To contrast the COVID-19 pandemic brought by the corona virus SARS-CoV-2, two mRNA-based anti-COVID-19 vaccines (by Pfizer-BioNTech and Moderna) were made available relatively quickly and deployed worldwide based on an emergency approval. Being considered vulnerable and at risk of infection, cancer patients have been prioritized for COVID-19 vaccination and vaccinated repeatedly because of the short time protection provided by these vaccines. Recently, a surge in the incidence and rapid progression of cancers has been observed in many countries, which could (at least partially) represent cancers undiagnosed or untreated during the pandemic. It has also been suggested that the SARS-CoV-2 itself or even the anti-COVID-19 mRNA vaccines could have contributed to the recurrence and worse clinical outcome in cancer patients, given the high incidence of COVID-19 in hospitalized patients and that these patients have been vaccinated with priority several times and in a short period. Although it appears extremely unlikely that SARS-CoV-2 and anti-COVID-19 mRNA vaccines elicit genotoxic events and cause neo-cancerogenesis in a short time, they could still cause non-genotoxic pro-carcinogenic effects by triggering an exaggerated inflammatory reaction, compromising immune homeostasis, stimulating cell proliferation, and negatively affecting cellular stress response and damage repair machinery. This could result in the promotion of regrowth of dormant micrometastases or relapses of stable minimal residual disease. Such a harmful outcome may likely result from a synergy between the virus and the vaccine, especially in multi-vaccinated and multi-infected individuals. Here, I bring the cell pathologist’s point of view and discuss the multiple possible mechanisms by which the virus and the anti-COVID-19 mRNA vaccine might favor tumorigenesis. While a causal link cannot be established at this stage, knowledge of potential carcinogenic risks could help doctors and health policymakers take the best actions to protect vulnerable patients and convince the vaccine developer to design a vaccine free from such harm.
为应对新型冠状病毒SARS-CoV-2引发的COVID-19大流行，基于紧急授权批准，两种mRNA抗COVID-19疫苗（辉瑞-生物科技与莫德纳研发）得以快速问世并在全球推广。癌症患者因免疫脆弱且感染风险高，被列为优先接种人群，并因疫苗保护期较短而需多次接种。近期多国观察到癌症发病率激增及病情快速进展现象，这可能（至少部分）反映了疫情期间未确诊或未治疗的癌症病例。鉴于住院患者中COVID-19高发率，且这类患者曾在短期内多次优先接种疫苗，有观点认为SARS-CoV-2病毒本身乃至抗COVID-19 mRNA疫苗可能促进了癌症患者的复发与不良临床结局。虽然SARS-CoV-2与抗COVID-19 mRNA疫苗在短期内引发基因毒性事件并导致新生癌症的可能性极低，但它们仍可能通过诱发过度炎症反应、破坏免疫稳态、刺激细胞增殖、负面影响细胞应激反应及损伤修复机制等非基因毒性途径产生促癌效应。这可能导致休眠微转移灶再生长或稳定微小残留病灶复发。此类有害结局很可能源于病毒与疫苗的协同作用，在多次接种且反复感染的个体中尤为显著。本文从细胞病理学视角出发，系统探讨病毒与抗COVID-19 mRNA疫苗可能促进肿瘤发生的多重潜在机制。尽管现阶段尚未建立确凿因果关系，但认知潜在致癌风险有助于临床医生与卫生政策制定者采取最佳防护措施保护脆弱患者，并推动疫苗研发者设计规避此类危害的新型疫苗。
SARS-CoV2 and Anti-COVID-19 mRNA Vaccines: Is There a Plausible Mechanistic Link with Cancer?
肿瘤(癌症)患者之家