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Patients with cancer can be immunocompromised from chemotherapy, corticosteroids, or the cancer itself, which may affect cellular and\/or humoral responses to vaccination. PD-1 is expressed on T effector cells, T follicular helper cells and B cells, leading us to hypothesize that anti-PD-1 immunotherapies may augment antibody or T cell generation after vaccination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Antibodies to the SARS-CoV-2 receptor binding domain (RBD) and spike protein were assessed in patients with cancer (n=118) and healthy donors (HD, n=22) after 1, 2 or 3 mRNA vaccine doses. CD4<jats:sup>+<\/jats:sup>and CD8<jats:sup>+<\/jats:sup>T cell reactivity to wild-type (WT) or B.1.617.2 (delta) spike peptides was measured by intracellular cytokine staining.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Oncology patients without prior COVID-19 infections receiving immunotherapy (n=36), chemotherapy (n=15), chemoimmunotherapy (n=6), endocrine or targeted therapies (n=6) and those not on active treatment (n=26) had similar RBD and Spike IgG antibody titers to HDs after two vaccinations. Contrary to our hypothesis, PD-1 blockade did not augment antibody titers or T cell responses. Patients receiving B-cell directed therapies (n=14) including anti-CD20 antibodies and multiple myeloma therapies had decreased antibody titers, and 9\/14 of these patients were seronegative for RBD antibodies. No differences were observed in WT spike-reactive CD4<jats:sup>+<\/jats:sup>and CD8<jats:sup>+<\/jats:sup>T cell generation between treatment groups. 11\/13 evaluable patients seronegative for RBD had a detectable WT spike-reactive CD4<jats:sup>+<\/jats:sup>T cell response. T cells cross-reactive against the B.1.617.2 variant spike peptides were detected in 31\/59 participants. Two patients with prior immune checkpoint inhibitor-related adrenal insufficiency had symptomatic hypoadrenalism after vaccination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>COVID-19 vaccinations are safe and immunogenic in patients with solid tumors, who developed similar antibody and T cell responses compared with HDs. Patients on B-cell directed therapies may fail to generate RBD antibodies after vaccination and should be considered for prophylactic antibody treatments. Many seronegative patients do develop a T cell response, which may have an anti-viral effect. Patients with pre-existing adrenal insufficiency may need to take stress dose steroids during vaccination to avoid adrenal crisis.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jitc-2022-004766","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T15:58:58Z","timestamp":1655913538000},"page":"e004766","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Antibody and T cell responses to COVID-19 vaccination in patients receiving anticancer therapies"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7248-847X","authenticated-orcid":false,"given":"Sherin Juliet","family":"Rouhani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9214-7576","authenticated-orcid":false,"given":"Jovian","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8902-7661","authenticated-orcid":false,"given":"Daniel","family":"Olson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Zha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apameh","family":"Pezeshk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Cabanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athalia R","family":"Pyzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Trujillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4070-1819","authenticated-orcid":false,"given":"Benjamin A","family":"Derman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"O'Donnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Jakubowiak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedy L","family":"Kindler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Bestvina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas F","family":"Gajewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"key":"2022062208551583000_10.6.e004766.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2034577"},{"key":"2022062208551583000_10.6.e004766.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2035389"},{"key":"2022062208551583000_10.6.e004766.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2101544"},{"key":"2022062208551583000_10.6.e004766.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31187-9"},{"key":"2022062208551583000_10.6.e004766.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30314-4"},{"key":"2022062208551583000_10.6.e004766.6","doi-asserted-by":"publisher","DOI":"10.1016\/J.CELL.2020.09.037"},{"key":"2022062208551583000_10.6.e004766.7","article-title":"Rapid generation of neutralizing antibody responses in COVID-19 patients","volume":"1","author":"Suthar","year":"2020","journal-title":"Cell Rep Med"},{"key":"2022062208551583000_10.6.e004766.8","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1056\/NEJMoa2022483","article-title":"An mRNA Vaccine against SARS-CoV-2 - 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