another question we have. Is the second vaccine exactly the same as the first one, same components, same amount of serum. Is everything the same? If they are the same can you mix and match vaccines?
Joshua Hill, M.D.:
Everything's the same. And so for both vaccines right now. It's basically like a flu shot. It's actually a little bit less volume than you get with one flu shot. The needle and everything is all the same. And it feels about the same when you get it. I can tell you that from experience, I've had both of my vaccines as well, and I did just fine with nothing, but a little bit of a sore shoulder for a day, and that went away. The formulations are the same at both doses, so that doesn't differ. And one question that's been coming up is whether or not you can mix and match vaccines, let's say that you got your first dose of the Moderna vaccine, but for whatever reason, can't get the second dose, and so then can you supplement that with the Pfizer vaccine? And that's something that we're not recommending. The studies haven't been done that way, we really don't know what that would do so that I would not recommend, I would wait until you can get finished the series with the same type of vaccine that you got the first time.
Dominique Bethea:
Okay. We have another great question. Someone says you had stated that it is okay to receive the second dose later than what is recommended. Is it okay to get it earlier?
Joshua Hill, M.D.:
Yeah, good question and no, it's not recommended to get it earlier. So I would definitely wait the minimum duration of at least three weeks for the Pfizer and four weeks for the Moderna. I would wait that amount of time to establish the types of immune cells that are needed to really get that good boost. And so I would recommend waiting the full amount of time. Look, if you're a day early, for some reason or two days early, I think there's no real magic there.
And that's not a big concern, if for whatever reason it needs to be scheduled that way. But ideally, wait around three to four weeks before getting each of those vaccines, as you're needed by the type of vaccine that you got. So I would err on the side of later than earlier.
Dominique Bethea:
Okay,great. Thank you. So for our next question we're going to change course a little. Someone posed the question. Why does COVID-19 seem to have a more detrimental effect on certain populations?
Joshua Hill, M.D.:
Yeah, that's a big question and a complicated one. That's got a lot of different components to it, but a really important one that we need to think carefully about.
We have seen that there are disparities in who is getting affected by COVID-19 and outcomes, and how people are doing after getting infected with COVID-19. So we are seeing that in certain communities and groups whether by socioeconomic status or by race, we do see differences in how people are doing.
And lots of factors go into play there. Part of it is based on the types of work that people do and whether or not they're able to socially distance and whether or not they're able to work remotely. So I think that's an important one. Part of it is based on how people's family structures, and whether you live in multi-generational households and your ability to isolate. And that's something that's not always so easy. It's easy for us to say, stay home. Don't see people. Isolate. But in reality, that's not possible for everyone. And we absolutely recognize that. And that's unfortunate that there isn't more equity there and what we see across our society.
So that's a big part of it. And unfortunately, we also see disparities in the burden of comorbidities, of underlying conditions. Certain communities have higher rates of high blood pressure or diabetes and different other conditions. There's complicated reasons for that.
If you do get COVID in that context, you can have worse outcomes. We know there are issues with access to primary care and to preventative care, to just the healthcare system in general. There are disparities there as well. So some people that are getting COVID-19 might present later, whether that's due to cultural reasons or really just to access to care that's available. Presenting later and getting less aggressive care upfront is contributing to this too.
If there's a silver lining at all from COVID-19, it's that it has brought these issues the forefront in a way that, perhaps, it wasn't, or maybe it wasn't as visceral in the past.
And so I think this [COVID-19] has really forced us to understand more and be more aggressive in the policies that we make in this country and access to care. So a little bit of a long-winded answer for a complicated question, but those are some
Dominique Bethea:
Thank you. Thank you. It's a very loaded question and I want to thank everyone. So the next question. Why should I, as a cancer patient, get the COVID-19 vaccine? What are some of the pros and what are some of the cons?
