Influenza Vaccine Indication During Therapy with Immune Checkpoint Inhibitors: A Transversal Challenge. The Invidia Study

Abstract

Considering the transversal unmet need for the counselling of advanced cancer patients treated with immune checkpoint inhibitors (CKI) about influenza vaccination, we planned an explorative study to assess the efficacy of influenza vaccine in this population, its potential impact on the severity and mortality of influenza syndrome (IS) and on of anticancer immunotherapy outcome. METHODS: INVIDIa was a retrospective, observational, multicenter, explorative study at 21 Italian centers, enrolling consecutive advanced cancer patients receiving treatment with CKI during the Italian influenza vaccinal season 2016-2017. All data regarding influenza vaccination, IS and treatment with CKI were collected. Subgroup analyses were pre-planned for elderly and lung cancer patients. RESULTS: The study enrolled 300 patients, 79 of which received flu vaccine; 221 unvaccinated patients constituted the control group. The incidence of IS was of 24.1% among vaccinated, vs 11.8% of controls; OR=2.4 (95%CI=1.23-4.59; p=0.009). Severity of

Controversies About COVID-19 and Anticancer Treatment with Immune Checkpoint Inhibitors

“…Their specific susceptibility to bacterial or viral infections has not been investigated. Considering that immunotherapy with ICI is able to restore the cellular immunocompetence, as we previously suggested in the context of influenza infection, the patient undergoing immune checkpoint blockade could be more immunocompetent than cancer patients undergoing chemotherapy [9,10].…”

Infectious Considerations for Patients on Immune Checkpoint Inhibitors

“…Administering age-appropriate vaccinations to patients who require ICPI therapy remains controversial; while enhanced T cell activity may improve serologic responses in these particularly vulnerable patients, additional antigen presentation may theoretically raise the risk for the development of infectious diseases or IRAE [22]. The first retrospective, multicenter study designed to explore the efficacy of influenza vaccination in oncologic patients treated with ICPI reviewed 300 patients and reported a significantly higher incidence of influenza lung infection among the 79 patients who were vaccinated (24.1% versus 11.8% unvaccinated; odds ratio = 2.4, p = 0.009) [23]. Despite suffering a higher incidence of influenza lung infection, however, vaccinated patients experienced greater one-year overall survival than their unvaccinated counterparts (86.7% versus 66.7%, p = 0.02) [23].…”

“…The first retrospective, multicenter study designed to explore the efficacy of influenza vaccination in oncologic patients treated with ICPI reviewed 300 patients and reported a significantly higher incidence of influenza lung infection among the 79 patients who were vaccinated (24.1% versus 11.8% unvaccinated; odds ratio = 2.4, p = 0.009) [23]. Despite suffering a higher incidence of influenza lung infection, however, vaccinated patients experienced greater one-year overall survival than their unvaccinated counterparts (86.7% versus 66.7%, p = 0.02) [23]. Two retrospectives studies of influenza vaccination in patients treated with ICPI did not find significantly elevated incidences of IRAE among vaccinated patients [24,25].…”

Palliative radiotherapy in advanced cancer patients treated with immune‑checkpoint inhibitors: The PRACTICE study

“…As the use of immunotherapy for treating various types of cancer becomes more widespread, several issues require investigation to determine their possible impact on the outcome of cancer patients treated with anti-PD-1/PD-L1 immune checkpoint inhibitors (CKIs) (1). Thus, the respective effects of concomitant medications, concurrent treatments and other possible immunomodulatory events in the clinical history of patients prior to the initiation of immunotherapy, or during its course, have been largely explored in the recent years, obtaining a wide range of controversial evidence (1)(2)(3)(4)(5). For example, it seems that the use of corticosteroids or antibiotics before or with CKIs may decrease efficacy of the latter, whereas the use of influenza vaccine may be beneficial irrespective of its anti-infectious efficacy (2)(3)(4).…”

“…Thus, the respective effects of concomitant medications, concurrent treatments and other possible immunomodulatory events in the clinical history of patients prior to the initiation of immunotherapy, or during its course, have been largely explored in the recent years, obtaining a wide range of controversial evidence (1)(2)(3)(4)(5). For example, it seems that the use of corticosteroids or antibiotics before or with CKIs may decrease efficacy of the latter, whereas the use of influenza vaccine may be beneficial irrespective of its anti-infectious efficacy (2)(3)(4). Amongst all the topics explored in relation to immunotherapy, radiotherapy (RT) is a considerably important issue, since the interest in the abscopal effect has recently been rediscovered, and described in relation to immunotherapy (6).…”