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.
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