South Florida Sun-Sentinel (Sunday)
First grader tests vaccine while fighting cancer
Girl, 6, feels ‘pretty good’ about being in Moderna’s trial
Imagine surviving two brain cancer surgeries and more than 30 radiation treatments only to end up getting COVID-19.
It was a very real worry for Shawn and Mariel Mahoney, whose 6-yearold daughter, Layla, received a very difficult diagnosis this summer at a time when no coronavirus vaccines have yet been approved for anyone younger than 12.
Selected over the summer to be among 60 local children to participate in an ongoing clinical trial of the Moderna vaccine in kids ages 6 to 11, the first grader nearly missed out.
As her father explained, a confirmed cancer diagnosis would have been reason enough for his daughter to have been denied entry into the trial. But, when the first vaccination appointment arrived on Aug. 20, the diagnosis still had not been confirmed. St. Jude’s Children’s Research Hospital in Tennessee had not yet verified an initial diagnosis from Rady Children’s Hospital in San Diego.
Doctors went ahead and pushed the plunger on that first shot, only for Shawn Mahoney to receive a call from a St. Jude’s specialist 10 minutes into the ride home. “She was supposed to call me an hour earlier but something delayed her,” Mahoney said. “It was just made to be.”
Layla did not have much reaction to that first dose, and her parents worried that she might have been among the 25% of trial participants assigned saline injections, making her part of the placebo group rather than among the 75% who receive the vaccine.
But a second shot left them celebrating a daughter who suddenly became exhausted and started running a fever. Those are the well-known minor side effects, they well knew, of a person’s immune system reacting to a vaccine.
“She was like, ‘it’s really cold in here,’ and I was like ‘yes!’ ” Mahoney said. “Terrible parents, so happy to have our kid have a low-grade fever.”
Knowing that his daughter is likely headed for a round of chemotherapy this winter, and also understanding that those drugs are known to weaken the immune system, the good chance that her body will already know how to protect itself from coronavirus, he said, provides a precious peace of mind.
The alternative was almost too difficult to consider.
“The thought was, ‘Great, we beat cancer, but COVID killed us because we’re immunocompromised, and we’re essentially the same as an 85-year-old unvaccinated person at that point,” Mahoney said.
Dr. Ezra Cohen, a medical oncologist at UC San Diego Moores Cancer Center, agreed. Though the amount of protection that the immune system can provide during chemotherapy treatment is highly variable, the specialist said vaccination before chemo does give the body a better fighting chance if coronavirus does come calling.
For Layla, talking about her latest arts and crafts project or about any sort of animal trumps any discussion of her vaccination experience so far.
Bright-eyed with a full head of hair despite undergoing two craniotomies over the summer, her assessment of coronavirus vaccination comes down to the fact that it involved needles, both for the shot and — especially disappointing — for the six vials of blood that had to be drawn. “The first time, they had to pin me down,” she said solemnly.
Getting to be among the first kids to be vaccinated? That, she said, feels “actually, pretty good.” Needles notwithstanding, she would, she said, recommend it to other kids “so they don’t get their germies.”
On Aug. 1, her parents frantically took her to Rady. A surgical team removed a large and rare tumor called an anaplastic supratentorial ependymoma on Aug. 2 then had to go back in at the end of the month when the aggressive growth reappeared on medical imaging.
Now, she is undergoing follow-up proton radiation therapy as a precautionary measure to keep the malignancy from returning. Chemo will provide yet another layer of insurance against recurrence.
Few parents will experience the cancer part of Layla’s journey. This kind of tumor is estimated to cause only about 200 cases per year nationwide.
Given that some adults still avoid getting their COVID-19 shots, the coming debate around vaccinating children is sure to be extensive.
Many will no doubt be looking to do their homework, a desire that Shawn Mahoney understands all too well, having just gone through that process. The decision to enroll Layla in the Moderna trial, he said, did not come lightly.
Though his gut reaction was no way, the underwater videographer and director couldn’t stop himself from delving deeper. He looked first at the results from Moderna’s study of its vaccine in children ages 12 to 17. The methods seemed rigorous and the numbers being tested seemed large.
His focus remained squarely on primary sources, largely the peer-reviewed studies of trial results rather than on websites giving their opinions about what those results mean.
Having medical professionals in his family, he said, made it relatively easy to make a few calls and get some feedback on how he should interpret what he had read. Most, he said, were jealous of Layla’s opportunity.
“The medical community is, you know, a diala-friend kind of thing, and there were probably a dozen medical professionals that said that they would have absolutely no hesitation putting their kids through it,” he said.
The Mahoneys are happy to discuss vaccinations, given what their daughter has already been through on the cancer front.
Layla’s tumor, called an ependymoma, was caused by mutations in the cells that line the fluid-filled spaces surrounding the brain.
Generally, these tumors quickly impinge upon their surroundings, pushing up against and even infiltrating brain tissue and often blocking the flow of cerebrospinal fluid that cushions a person’s gray matter.
Medical imaging showed just such a blockage in Layla’s case, said Dr. Michael Levy the neurosurgeon at Rady Children’s who performed both of her surgeries. The tumor, he said, was large and of a complex shape near areas that control motor function, speech and memory. Removing such an obstacle, he said, is an exercise in aggressive restraint.
“You try to temper what you’re doing based on the benefits and risks of what’s located nearby,” Levy said. “Too high and you’re affecting speech, too low and it’s memory.”