CAPTURE: COVID-19 antiviral response in a pan-tumour immune study

This prospective observational cohort study aims to understand the effects of the SARS-CoV-2 pandemic in patients with cancer and in healthcare workers (HCWs) who may be exposed to the virus in the course of their work.

The SARS-CoV-2 pandemic has been particularly challenging for the management of patient groups considered to be at higher risk of severe illness, including patients with cancer. Prospective data are urgently needed to understand, quantify and minimise the risks associated with COVID19, whilst maintaining the best possible outcomes for the underlying disease. 

This study aims to understand the impact of the SARS-CoV-2 virus in all patients with cancer, as well as healthcare workers (HCWs) who care for them.

Go to latest findings 

CAPTURE is sponsored by The Royal Marsden NHS Foundation Trust and funded from a generous grant from The Royal Marsden Cancer Charity. 

About the project

For patients living with cancer, there is an urgent need to understand the impact of the SARS-CoV-2 infection. In the early days of the pandemic, patients with cancer, and specifically those receiving active treatment (e.g. chemotherapy, immunotherapy or bone marrow transplant) were identified as “extremely vulnerable” and advised to self-shield (stay home at all times) for at least 12 weeks, which is not a sustainable measure to protect this group in the longer-term. Furthermore, to mitigate the risk of severe infection in these patients, cancer treatment plans were altered, delayed or suspended without a solid evidence base – this is likely to severely effect cancer related outcomes in these patients.

As lockdown measures lift, there are more uncertainties ahead for the oncology community at large – including unknown risks for frequent hospital visits, what the viral transmissions risks are in acute and outpatient departments, and do cancer patients particularly those receiving immune altering or chemotherapy treatments develop immunity against the virus in the same way as those without cancer.

There is an urgent need therefore, to quantify the risk of COVID-19 illness in patients with cancer and to understand what impact anti-cancer treatments have on the immune system’s response to the SARS-CoV-2 virus. There is also a need to understand how the pandemic impacts Health Care Workers (HCWs) who may be exposed to the virus in the course of their clinical duties and who are at risk to transmit the virus to vulnerable patients and colleagues in the asymptomatic phase of infection.  

The CAPTURE study is a long-term study. We are establishing large observational cohorts with an intentionally broad inclusion of different tumour types and treatment schedules. In CAPTURE, we will enrol both patients infected and uninfected by the virus, and patients with all types of cancer (blood and solid cancers), and of all walks of the clinical journey (in remission, follow-up, having treatment or undergoing surgery). We also will enrol HCWs within the hospital from all sectors of care delivery - from nurses to doctors, administrative staff to catering staff, allied health and support workers. 

The study will enrol patients/participants into three groups:
Group A: patients with confirmed or suspected COVID-19 and a history of cancer (n=200)
Group B: patients without a history of COVID-19 infection and a history of cancer (n=1000)
Group C: Hospital staff with or without a history of COVID-19 (n=200)

Comprehensive, longitudinal clinical annotation, participant questionnaires, meticulous and frequent sampling and long-term follow-up of these groups will allow robust and rapid insights that are urgently needed to guide clinical and workforce management. 

This knowledge is required well beyond the current pandemic as cancer and SARSCo-V2 will coincide in the same patients, and especially given the uncertainty regarding the nature and duration of immunity in cancer patients who develop the illness and the effectiveness of vaccines in the cancer population. This study will provide us with detailed information on how to safely manage cancer patients by both minimising the risk of infection but maintaining their cancer treatment. 

CAPTURE is sponsored by The Royal Marsden NHS Foundation Trust and funded from a generous grant from The Royal Marsden Cancer Charity.

Findings

Latest findings - December 2021:

Third COVID-19 vaccine dose effectively boosts immunity for the majority of patients with cancer
Nearly 100% of cancer patients with solid tumours have antibodies effective against the Delta variant after a third dose of COVID-19 vaccine, in results that will be published in Cancer Cell in the coming days. The the new findings also highlight a proportion of patients with blood cancers who still have undetectable antibody levels against Delta after three doses, and should take up invitations for their fourth, especially as we enter a wave of new Omicron infections. 

As part of the ongoing CAPTURE study led by the Francis Crick Institute and The Royal Marsden NHS Foundation Trust, and generously funded by The Royal Marsden Cancer Charity, researchers have been monitoring the immune responses of hundreds of patients with different types of cancer, after one, two and three doses of COVID-19 vaccine. Using a highly accurate test, a viral neutralisation assay developed at the Crick, the team measured levels of antibodies which specifically block the Delta variant from infecting cells. In 199 people with cancer who had received a third vaccine dose (115 with solid cancers and 84 with blood cancers), they assessed whether levels of these neutralising antibodies in the blood were sufficient to block at least 50% of virus infection under laboratory conditions.

To examine the added benefit of a booster, the team specifically analysed responses in patients who had not shown a neutralising antibody response against Delta after their second vaccine dose, or in patients whose response had waned since. They found that after a third dose, 94% (47/50) of patients with solid cancers had newly detectable levels of neutralising antibodies against Delta. While a third vaccine dose also effectively boosted antibody levels for many patients with blood cancers (54% or 28/52), a substantial proportion still had undetectable levels in their blood. Overall, across all patients studied after three doses, 97% of patients with solid cancer and 71% of patients with blood cancers had detectable antibody levels against Delta.

The research team suggest that patients with solid cancers should be as protected against Delta as healthy individuals after three vaccine doses. But patients with blood cancers should remain cautious and come forward for a fourth dose when invited. UK guidance already says that adults and children aged 12 and over who are severely immunosuppressed should have three primary doses of the Covid vaccine, followed by a fourth booster dose.

You can read the accepted correspondence in full by downloading the letter and supplementary information.

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In patients with solid tumour cancers that had Covid-19, immune response was the same as for non-cancer patients. Patients with blood cancers had partially reduced immune responses. Overall, the immune response for cancer patients was not affected by cancer stage, disease status, and treatment with the exception of anti-CD20 antibody treatment (used to treat some blood cancers) (Fendler, Nature Cancer, 2021).

After vaccination, patients with blood cancers were less likely to have antibodies than people of a similar age without cancer. Antibody levels against variants of concern (Alpha, Beta, and Delta), which are kept under the closest watch by health officials, were especially low in these patients. Patients with solid cancers had an antibody response that was like individuals without cancer (Fendler, Nature Cancer, 2021).

The CAPTURE study provides evidence that variants of concern pose a greater threat to people with blood cancers, providing support that they should be prioritised to receive a third vaccine. In September, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that adults with weak immune systems should receive a third dose. This includes patients with blood cancers and patients with solid cancers receiving chemo- or radiotherapy that weakens the immune system. We submitted our findings to the JCVI, as evidence of the level of protection cancer patients have against Covid-19.

Contact us 

E-mail: CAPTURE@rmh.nhs.uk

The Renal & Melanoma Unit,
The Royal Marsden NHS Foundation Trust
Fulham Road,
London

The CAPTURE trial is registered at Clinical Trial.gov: NCT03226886 

Download study documents here