{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:44:08Z","timestamp":1790163848640,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T00:00:00Z","timestamp":1719360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NCI SeroNET","award":["U54CA260560"],"award-info":[{"award-number":["U54CA260560"]}]},{"name":"Mount Sinai Biorepository and Pathology CoRE","award":["U54CA260560"],"award-info":[{"award-number":["U54CA260560"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>In patients with lung cancer (LC), understanding factors that impact the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike antibody (SAb) titers over time is critical, but challenging, due to evolving treatments, infections, vaccinations, and health status. The objective was to develop a time-dependent regression model elucidating individual contributions of factors influencing SAb levels in LC patients using a prospective, longitudinal, multi-institutional cohort study initiated in January 2021. The study evaluated 296 LC patients\u2014median age 69; 55% female; 50% stage IV. Blood samples were collected every three months to measure SAb levels using FDA-approved ELISA. Asymptomatic and unreported infections were documented through measurement of anti-nucleocapsid Ab levels (Meso Scale Discovery). Associations between clinical characteristics and titers were evaluated using a time-dependent linear regression model with a generalized estimating equation (GEE), considering time-independent variables (age, sex, ethnicity, smoking history, histology, and stage) and time-dependent variables (booster vaccinations, SARS-CoV-2 infections, cancer treatment, steroid use, and influenza vaccination). Significant time-dependent effects increasing titer levels were observed for prior SARS-CoV-2 infection (p &lt; 0.001) and vaccination\/boosters (p &lt; 0.001). Steroid use (p = 0.043) and chemotherapy (p = 0.033) reduced titer levels. Influenza vaccination was associated with increased SAb levels (p &lt; 0.001), independent of SARS-CoV-2 vaccine boosters. Prior smoking significantly decreased titers in females (p = 0.001). Age showed no association with titers. This GEE-based linear regression model unveiled the nuanced impact of multiple variables on patient anti-spike Ab levels over time. After controlling for the major influences of vaccine and SARS-CoV-2 infections, chemotherapy and steroid use were found to have negatively affected titers. Smoking in females significantly decreased titers. Surprisingly, influenza vaccinations were also significantly associated, likely indirectly, with improved SARS-CoV-2 titers.<\/jats:p>","DOI":"10.3390\/vaccines12070713","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T05:11:39Z","timestamp":1719465099000},"page":"713","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Time-Dependent Effects of Clinical Interventions on SARS-CoV-2 Immunity in Patients with Lung Cancer"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4750-3812","authenticated-orcid":false,"given":"Philip C.","family":"Mack","sequence":"first","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-2112","authenticated-orcid":false,"given":"Chih-Yuan","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Vanderbilt University, Nashville, TN 37235, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananda M.","family":"Rodilla","sequence":"additional","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6859-363X","authenticated-orcid":false,"given":"Jorge E.","family":"Gomez","sequence":"additional","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jazz","family":"Cagan","sequence":"additional","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6064","authenticated-orcid":false,"given":"Yuanhui","family":"Huang","sequence":"additional","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-7214","authenticated-orcid":false,"given":"Sooyun","family":"Tavolacci","sequence":"additional","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh M.","family":"Valanparambil","sequence":"additional","affiliation":[{"name":"Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA"},{"name":"Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Rohs","sequence":"additional","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittney","family":"Nichols","sequence":"additional","affiliation":[{"name":"GO2 Foundation for Lung Cancer, Washington, DC 20006, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9039-9275","authenticated-orcid":false,"given":"Juan Manuel","family":"Carre\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-9546","authenticated-orcid":false,"given":"Sheena","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Hamon Center for Therapeutic Oncology Research, Departments of Internal Medicine and Pharmacology UT Southwestern Medical Center, Dallas, TX 75235, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Rolfo","sequence":"additional","affiliation":[{"name":"Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7812-6741","authenticated-orcid":false,"given":"David E.","family":"Gerber","sequence":"additional","affiliation":[{"name":"Hamon Center for Therapeutic Oncology Research, Departments of Internal Medicine and Pharmacology UT Southwestern Medical Center, Dallas, TX 75235, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Moore","sequence":"additional","affiliation":[{"name":"LUNGevity Foundation, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"King","sequence":"additional","affiliation":[{"name":"GO2 Foundation for Lung Cancer, Washington, DC 20006, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafi","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA"},{"name":"Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7776-0767","authenticated-orcid":false,"given":"John D.","family":"Minna","sequence":"additional","affiliation":[{"name":"Hamon Center for Therapeutic Oncology Research, Departments of Internal Medicine and Pharmacology UT Southwestern Medical Center, Dallas, TX 75235, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Paul A.","family":"Bunn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Colorado Cancer Center, Denver, CO 80045, 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Shyr","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Vanderbilt University, Nashville, TN 37235, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/S1470-2045(20)30314-4","article-title":"COVID-19 in patients with thoracic malignancies (TERAVOLT): First results of an international, registry-based, cohort study","volume":"21","author":"Garassino","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1016\/S0140-6736(20)31173-9","article-title":"COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: A prospective cohort 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