COVID-19 breakthrough infections in patients with colorectal cancer: A propensity-matched score analysis.

person Saqr Alsakarneh University of Missouri Kansas-city, Kansas City, MO info_outline Saqr Alsakarneh, Hana Qasim, Yazan Sallam, Ibrahim Khamees, Ammar Al-Obaidi, Mohammad Adam

Authors person Saqr Alsakarneh University of Missouri Kansas-city, Kansas City, MO info_outline Saqr Alsakarneh, Hana Qasim, Yazan Sallam, Ibrahim Khamees, Ammar Al-Obaidi, Mohammad Adam Organizations University of Missouri Kansas-city, Kansas City, MO, University of Missouri–Kansas City, Kansas City, MO, University of Missouri-Kansas City, Kansas City, MO, University of Missouri Kansas City, Kansas City, MO Abstract Disclosures Research Funding No funding sources reported Background: Previous data showed that cancer patients are more prone to have severe outcomes due to SARS-CoV-2 infection. While there are promising data on anti-mRNA antibodies titer post-COVID-19 vaccination in solid malignancies, concerns arise regarding durability of this immune response. We aim to evaluate the risk of breakthrough COVID-19 infection in colorectal cancer patients (CRC). Methods: We conducted a retrospective cohort study using TriNetX, a population-based database that sources data from electronic medical records (EHRs) of 61 health care organizations in the US. Using ICD-10 codes, we created two cohorts of patients with vaccination against COVID-19: with CRC and without CRC. Within each cohort, we collected data on demographics, and several risk factors for COVID-19. We performed propensity score matching (PSM) of 44 variables to control for confounding. Primary aim of our study was to compare the risk of COVID-19 breakthrough infection between CRC patients and control group. Odds ratio (OR) and 95% confidence interval (CI) were used to report associations for the propensity-matched cohorts. Results: A total of 6,152 vaccinated CRC patients were identified (mean age = 68.3 ± 12.7, females: 47.4%). In CRC vaccinated patients, (68.9%) were White, (12.50%) were African Americans, (8.3%) were Hispanics/Latino individuals. 6051 received 2 doses, and 2087 received 3 doses of COVID-19 messenger RNA vaccine. Vaccinated CRC patients were found to be at significantly higher risk for breakthrough COVID-19 infections compared to patients without CRC (adjusted odds ratio [aOR] = 1.46; [95% confidence interval (CI): 1.33 - 1.59]). Sub-group analysis based on the number of vaccines administered revealed consistent findings, with aOR of 1.39 [1.27 - 1.52] after 2 doses, and 1.36 [1.18 - 1.57] after 3 doses. There were no differences in risk of breakthrough infection based on gender or age groups in patients with CRC (P > 0.05). Conclusions: Our study showed that CRC patients are at a significantly elevated risk of breakthrough COVID-19 infections. Our study provides a valuable finding that may enlighten public health measures and clinical interventions for this vulnerable patient population. Further research is warranted to investigate the biological mechanisms that contribute to the breakthrough infections COVID-19 among CRC patients. CRC Cohort. N, % Non-CRC Cohort aOR* 95% CI Vaccinated 1,413; 23% 1,044; 17% 1.46 1.33 - 1.6 2 doses 1,381; 23% 1,061;18% 1.39 1.27 - 1.52 3 doses 582; 28% 462; 22% 1.36 1.18 - 1.57 * Adjusted for demographics, social determinants of health (SDHOs), comorbidities, vaccine, and cancer treatment types (including immunotherapy, radiotherapy, and chemotherapy).