ABSTRACT
HypothesisCoronavirus disease 2019 (COVID-19) resulted in a 30% mortality rate in thoracic cancer patients. Given that cancer patients were excluded from serum anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccine registration trials, it is still unknown whether they would develop a protective anti-spike antibody response following vaccination. This prospective vaccine monitoring study primarily aimed to assess humoral responses to SARS-CoV2 vaccine in thoracic cancer patients. MethodsSARS-CoV2-spike antibodies were measured using Abbot ARCHITECT SARS-CoV-2 IgG immunoassay, prior to first injection of BNT162b2 mRNA vaccine, as well as at Week 4, and two-to-sixteen weeks after second vaccine dose. The factors associated with antibody response were analyzed. ResultsOverall, 306 patients, with a median age of 67.0 years (IQR=58-74), were vaccinated. Of these, 283 patients received two vaccine doses at 28-day intervals. After 4.7-month median follow-up, seven patients (2.3%) contracted proven symptomatic SARS-CoV-2 infection, with rapid favorable evolution. Of 269 serological results available beyond Day 14 post-second vaccine dose, 17 (6.3%) were still negative (<50 AU/mL) (arbitrary units/mL), while 34 (11%) were <300 AU/mL (12.5th percentile). In multivariate analysis, only age and chronic corticosteroid treatment were significantly associated with a lack of immunization. Thirty patients received a third vaccine dose, with only three patients showing persistent negative serology thereafter, whereas the others demonstrated clear seroconversion. ConclusionSARS-CoV2 vaccines were shown to be efficient in thoracic cancer patients, most of them being immunized after two doses. A third shot given to 1% of patients with persistent low antibody titers resulted in a 88% immunization rate.
Subject(s)
Neoplasms , Coronavirus Infections , COVID-19 , DiseaseABSTRACT
Background: Chest CT (CT) is the reference for assessing pulmonary injury in suspected or diagnosed COVID-19 with signs of clinical severity. We explored the role of lung ultrasonography (LU) in quickly assessing lung status in these patients. Methods: eChoVid is a multicentric study based on routinely collected data, conducted in 3 emergency units of Assistance Publique des Hopitaux de Paris (APHP); 107 patients were included between March 19, 2020 and April 01, 2020 and underwent LU, a short clinical assessment by 2 emergency physicians blinded to each other's and a CT. LU consisted of scoring lesions in 8 chest zones from 0 to 3, defining a severity global score (GS) ranging from 0 to 24. CT severity score ranged from 0 to 3 according to the extent of interstitial pneumonia signs. 48 patients underwent LU by both an expert and a newly trained physician. Findings: The GS showed good performance to predict CT severity assessment of COVID-19 as normal versus pathologic: AUC=0.93, maximal Youden index 1 with 95% sensitivity, and 83% specificity. Similar performance was found for CT assessment as normal or minimal versus moderate or severe (n=90): AUC 0.89, maximal Youden index 7 with 86% sensitivity, and 78% specificity. Good agreement was found for zone scoring assessed by new trainee (30mn theory + 30mn practice) and expert (n=14,14*8 checkpoints), weighted kappa 0.85-1; moderate agreement was found for new trainee (n=48, 30mn theory) and expert, kappa 0.62-0.81. Interpretation: GS score is a simple tool to assess lung damage severity in patients with suspected or diagnosed COVID-19. Comparing the performance of new trainees and expert physicians opens a path for adoption beyond the scope of experts. LU is a good candidate for patients triage, especially in case of CT availability issues.