Today, the National Comprehensive Cancer Network® (NCCN®) announced significant updates to the NCCN: Cancer and COVID-19 Vaccination guidance. This is the fourth version of NCCN’s COVID-19 vaccination guide and incorporates the latest data plus recent approvals from the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) regarding a third mRNA vaccine dose for immunocompromised people. The updated guidance is available for free at NCCN.org/covid-19.
The NCCN COVID-19 Vaccination Advisory Committee comprises multidisciplinary physicians from across NCCN’s Member Institutions, with particular expertise in infectious diseases, vaccine development and delivery, cancer management, and medical ethics. The recommendations have been used by cancer care providers around the world to make management decisions during the COVID-19 pandemic based on all available evidence plus expert consensus.
Robert W. Carlson, MD
“COVID-19 can be very dangerous, especially for people living with cancer, which is why we’re so grateful for safe and effective vaccines that are saving lives,” said Robert W. Carlson, MD, Chief Executive Officer of NCCN. “Our organization exists to improve the lives of people with cancer; we have a long track record for making recommendations that improve quality and length of life. We want our patients to live the longest and best lives possible, which means following the science on vaccination and mask-wearing.”
Recommendations
According to the NCCN recommendations, the following groups should be considered eligible for a third dose of the mRNA COVID-19 vaccine right away based on the latest FDA/CDC decisions:
- Patients with solid tumors (either new or recurring) receiving treatment within 1 year of their initial vaccine dose, regardless of their type of cancer therapy
- Patients with active hematologic malignancies regardless of whether they are currently receiving cancer therapy
- Anyone who received a stem cell transplant (SCT) or engineered cellular therapy, especially within the past 2 years
- Any recipients of allogeneic SCT on immunosuppressive therapy or with a history of graft-vs-host disease, regardless of the time of transplant
- Anyone with an additional immunosuppressive condition or being treated with immunosuppressive agents unrelated to their cancer therapy.
The update highlights timing recommendations from the CDC that people wait at least 4 weeks between second and third doses. Patients who develop COVID-19 despite initial vaccination should wait until they have documented clearance of the virus before their third dose.
People living in the same household with immunocompromised individuals should also get a third dose once it is available to them, according to the panel. The committee points out that it’s best to get the same type of vaccine as the first two doses, but a different mRNA vaccine is also acceptable. The guidance includes a preference for immunocompromised individuals to try to receive their third dose in a health-care delivery setting—rather than a pharmacy or public vaccination clinic—whenever possible, in order to limit their risk of exposure to the general population.
Steve Pergam, MD, MPH
“When it comes to people’s safety, we have to take every precaution,” said Steve Pergam, MD, MPH, Associate Professor in the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center, Infection Prevention Director at Seattle Cancer Care Alliance, and co-leader of the NCCN COVID-19 Vaccination Advisory Committee. “That means even after a third dose of vaccine, we still recommend immunocompromised people—such as those undergoing cancer treatment—continue to be cautious, wear masks, and avoid large group gatherings, particularly around those who are unvaccinated. All of us should do our part to reduce the spread of COVID-19 and get vaccinated to protect those around us from preventable suffering.”
The recommendations from the NCCN COVID-19 Vaccination Advisory Committee are intended for clinicians and other health system workers. The organization also publishes a nonmedical version intended for patients and caregivers; that guidance will be updated in the days ahead to also include information about a third dose.
