Patients with advanced cancer were treated with immune checkpoint inhibitors and injected with COVID-19 vaccine to improve their prognosis without increasing pancreatic related adverse events

Figures & data

Figure 1. Flowchart diagram of patient selection.

Table 1. Patient characteristics.

Patients	No. (%)
Sex
Male	171(66.8)
Female	85(33.2)
Mean age, years (SD)	59.9±10.3
Attribution
Anti–PD-1	249(97.3)
Anti–PD-L1	6(2.3)
Anti–PD-1/CTLA5	1(0.4)
Cancer type
Melanoma	8(3.1)
Genitourinary	16(6.3)
Lung	50(19.5)
Digestive system	157(61.3)
Gynecologic	3(1.2)
Lymphoma	2(0.8)
Other solid tumors	20(7.8)
Covid-19 Vaccine
Vaccination	65(25.4)
Unvaccinated	131(51.2)
Unclear	60(23.4)
Enzyme abnormality	63(24.6)
ICIPI	6(2.3)

ICIPI: immune checkpoint inhibitors (ICIs) induced pancreatic injury.

Table 2. Pancreatic enzymes.

	No	Average cycle	Median time(day)
Enzyme abnormality	63	2.7	49 (26.5, 92.5)
Diastase (pure)	14	3.7	62 (29.0, 132.25)
Lipase (pure)	20	2.4	45.5 (26.7, 87.0)
Lipase& Diastase	29	2.5	49（30.0, 93.0）
Diastase	43	2.9	57.0 (28.0, 98.0)
Lipase	49	2.4	49(27.0, 91.0)
Grade
G1	48	2.5	50.2（29.3, 92.5）
G2	11	2.5	27（24.5, 84.5）
G3–4	4	2	71.5（52.8, 112）
Image	5	5	99（19, 190）
Asymptomatic	51	2.3	43（24, 84.5）
Accompanying symptom	12	4.5	109(72.3, 139.8)
Covid-19 Vaccine
Vaccination	14	3.6	91.5(51, 114.5)
Unvaccinated	34	3.6	62(33.3, 100.5)
Drug withdrawal	16	4.0	67(36, 139.8）
Not-drug withdrawal	47	2.3	49(26, 87.5)
ICIPI	6	4.4	120.5(86.8, 122.8)

Table 3. COVID-19 vaccine and pancreatic enzymes.

Vaccine	Abnormal	Normal	Total	χ2	p
Vaccination	14	51	65	0.50	.46
Unvaccinated	34	97	131
Total	48	148	196

Table 4. Efficacy evaluation.

Efficacy	Abnormal	Normal	p	Vaccination	Unvaccinated	p
Total	53	193		65	127
CR	0	0		0	0
PR	6	0		3	1
SD	22	72		40	41
PD	25	121		22	85
ORR (%)	6(11.3)	0		3(4.6)	1(0.8)
DCR (%)	28(52.8)	72(37.3)	p = .044	43(66.2)	42(33.1%)	p < .0001

Figure 2. a. OS curves for patients with and without enzyme abnormalities; b. PFS curves for patients with and without enzyme abnormalities; c. OS curves for COVID-19 vaccinated patients versus those unvaccinated; d. PFS curves for COVID-19 vaccinated patients versus those unvaccinated.