Cytokine release syndrome in a patient with colorectal cancer after vaccination with BNT162b2.
journal contributionposted on 2021-08-20, 09:53 authored by Lewis Au, Annika Fendler, Scott TC Shepherd, Karolina Rzeniewicz, Maddalena Cerrone, Fiona Byrne, Eleanor Carlyle, Kim Edmonds, Lyra Del Rosario, John Shon, Winston A Haynes, Barry Ward, Ben Shum, William Gordon, Camille L Gerard, Wenyi Xie, Nalinie Joharatnam-Hogan, Kate Young, Lisa Pickering, Andrew JS Furness, James Larkin, Ruth Harvey, George Kassiotis, Sonia Gandhi, Crick COVID-19 Consortium, Charles Swanton, Charlotte Fribbens, Katalin A Wilkinson, Robert J Wilkinson, David K Lau, Susana Banerjee, Naureen Starling, Ian Chau, CAPTURE Consortium, Samra Turajlic
Patients with cancer are currently prioritized in coronavirus disease 2019 (COVID-19) vaccination programs globally, which includes administration of mRNA vaccines. Cytokine release syndrome (CRS) has not been reported with mRNA vaccines and is an extremely rare immune-related adverse event of immune checkpoint inhibitors. We present a case of CRS that occurred 5 d after vaccination with BTN162b2 (tozinameran)-the Pfizer-BioNTech mRNA COVID-19 vaccine-in a patient with colorectal cancer on long-standing anti-PD-1 monotherapy. The CRS was evidenced by raised inflammatory markers, thrombocytopenia, elevated cytokine levels (IFN-γ/IL-2R/IL-18/IL-16/IL-10) and steroid responsiveness. The close temporal association of vaccination and diagnosis of CRS in this case suggests that CRS was a vaccine-related adverse event; with anti-PD1 blockade as a potential contributor. Overall, further prospective pharmacovigillence data are needed in patients with cancer, but the benefit-risk profile remains strongly in favor of COVID-19 vaccination in this population.