Joshua Hill, M.D.:
And that's probably something I should have addressed upfront. We have lots of data and lots of studies that have been done now on people who have cancer and who get COVID-19. There are more complications and that's not just the case for COVID-19, it's not unique to COVID-19, we know that cancer patients have an increased risk of infection. That's my clinical practice and my research, and what I do every day throughout the Cancer Center. And that's why there are dedicated infectious disease physicians at cancer centers, because we deal with a lot of infections in our patients because your immune systems are lowered by the types of therapy that you get. So patients with cancer are at increased risk for having more symptoms, higher rates of hospitalization. If you get COVID-19, it's possible that you can get infected with the virus more easily as well, just because you have less ability to fight it off from the outset, plus you've got to leave the house more to access medical care. So perhaps, there are more opportunities for exposure as well. To me, it's clear that if you get COVID-19 and you're a cancer patient , there's an increased chance that you could have complications. We know that in some cancer patients there's a higher chance that you've got other underlying conditions that might be related to the chemotherapy that you got, that maybe affected your kidneys or other problems. Because of that cancer patients should be prioritized for getting the COVID-19 vaccine.
And this is an argument that we've been making to the CDC. We've written editorials about this and are really pushing to bump the priority of patients with cancer if you don't meet some of the other metrics to get earlier access to the vaccine, because we think, this is a high risk characteristic.
And so you should qualify to get this vaccine earlier to reduce the chances that you have complications. So I really don't see any downsides to it. I think the vaccines are safe. I think they're effective, and I think they will be in cancer patients as well. it's a bias perspective. It's not really biased because this is driven by what we've seen in the data, it is based on what we've observed. So I would recommend that patients do get it. I don't think there's really any downside. There's a lot to be gained, a lot of upside. The one other comment that I'll make. You should really be focused on getting your immediate family or your immediate bubble of people vaccinated as well.
So if your care providers, if your family members, if your spouse or your kids can get access to the vaccine, that's critical because they hopefully will also have good responses to the vaccine and then really build that bubble of protection around you. So the more that you can do that, the better.
So I think that's an important piece.
Dominique Bethea:
Wow. Thank you so much. Thank you for answering all these questions. We have another question here. How long should I wait after the vaccination before resuming any cancer related treatment?
Joshua Hill, M.D.:
I would say for that, that your cancer therapies are the priority. That's what you really need to be focused on. And so I don't think you need to delay. We don't have evidence that says that if you delay a week or two weeks or three weeks, that you're going to have a better response to this vaccine.
If you're practicing all the appropriate public health measures of not going out unless you have to, wearing your mask when you're out, social distancing and really just doing all the bread and butter things to prevent your exposure. That's the most important piece here and that's already going to reduce your risk.
Plus if you got the vaccine, that's an added layer of protection, but, of course, you need to continue doing all these kind of distancing and mask wearing and hygiene things that we're already doing. So getting the vaccine does not take that off the table. So if you're doing all of those things, ultimately your risk of getting virus and having a complication are extremely low.
I would not put your cancer therapy on hold or alter your cycle or your schedule at all because of the vaccine. Keep the rest of your healthcare maintenance in place and get the vaccine when we can.
Dominique Bethea:
Okay. It's another question, but it ties in. Do you know if there's anything about these vaccines that would encourage cancer to grow or spread?
Joshua Hill, M.D.:
Yeah, that's an important question that lots of people are worried about and similar to some of the other comments I've made about the type of vaccine and the fact that it's got this messenger RNA, this genetic code. As I mentioned, it's unique, it's novel. We don't have other vaccines like this. It opens up this whole other kind of concerns and questions about you're giving me RNA, or DNA and genetic code.
It's scarier than it sounds, because it really is something that's rapidly degraded by enzymes within your body and it's recognized ultimately as foreign, it gets broken down. The reason that the Pfizer vaccine and the Moderna vaccines (I'm sure many people have heard that they're very unstable), have to be frozen at the really ultralow cold temperatures. They can only be stored for 10 days. The Modernas may be more stable, but that's because even when they're in this lipid nanoparticle, this kind of oil droplet, which is what allows them to persist, they're very unstable. And the second they come out of that and are in your body, their lifespans are literally seconds.
