COVID-19 Vaccination Around ICI Initiation and Survival in Lung, Kidney, and Melanoma

Emerging evidence suggests that concurrent COVID-19 mRNA vaccination may enhance immune checkpoint inhibitors (ICIs) effectiveness by augmenting antitumor immune activation. Yet real-world estimates of survival benefit across cancers and clinical subgroups are limited. We emulated a randomized trial comparing two strategies at initiation of first-line ICI therapy: receipt of ≥1 COVID-19 mRNA vaccine within 100 days of ICI initiation versus no vaccination. Using the TriNetX linked network, we identified 7,966 adults with lung, melanoma, or kidney cancers who initiated first-line ICI between Sep 2020 and Nov 2024, among whom 458 received a COVID-19 vaccine within ±100 days of initiation. Vaccination was associated with improved overall survival (OS) and treatment-free survival (TFS) in lung cancer (OS aHR, 0.81; 95% CI, 0.74–0.89; P<0.001), with a modestly longer 3-year mean OS of 2.33 months (95% CI, 1.41–3.23; P<0.001). Vaccination was not associated with TFS or OS improvement in kidney or melanoma.