COVID-19 united the scientific world in seeking to understand the disease and finding means to treat and prevent it. Vaccines were developed and tested—thanks to ongoing work with similar viruses—in record time.

One group of especially vulnerable people could not take part in clinical trials for the vaccines: patients with cancer. Many cancer treatments leave patients with a weakened immune system, as do some cancers. These patients faced many questions about the impact of COVID-19 and the COVID-19 vaccines on their bodies.

"Many of us will adjust to the new normal," says Jane Figueiredo, PhD, associate professor of Medicine and director of Community and Population Health Research at the Samuel Oschin Comprehensive Cancer Institute "We'll get booster vaccines at a certain frequency, and our immune systems will be primed to fight off new variants. But patients with cancer may be unable to fight off serious infection due to their disease or the treatments they receive, and they remain at risk."

Figueiredo is a co-principal investigator on the Coronavirus Risk Associations and Longitudinal Evaluation (CORALE) study at Cedars-Sinai. The work is funded by a five-year, $8.3 million grant from the National Cancer Institute (NCI) to study diversity and other factors that influence the immune response to SARS-CoV-2, the virus that causes COVID-19. Cedars-Sinai is part of NCI's Serological Science Network (SeroNet), a collaboration of 25 universities, cancer centers and laboratories studying immunology and COVID-19—and one of the largest efforts of its type.

Figueiredo, at the request of NCI's acting director, shared progress and findings from the team's first two years to SeroNet's advisory committee. 

Jane Figueiredo: After nearly two years of collaborative work, we have several major accomplishments. We've established a large cohort of patients with cancer—nearly 800—and have systematically collected surveys and blood samples to measure their antibody responses to SARS-CoV-2 infection and vaccination. We've also contributed to the global scientific literature on the immune responses to SARS-CoV-2 in patients with cancer who are undergoing active treatment. We and others have reported that antibody responses to vaccination in cancer patients depend on the type of vaccine they get, the type of tumor they have and the type of treatment they are receiving. Understanding how to best tailor the timing of vaccination with respect to anti-cancer therapies may be helpful to ensure a cancer patient has a robust immune response that will continue to protect them.

JF: Highly immuno-compromised people were prioritized when vaccines were rolled out—that's why seniors and people with certain health conditions were eligible to be vaccinated before other populations. Since none of the initial Phase III vaccine clinical trials included patients with cancer, there was initially a lack of clarity on potential side effects and immune responses for that group. Some patients with cancer delayed or refused vaccination, while others may have received multiple vaccine doses.

Data from our study, and others like it, emerged quickly, which was important to reassure patients that the available vaccines were safe for people with cancer. However, we did find that antibody levels after vaccination were low in people with hematologic malignancies, such as leukemia and lymphoma, and in some individuals receiving specific therapies. The vaccines seemed less effective in these patients compared to healthy individuals. Right now, we're studying the underlying immune responses in cells after vaccination and risk of long COVID in immuno-compromised populations.

Read: What Did COVID-19 Teach Us for the Next Pandemic?

JF: The lessons learned through the SeroNet research program and the infrastructure it's developing can help inform preparedness and response for emerging diseases around the world. In the coming months, the COVID-19 pandemic will no doubt continue to rapidly change, both biologically with emergence of new variants and medically with development of new vaccines, variations in attitudes toward vaccines, uptake of vaccines across different populations and new antiviral agents. SeroNet represents an ambitious effort to coordinate the study of this infection in real time and track these factors as they evolve. We're building a framework for epidemiologic and immunologic study of this virus on a national and international scale, and the networks we're creating will help us track, study and address future pandemic threats. 

In addition, our studies have established critically important early benchmarks for tracking immune responses—both to the virus that causes COVID-19 and to vaccination—and how those immune responses evolve over time. All of these findings, and the networks we're creating, will be invaluable any time another powerful virus emerges.

JF: The pandemic affected every single one of us. Whether we have personally been sick or not, it's changed our daily lives in so many ways. Cancer also fundamentally changes countless aspects of a person's life. There are numerous questions we still need to answer about the effects of viral exposure and disease recovery on cancer patients—what it means for their outcomes, how they respond to treatment and their quality of life. We still have much to learn about the impact of isolation, stress, financial worries and possible delays in treatment due to infection or other factors on cancer patients. We will focus on these questions in our continuing work.