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Dr. Tian Zhang is a medical oncologist at the Duke Cancer Institute. She is a 2019 KCA Young Investigator Award recipient and has contributed to the “Ask the Experts” resource about COVID-19 and kidney cancer.

UPDATED information about Moderna’s COVID-19 vaccine below.

Nearly 10 months after the COVID-19 pandemic became a major public health threat, hopes for a vaccine are now a reality.

On December 11, the US FDA issued the first emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine, a two-dose vaccine for the prevention of COVID-19 in people aged 16 and older.

Although this vaccine has not specifically been tested in populations of people with cancer, at Duke we would advise people with cancer to undergo vaccination when a vaccine is available, as long as patients have not had prior allergic reactions to components of the vaccine, per the FDA label. These components are:

  • mRNA
  • lipids
  • potassium chloride (KCl)
  • monobasic potassium phosphate
  • sodium chloride (NaCl or table salt)
  • dibasic sodium phosphate
  • sucrose

Given the high community transmission of COVID-19 and the potential for severe cases and death, the benefits of the vaccine likely outweigh the risks.

Patients with kidney cancer (especially those whose cancer has spread to other organs) will often be taking targeted treatments or immunotherapies. From our current knowledge, we do not think that these treatments will have any impact on those patients’ reactions to this new COVID-19 vaccine. As long as a vaccine is being offered and is not otherwise contraindicated (see allergic reactions to the components above), patients with kidney cancer are still good candidates to receive the COVID-19 vaccine and protect themselves from developing this potentially severe and deadly infection.

“The vaccine prompts your immune system to produce antibodies, which helps protect you if the real virus enters your system later”

The Pfizer-BioNTech COVID-19 vaccine contains a type of modified messenger RNA (mRNA) that codes for a protein present in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. The vaccine prompts your immune system to produce antibodies when they spot that SARS-CoV-2 protein, which helps protect you if the real virus enters your system later.

There is a common misconception that the mRNA component of the vaccine could be integrated into the human genome. This is scientifically not possible for several reasons:

  1. mRNA is transient,
  2. the carrier lipid nanoparticle of the vaccine is degradable,
  3. humans do not have the enzyme required (called reverse transcriptase) to incorporate the mRNA sequence into the human genome.

The FDA’s emergency authorization was based on a trial, published this month in the New England Journal of Medicine, in which 37,706 patients were given two doses of either the vaccine or a salt water placebo. Among the people given the placebo, 169 out of 18,708 (0.9%) of them developed a COVID-19 infection. Among people who received two doses of the vaccine, nine out of 18,559 (0.05%) developed a COVID-19 infection. Therefore, the vaccine has an efficacy of 94.6%.

This is a powerful number. A 94.6% vaccine efficacy means that people who get a vaccine have a 94.6% reduced chance of disease compared with people who aren’t vaccinated.

It’s important to note, though, that someone who is vaccinated can still harbor virus and pass it to others. And some people can’t or won’t be vaccinated. That’s why it’s important to protect yourself and others by continuing to wear masks, avoid crowded areas and large gatherings, and practice good hygiene.

There were some side effects from the vaccine including injection site pain, redness, or swelling, tiredness and achiness, fever, feeling unwell, and swollen lymph nodes. But overall, the vaccine was well tolerated and researchers will continue to follow the trial participants for a few years to see what the long-term effects might be.

The COVID-19 pandemic has been an immense challenge for everyone, including for my patients and my colleagues in healthcare. But the speed and efficacy of this first COVID-19 vaccine is a triumph of science. And there are more COVID-19 vaccines on the horizon that look to be very effective too. I’m hopeful we will soon be on the other side of this pandemic.

Stay well and safe!

UPDATE (12/21/20): The FDA issued another emergency use authorization on December 18 for a second COVID-19 vaccine, this one made by Moderna. Like the Pfizer vaccine, the Moderna vaccine should be appropriate for use in people with solid organ cancers, including kidney cancer, unless they are allergic to the vaccine components.

Moderna’s phase III clinical trial of 30,351 people showed their vaccine had a 94.1% efficacy – that means it prevented 94.1% of trial participants who received the vaccine from developing COVID-19. There were 11 cases of COVID-19 in people who received the vaccine compared to 185 cases of COVID-19 in people who received the placebo. Common side effects from the Moderna vaccine included injection site pain, fatigue, feeling unwell, body ache, and headache. But, like the Pfizer vaccine, the Moderna vaccine was overall well tolerated.

Like the Pfizer vaccine, the Moderna vaccine uses mRNA that codes for distinctive SARS-CoV-2 proteins that help the body develop a protective immune response for COVID-19 and is administered in two doses. The dosing regimen is slightly longer, at two doses administered 28 days apart, compared with Pfizer’s regimen (two doses administered 21 days apart). And while the Pfizer vaccine is approved for people 16 and older, the Moderna vaccine is approved for people 18 and older. Moderna’s vaccine needs to be stored cold (at -4 degrees Celsius), but not as cold as Pfizer’s vaccine (at -70 degrees Celsius), and can be ordered in 100-dose batches (compared to Pfizer’s which is ordered in 975-dose batches), both of which may make distribution easier.

It is important to note that these vaccines are given intramuscularly and therefore will generate antibodies called IgG, a subtype that goes throughout the body but is not the prevalent form on the mucosal surfaces in the nasal passage and airways, where IgA subtype of antibodies is needed. Therefore, people who receive the vaccines may not develop symptomatic COVID-19 but may still harbor and transmit the virus. We are still urging everyone to continue social distancing and masking.

6 thoughts on “What the first COVID-19 vaccine means for patients”

  1. Well written for even us simpleton from Bowling Green, OH! Mrs. Dunn tagged you, and this is a great piece for anyone, done with a tone of calmness & surety.

    1. Hi Pat! Thanks so much, I’m very glad it’s helpful for you and friends in BG! Take care and stay safe out there.
      Happy Holidays,
      Tian

  2. What about those who had a kidney removed from Kidney Cancer but now has stage 3 kidney disease in the other kidney?

    1. Thanks for your message! This from Dr. Zhang:

      In general, patients with a single kidney who have decreased renal function should not have impaired immune function. They should also be able to receive the COVID-19 vaccines. If in doubt, you should check with your urologist or oncologist for their medical recommendation that’s more specific to your medical situation.
      Thanks,
      TZ

  3. Happy New Year Dr. Tian,
    I am the director of the Judy Nicholson Kidney Cancer Foundation in Jacksonville, FL. I would very much like to share this article with our support groups, if I can have your permission. It was very well written and understandable. Thank you!

    Please let me know your thoughts on sharing this article. You can look our foundation up on JNFKidneycancer.org if you would like to check us out.

    Have a wonderful day!

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