So that's why they have to maintain them in these ultralow kind of cold conditions because it's a very unstable product. So it's not something that we think would in any way interact with your underlying cancer or if you've previously had a history of cancer. There's no reason to think it would be more likely for it to recur because of that.
Dominique Bethea:
Okay, great. Is there a risk in taking the vaccine for a person that has a compromised immune system due to chemotherapy?
Joshua Hill, M.D.:
Great. Thanks for that question. The vaccines that we avoid in that context, are the live vaccines or the live attenuated vaccines that are alive, but slightly reduced in their infectivity.
And those are things like the measles, mumps, rubella vaccine. Some of the shingles or chicken pox vaccines in the past have been like that. This vaccine is not live in any way. So there are no concerns about that. It doesn't increase your risk in any way, which is good. Many people are really excited about
this type of vaccine. This mRNA vaccine, by having it approved for COVID-19, has really opened the door for using this type of vaccine for lots of other preventable infections and, perhaps, replace some of our other vaccines, that we've had for a long time, with this type of technology. It's thought to be one of the safest out there because you can't get infected from it.
It's rapidly destroyed within your body and it seems to be very effective. We think that this is one of the safest vaccine platforms that we've ever had. The proof will be in the pudding. It's still early days. We've vaccinated lots of people feel very comfortable about the safety, but we still need to learn more about it. But I don't think there's any concerns if you're highly immunocompromised.
Dominique Bethea:
Okay. There seems to be a lot of confusion about whether cancer patients could and should get the vaccine while they are in active treatment.
Can you clarify just a little bit more about being an active treatment and the vaccine?
Joshua Hill, M.D.:
Yeah, I wish I could. So what I would say is that it depends on an individual scenario. So if you are on a cycle of chemotherapy, that's going to take a break for a few months for instance, and you've got a few more weeks left, what I would recommend there, is probably wait until your cycle is done and then get it after you've recovered your white blood cell counts or whatever, a few weeks out from your chemotherapy. If you're going to finish all of your chemotherapy for good in the next few weeks or a month, it might make sense then just to wait until you're done and then go and get your vaccine, if you have that sort of flexibility. If you're off and on and in between cycles we really don't know whether you're going to have less of a response, if you get it during your chemo or after your chemo, I think that's really splitting hairs. And again, I would just get this as soon as you can.
The sooner you got the better, is my kind of perspective on that. So if it makes sense and there's a clear scenario of which you're going to be done soon, and you can wait and get it, that makes sense. But otherwise I would just get it.
Dominique Bethea:
So for our next question, we're getting a little more specific. Is it true that the COVID vaccines contain ingredients that may attach to solid tumors? And what is the effect on dormant cancer?
Joshua Hill, M.D.:
Yeah, we addressed this question a little bit in a prior question about how this might affect your underlying cancer. Do the components of this vaccine interact with cancer?
They're injected in this lipid particle, which is a nonspecific particle that lets the vaccine particles bind to any cell. So it could bind to a tumor cell if it was to happen to get into a tumor cell or to attach for whatever reason to a tumor cell, rev up that activity or amplify that cells replication to make the cancer worse or metastasize. So there really are no concerns about that. There are some theoretical ideas that it could go there, but we don't think that there's any clinical implications of that at all. So no, I would say we really don't have any concerns about that and are fully recommending this vaccine to people with solid tumors, with blood cancers and other types.
Dominique Bethea:
Why aren't high risk patients who are under 65 being prioritized? or is it personalized in some way, say by weight, gender age?
Joshua Hill, M.D.:
Yeah. The priority has been a very hot topic and it's been a challenging thing for everyone to navigate.
