Vaccinations and boosters
But even as public health efforts end, patients can take their own steps to protect themselves.
Hutch clinical researcher and infectious disease expert Dr. Catherine Liu said, first and foremost, individuals who are vulnerable should make sure they get all necessary vaccinations.
“Some of the patients in our cancer center haven’t gotten their boosters,” she said in a recent Science Says event. “For immunocompromised individuals, we’re recommending three doses of the primary series and a fourth dose as a booster.”
This advice echoes the Centers for Disease Control and Prevention which revised their guidelines in early February. According to new guidance, “people who are moderately or severely immunocompromised should receive a booster dose at least three months after the last (third) dose of an mRNA COVID-19 vaccine.” Previous guidelines called for a five-month break between the last dose and the booster.
“I’ve taken every shot,” said Ben Young, a 67-year-old prostate cancer survivor and liver transplant recipient who takes immunosuppressing drugs each day to ensure his body doesn’t reject the organ. “I had my third and now I’m getting ready to do my fourth. It was recommended by the transplant clinic.”
Young, who lives in Everett, Wash., and works as the director of marketing and grants for the Communities of Color Coalition, said when it comes to people being considerate of his compromised health, “Some are and others aren’t.”
Is he bothered by the very vocal anti-maskers, anti-vaxxers or others who believe their freedoms are being trampled by state or federal mandates?
“I don’t want to get caught up in that exceptionalism,” he said. “I want others to treat me as if they’re treating themselves. If they do that, then I’m good. I’m going to protect myself and if I see it’s a bad situation — or close to a bad situation — I’m going to stay away.”
Preventive therapies for the vulnerable
In addition to vaccines and boosters, new options are becoming available.
New York educator Edie Miller, diagnosed with a slow-growing lymphoma in 2012, went through months of chemotherapy when her disease became aggressive last summer.
“I’ve barely left my house except for hospital visits,” she said. “The COVID death rate for people like me is about 15%.”
Fortunately, Miller’s fragile health qualified her for a prophylactic long-acting monoclonal antibody combo called Evusheld, specifically designed for moderate or severely immunocompromised people.
“I got a call from my oncologist's office on a Sunday evening that they had 120 doses and I happily got the injections,” said the 61-year-old, who is fully vaccinated. “One in each cheek! I go for a follow-up dose in 6 months. They told me it boosts my Covid immunity by up to 77%.”
Infectious disease expert Liu encouraged other vulnerable patients to ask about the drug, which is intended for those who have not been exposed to or have COVID-19.
“It reduces the risk of developing symptomatic COVID by 80%,” Liu said. “It’s not a replacement for vaccination but it supplements it, offering another layer of protection. If people can access it.”
The challenge is the supply is limited, a familiar refrain in a time of shortages and supply-chain issues.
Boonyaratanakornkit reiterated the drug’s effectiveness — and its short supply — adding other important caveats.
“You have to be extremely high risk and even then, you may need to be put on a wait list,” he said. “And patients with heart disease may have a slightly higher rate of heart complications after Evusheld as compared to placebo. But it is an option to provide protection against COVID-19.”
Additional anti-COVID-19 drugs are under study in clinical trials, including the monoclonal antibody sotrovimab, approved for treatment in an Emergency Use Authorization by the Food and Drug Administration.
Boonyaratanakornkit is one of the principal investigators on a Phase 1 Fred Hutch/Seattle Cancer Care Alliance trial testing sotrovimab’s effectiveness as a COVID-19 preventive in blood stem cell transplant patients. New treatments and preventive therapies are still sorely needed, he said, because the virus continues to mutate, rendering some treatments — like the monoclonal antibody made by Regeneron — unusable.
“The FDA revoked the EUA for [the drug made by] Regeneron as treatment,” he said. “If the virus is resistant to it as treatment, it will be resistant for prevention. As a result, we had to close a study using the Regeneron antibodies for prevention and have started a new one with sotrovimab, which is thought to still be effective for the main omicron variant.”
But the field, he stressed, is changing very quickly.
The research team, which includes Hutch scientists Drs. Alpana Waghmare and Michael Boeckh, is giving sotrovimab as an infusion to transplant patients before their “conditioning,” rigorous chemotherapy and/or radiation to eliminate a patient’s immune system before transplanting a new healthy one. The trial, dubbed COVIDMAB, is now open and currently enrolling; patients will be followed for six months to determine the drug’s efficacy. Read more about COVID-19 clinical trials here.
“After a transplant, it can take months for our immune systems to recover,” Boonyaratanakornkit said. “The hope is a single dose provides months of protection. That’s the purpose of the study — to see how long the antibodies last.”
A larger additional trial of the same drug may be in the works, as well, he said, something he welcomes.
“Our patients are at greater risk because they don’t respond to a vaccine as robustly,” he said. “So having another preventative measure to tide them through the pandemic, especially when there are surges of variants and this pattern of waxing and waning outbreaks like we’re seeing now, is crucial.”