NCCN Provides Major Update to COVID-19 Vaccination Recommendations – Inside Precision Medicine

Injecting Vaccine.
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The National Comprehensive Cancer Network (NCCN) released this morning significant revisions from its NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis to include recommendations on the recently-approved bivalent vaccines as well as how to protect children with cancer. The new, evidence-based, expert consensus-formulated summary on cancer and COVID-19 vaccination and prevention is available on the NCCN website.

“There is a lot to keep track of when it comes to keeping people with cancer safe from poor outcomes related to COVID-19,” said Robert W. Carlson, MD, CEO of NCCN in a press release announcing the update. “Our committee of leading experts meets frequently to examine all of the latest research and organizes it into a clear, one-stop source for people with cancer, their loved ones, and their health teams. We’ve expanded our committee for this latest update to include a focus on pediatric patients.”

Included in the recommendations are definition of what it means to be “immunocompromised” and how that can affect both eligibility for vaccine boosters and their scheduling. This guidance is categorized based on a patient’s tumor and/or treatment regimen as well as by the type of vaccine.

New information in the updated guidance includes:

  • Immunosuppressed people who have previously received a three-dose primary series and boosting through prior recommendations are now eligible to receive one of the bivalent boosters if they are 12-years-old or older for Pfizer, or at least 18-years-old for Moderna. This has been shown to improve immune response against Omicron strains in people with full immune system capacity. The committee supports this recent approval but cautions they are still awaiting data on bivalent booster effectiveness in immunocompromised people.
  • Moderna is the preferred mRNA vaccine for pediatric immunosuppressed patients ages six-months to 17-years.
  • Preliminary data shows myocarditis cases are very rare, although relatively more frequent in adolescent and young adult males 16-and-older.

“Protecting kids from harm is one of the most important things we can do. That’s why we recommend vaccination against COVID-19 for anyone over 6-months of age, especially infants, children, and adolescents who are immunocompromised,” noted committee co-leader Tina Q. Tan, MD, who is an infectious diseases physician at the Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern Medicine. “It is especially important for eligible household members and caregivers to make sure they are vaccinated as well, since immunocompromised children under age 12 or weighing less than 40kg are unable to receive monoclonal antibodies for protection.”

While these measures are important preventative steps for cancer patients, and young cancer patients, to help prevent contracting COVID-19, the NCCN committee recommends that cancer patients continue to wear masks, maintain social distancing, avoid crowds, and follow other non-pharmacologic recommendations for COVID-19 prevention after vaccination. These measures are necessary, NCCN said, because vaccine hesitancy has impeded the development of herd immunity, and this is a factor in community spread of COVID-19.

In addition to the new recommendations, the NCCN has reiterated earlier COVID-19 prevention advice such as:

  • Not recommending antibody testing, outside of a research study;
  • Recommending boosters for everyone with a hematologic malignancy regardless of whether they are in active treatment;
  • Preferring mRNA vaccination in most situations;
  • Endorsing the option of mix-and-matching the two mRNA vaccines;
  • Re-vaccinating after a patient undergoes hematopoietic cell transplantation or engineered cellular therapy (e.g. chimeric antigen receptor [CAR] T-cell therapy);
  • Vaccines are considered safe for people undergoing immunotherapy;
  • Vaccination status shouldn’t impact participation in clinical trials; and
  • Using monoclonal antibodies (tixagevimab plus cilgavimab) as prophylaxis (in addition to vaccination) in selected immunocompromised patients at risk for COVID-19 complications

An existing section labeled “Societal Considerations,” states: “It is imperative that all patients have equitable access to the vaccines.” The section features recommendations for the incorporation of social vulnerability awareness to help address health disparities, including tracking racial/ethnic and socioeconomic data for vaccine distribution wherever possible.

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