And even within the states this is being done differently. I don't know if that question is entirely accurate. It just depends on where you are in the rest. If you've got high-risk features and you're above 65, you check two of the boxes, you've got a high risk characteristic and you've got the age risk factor,
So certainly it makes sense to be vaccinating those individuals upfront. But at least in our state, and I think this is also according to the CDC phases, if you are younger than 65, but you have two or more high risk characteristics, cancer is certainly one of them, you should be in a priority group to get this vaccine and where you are advocating and making noise to the powers that be that if you have cancer, regardless of any other comorbidities, you should be prioritized into a high risk group. We will do the best that we can to get that into the hands of the policy makers and to get that enacted, but most places with a cancer diagnosis even if you're younger, you should be able to get some priority access. That's something we're continuing to advocate for.
Dominique Bethea:
Okay. So for our next question, is it true that people who had allergic reactions to Taxol or Taxotere should not get the vaccine?
Joshua Hill, M.D.:
Yeah. So those are two types of chemotherapy that are commonly used in some of the breast or ovarian or uterine cancers.
And no, I don't think that there's a reason not to get this vaccine. If you happen to have had an adverse reaction or an allergic reaction to one of those chemotherapies, there is a subtle distinction between an allergic reaction or a side effect that might not necessarily be an allergic or an immune related reaction to the medication.
Specific immune related reactions to those medications is really quite rare. But I don't think that there's any specific overlap in the components of those chemotherapeutic agents and what's in this drug to make me concerned that you would be any higher risk for developing an allergic reaction.
So I think the benefits outweigh any small theoretical risks there.
Dominique Bethea:
Okay. Another question that we have, how long does immunity last after having the vaccines?
Joshua Hill, M.D.:
I think that question is actively being investigated. These vaccines have not been around for very long, so you can kind of count on one or two hands,
the number of months when the first person got one of these vaccines. It was not that long ago. So that's a question that we really don't know the answer to yet, but I think as time goes on, we'll start to understand that. With influenza virus, for instance, the influenza vaccines, we typically see immunity lasting for six to nine months, and then it starts to fade a little bit.
And that's why we re-boost on an annual basis. The expectation here with the coronavirus vaccine is that it'll likely be at least that good, at least 6-12 months or 6-9 months, in that range. And perhaps, we'll have to boost this on an annual basis. We're hoping that it might turn out that it's going to be every three years and this might be affected by how fast the virus is mutating.
If it does change, whether the current vaccines will fully protect against new strains of the virus or not. So it's a combination of how long your own immunity lasts and what's going on with the viruses that are in circulation. For now, we think that at least 6 months to 12 months, you should have good antibody responses to the vaccine that you got and hopefully more.
Dominique Bethea:
Okay, wonderful. Is there any cancer research that is being done to use mRNA technology to treat cancer?
Joshua Hill, M.D.:
Yeah, that's a really great and interesting question. So, the mRNA vaccine technology, although this is the first approval for use more broadly in the population, it’s not a new technology.
It's been around for many years. for at least 5 to 10 years and probably longer that we've been using mRNA approaches similar to this for different studies. So it's been used in vaccines for other infections, like more obscure viral infections, like dengue fever and malaria. So we've done these vaccine studies. Nothing's approved, but it's been shown to be safe in those contexts too.
So there is a history of safety in other contexts using these types of vaccines and in the cancer field. There are mRNA vaccines that have been used to directly target cancer. So that is true. And that's an informed question from whoever posed that, and there's nothing that's commercially approved, but it is something that's been shown to be effective.
So we'll see how that unfolds. But that's a good question.
Dominique Bethea:
Okay, great. Thank you. So we have a few questions about the vaccine and PARP inhibitors. The first question is. What is the effect of the COVID-19 vaccine on cancer patients on PARP inhibitors? The second part of the question was if the PARP inhibitor does effectively change the DNA, is it safe to add the vaccine that will affect my RNA?
Joshua Hill, M.D.:
Yeah. That's a pretty specific question to that specific type of medication that prevents cells from repairing their DNA caused by natural problems with the DNA. So it promotes cell death in the cancer cells, which is what you want to happen. I don't think that that would have any interaction with this specific vaccine. If anything, the other chemotherapies that you're getting in combination with a drug like that, might just reduce your immune system a bit and maybe you wouldn't have as strong of a response to the vaccine, but I don't have any particular concerns there beyond kind of the general things that we're talking about.
