Information on third mRNA COVID-19 vaccine dose added to guidance for people with cancer

The National Comprehensive Cancer Network (NCCN)—a nonprofit alliance of leading cancer centers—today 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 FDA and CDC regarding a third mRNA vaccine dose for immunocompromised people.

The NCCN COVID-19 Vaccination Advisory Committee is comprised of 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.

"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, 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."

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 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

The update highlights timing recommendations from the CDC that people wait at least four 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 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. 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.

"When it comes to people's safety, we have to take every precaution," said Steve Pergam, MD, 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 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 non-medical version intended for patients and caregivers; that guidance will be updated in the days ahead to also include information about the third dose.