New Guidance for People with Cancer and 3rd mRNA COVID-19 Vaccination

The National Comprehensive Cancer Network® (NCCN®) announced significant updates to the NCCN: Cancer and COVID-19 Vaccination guidance today. This is the fourth version of NCCN’s COVID-19 vaccination guide.

Published on August 30, 2021, the new version incorporates the latest data plus recent approvals from the U.S. FDA and CDC regarding a third mRNA vaccine dose for immunocompromised people.

The update highlights timing recommendations from the CDC that people wait at least four weeks between second and third doses. In addition, cancer patients who develop COVID-19 despite initial vaccination should wait until they have documented clearance of the virus before their third vaccination.

According to the NCCN clinical recommendations, the following groups of people should be considered eligible for a third dose of the mRNA COVID-19 vaccine:

• Patients with solid tumors (either new or recurring) receiving treatment within one 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 (e.g., CAR T-cells), especially within the past two years
• Any recipients of allogeneic SCT on immunosuppressive therapy or with a history of graft-versus-host disease (GvHD) regardless of the time of transplant
• Anyone with an additional immunosuppressive condition (e.g., HIV) or being treated with immunosuppressive agents unrelated to their cancer therapy

“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,” commented Robert W. Carlson, M.D., CEO, 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.”

Furthermore, according to the panel, people living in the same household with immunocompromised individuals should also get a third dose once it is available.

The NCCN committee also 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.

“When it comes to people’s safety, we have to take every precaution,” added Steve Pergam, M.D., MPH, Associate Professor, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center and Infection Prevention Director at Seattle Cancer Care Alliance, Co-leader of the NCCN COVID-19 Vaccination Advisory Committee. 

“That means even after the 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 non-medical version intended for patients and caregivers; that guidance will be updated in the days ahead to include information about the third dose.

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. Cancer care providers worldwide have used the recommendations to make management decisions during the COVID-19 pandemic based on all available evidence plus expert consensus.

Based in Plymouth Meeting, PA, the NCCN is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education.