And just to reiterate there that this vaccine should not affect your DNA or RNA in any way.
Dominique Bethea:
Okay. We had several questions about allergic reactions, to milk, eggs, et cetera.
Joshua Hill, M.D.:
Influenza vaccines are classically grown in an egg containing products.
And so there's been concerns in the past. Although we typically don't have an issue given the flu vaccine. Even if you have an egg allergy now, we still recommend it If you're in a higher risk group. This product, and that the beauty of the mRNA vaccines, is that they're not grown in anything, they're synthetically made for the specific kind of product.
And there are fewer components of the vaccine, so there aren't egg products or dairy or milk products in this. So there's no concern there
Dominique Bethea:
Okay. So our next question is.
If you have an antibody response for 6 to 12 months that then declines, wouldn't your B cells be trained to fight it?
Joshua Hill, M.D.:
Yeah, it's a good question. I think what that individual is getting at is there's been a lot of media coverage about antibodies waning, or antibodies going down early after someone got infected or early after a vaccine.
That's totally normal and expected and not a sign that immunity is waning. Hopefully the right voices are getting out there to push back and say, we expect to see antibodies go down. That's actually something totally normal in biology. So that's how it works. You initially get a high response that comes down and plateaus out.
But the way that the immune system works is that you make these things called memory B cells that are circulating in your system and in your lymph nodes. And when you get re-exposed, if you got re-infected, those would rapidly be able to boost the number of antibodies that you have. So yeah, those memory B cells are expected to persist and even if your antibodies go down and can’t even be detected, there's the possibility that those B cells rapidly respond and protect you. So that's why getting this vaccine is important and it will generate those memory B cells. So that's a good point.
Dominique Bethea:
Okay, great. The next question we had is in regards to immunotherapy . Is the vaccine recommended for people undergoing immunotherapy treatment for cancer?
Joshua Hill, M.D.:
Yes, it is. Immunotherapy kind of implies a specific type of cancer therapy using different types of drugs that might rev up your immune system, or giving you T-cells and other things to treat your cancer. There have been concerns in the past with so many immunotherapies that your immune system's already revved up and if you give a vaccine, can that boost it even more and lead to some kind of auto-immune type of symptoms? Again, we don't know, it hasn't been given to people receiving immunotherapies, but we've studied other vaccines in that kind of context, and there hasn't really been a big concern that it increases the risk of having side effects from the immunotherapy.
So we are recommending it to patients getting immunotherapy as well, and I don't have particular reason to be concerned there.
Hello, World!
Dominique Bethea:
Do we know what groups are at higher risk for severe illness from COVID-19? And do we know what some of those long-term serious complications associated with COVID-19 are?
Joshua Hill, M.D.:
We do. And we've really learned a lot over the past year here. And we've learned very clearly what the high risk conditions are. Not to say that just because you fall into one of those categories, you're going to have a complication, because that's not true. But the way that the CDC has worked, some of the priority schedules is really based on getting vaccines into people that do have those high risk features. So we know that age above 65 is a risk factor, but there are plenty of people that are 70, 80, 90 years old who have done just fine. We know that having heart disease, lung disease, kidney disease are definitely risk factors.
Having a suppressed immune system is a risk factor. So these are some of the main risk factors that are having more complications. I still just want to reassure people here that we're only seeing about 10% or so of people in that high risk group who require hospitalization. And if you do happen to be unfortunate enough to have more severe symptoms and land in the hospital, the chance that someone dies from COVID among those people is also relatively low. So we've come a long way in being able to support people. We have new tools in our tool belt, so that's all good. And one of the great things that we found with almost all of the vaccine studies that have been out there, that even if you are one of the people that got infected despite getting the vaccine, almost none of those people have required hospitalization.
So basically this vaccine has turned this deadly virus into something that might just be like the common cold. So the key point is that, even if you still get infected despite getting the vaccine, it's still very important because it significantly reduces the chance that you have any complications from it.
So that's really key.
