Cytokine release syndrome in a patient with colorectal cancer after vaccination with BNT162b2

Au, Lewis; Fendler, Annika; Shepherd, Scott T. C.; Rzeniewicz, Karolina; Cerrone, Maddalena; Byrne, Fiona; Carlyle, Eleanor; Edmonds, Kim; Del Rosario, Lyra; Shon, John; Haynes, Winston A.; Ward, Barry; Shum, Ben; Gordon, William; Gerard, Camille L.; Xie, Wenyi; Joharatnam-Hogan, Nalinie; Young, Kate; Pickering, Lisa; Furness, Andrew J. S.; Larkin, James; Harvey, Ruth; Kassiotis, George; Gandhi, Sonia; Swanton, Charles; Fribbens, Charlotte; Wilkinson, Katalin A.; Wilkinson, Robert J.; Lau, David K.; Banerjee, Susana; Starling, Naureen; Chau, Ian; Turajlic, Samra

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.