Dominique Bethea:
Well we have just a few more minutes left, so I'm going to try to get those last few questions in. How long before the vaccine is the most effective?
Joshua Hill, M.D.:
I saw that question pop up here on the sidebar and was going to try to work that in. I think that's an important one to answer. So the trials have shown that really about a week after your second dose is when you achieve that maximum kind of immune response that then persists and that's how those trials were really designed.
So about a week after you've gotten that second vaccine dose in, you are considered to be as protected as you're going to be. So that's good. You should continue doing all of those standard measures of mask wearing and social distancing and physical distancing, but about a week after that second vaccine dose, when you hit that peak.
Dominique Bethea:
Okay. And our next question, any concerns about taking Tylenol or any general pain reliever after the second vaccine, if you're experiencing side effects?
Joshua Hill, M.D.:
Yeah, great question. And that's a really important one and relevant one. So don't be afraid to treat those side effects if you've got them.
If you're feeling really poorly after you get that second vaccine or the first vaccine for that matter, because that can happen after the first, just because you have problems after the first doesn't mean you're going to have symptoms after the second and vice versa. But if you have symptoms of fever or, you're just not feeling well, it's okay to take Tylenol.
We're recommending that people do not take Tylenol beforehand trying to prevent that from happening. That theoretically could reduce your response to the vaccine. That hasn't been definitively shown for this or for other vaccines. But really what we are saying, if you happen to develop some side effects afterwards, it's okay to treat that with ibuprofen, Tylenol, et cetera.
Dominique Bethea:
Must you get the vaccine in your arm? Can you get it perhaps in your stomach. Women should not get the vaccine in the arm that had their lymph nodes removed. It's a concern.
Joshua Hill, M.D.:
Yeah, that's a great concern, especially for this forum and this group. I think that's not uncommon for breast cancer patients to have lymph nodes that have been affected, taken out or biopsy. So I would recommend that you avoid the side where that was done. If it was done on both arms or on both sides, I think you can get this vaccine anywhere. I don't know if the stomach's necessarily the right place to do it. You could probably do it in a thigh or in the buttocks is possible as well. So there's no magic to where it goes in necessarily. And it makes sense to avoid a side that you've had lymph node resections performed on.
Dominique Bethea:
Okay. And someone is asking why have these vaccines not been FDA approved yet?
Joshua Hill, M.D.:
Yeah, that's a good question. Extremely rigorous metrics have to be met in order to get final approval. And so some of the data that was brought to them was still not fully finalized and there was some longer-term follow-up that I believe the FDA wants to see and they want to see longer-term follow-up for side effects and for outcome. So I think they're waiting on additional data. Sometimes the FDA likes to see two trials that show benefit, but here, a final approval is expected. And I think it's a matter of doing the full on formal analysis of safety and efficacy. I think there's still just getting all the data together, but there was certainly enough there to make us confident in recommending this to move forward.
And, there was representation from our institution and from colleagues of mine that were on that FDA review committee. So I feel very comfortable and confident in their conclusions to make these available as a vaccine for the population at large.
Dominique Bethea:
Thank you doctor Hill for that, that answers a lot of the questions that we did have, but we have so many other good questions. So, I would like to start with the question. Does each person receive the same dose of vaccine or is it personalized in some way, say by weight, gender age?
Joshua Hill, M.D.:
Yeah, no, that's a great question right now. It's standardized. So the vaccines that are out there, Moderna and Phizer are currently approved for adults aged 18 and older, even as young as 16 have been studied in the trials.
And the dose is standardized regardless of your weight or your gender or your underlying conditions. So that is all standardized. There are trials going on right now in pediatric patients and children. And likely the dose will be lower there. There are some medications that we do as weight-based medications. Typically for vaccines that isn't done.
So right now it is a standard dose.
Dominique Bethea:
Okay. Wonderful. Dr. Hill , I want to thank you so much.
It was a very informative program and you answered all the questions
Joshua Hill, M.D.:
Thanks so much everyone for the great questions and your attention. And hopefully this was helpful.
