Safety and Efficacy of Influenza Vaccination in Patients Receiving Immune Checkpoint Inhibitors. Systematic Review with Meta-Analysis

López-Olivo, María A.; Valerio, Valeria; Matusevich, Aliza R. Karpes; Brizio, Marianela; Kwok, Michelle; Geng, Yimin; Suarez‐Almazor, María E.; Colmegna, Inés

doi:10.3390/vaccines10081195

Cited by 12 publications

(11 citation statements)

References 47 publications

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“…Previous literature has suggested a possible synergistic effect of vaccination or viral infection with checkpoint inhibitor immunotherapy. For example, influenza vaccination has been associated with better survival among cancer patients undergoing immunotherapy [ 20 ]. It is hypothesized that vaccination can enhance the infiltration of central memory T cells into the tissues, leading to an enhanced anti-cancer immune response [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 Pandemic on Frontline Pembrolizumab-Based Treatment for Advanced Lung Cancer

Tanvetyanon

Chen

Gray

2023

JCM

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Background: Pembrolizumab monotherapy or pembrolizumab plus chemotherapy has become an important frontline treatment for advanced non-small cell lung cancer (NSCLC). To date, it remains unclear how the coronavirus disease 2019 (COVID-19) pandemic impacted the treatment outcome. Methods: A quasi-experimental study was conducted based on a real-world database, comparing pandemic with pre-pandemic patient cohorts. The pandemic cohort consisted of patients who initiated treatment from March to July 2020, with follow-up through March 2021. The pre-pandemic cohort consisted of those initiating treatment between March and July 2019.The outcome was overall real-world survival. Multivariable Cox-proportional hazard models were constructed. Results: Analyses included data from 2090 patients: 998 in the pandemic cohort and 1092 in the pre-pandemic cohort. Baseline characteristics were comparable, with 33% of patients having PD-L1 expression level ≥50% and 29% of patients receiving pembrolizumab monotherapy. Among those treated with pembrolizumab monotherapy (N = 613), there was a differential impact of the pandemic on survival by PD-L1 expression levels (p-interaction = 0.02). For those with PD-L1 level < 50%, survival was better in the pandemic cohort than the pre-pandemic cohort: hazard ratio (HR) 0.64 (95% CI: 0.43–0.97, p = 0.03). However, for those with PD-L1 level ≥ 50%, survival was not better in the pandemic cohort: HR 1.17 (95% CI: 0.85–1.61, p = 0.34). We found no statistically significant impact of the pandemic on survival among patients treated with pembrolizumab plus chemotherapy. Conclusions: The COVID-19 pandemic was associated with an increase in survival among patients with lower PD-L1 expression who were treated with pembrolizumab monotherapy. This finding suggests an increased efficacy of immunotherapy due to viral exposure in this population.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 Pandemic on Frontline Pembrolizumab-Based Treatment for Advanced Lung Cancer

Tanvetyanon

Chen

Gray

2023

JCM

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“…A systematic review evaluated the immune-related adverse events (irAEs) rates in the vaccinated group compared to the unvaccinated group. This rate was slightly lower (32%) than that reported in the unvaccinated group (41%) with a difference not significant (RR 0.90, 95%CI 0.72 to 1.1, n=2485, I2=64.8%) [ 54 ]. In a retrospective cohort of patients with cancer undergoing ICIs, the rate of flu vaccine cases was lower among ICI-related myocarditis than controls on ICIs without myocarditis.…”

Section: Effectiveness Of Influenza Vaccine In Patients With Solid Tu...mentioning

confidence: 99%

Vaccination for seasonal influenza, pneumococcal infection and SARS-CoV-2 in patients with solid tumors: recommendations of the Associazione Italiana di Oncologia Medica (AIOM)

Pedrazzoli¹,

Lasagna²,

Cassaniti³

et al. 2023

ESMO Open

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“…6 Prior literature on the use of influenza vaccination in patients with cancer receiving ICI, suggests that it is safe. 9 However, to the best of our knowledge, there are no prior systematic reviews specifically evaluating COVID-19 vaccination in patients with cancer receiving ICI. The aim of this systematic review and meta-analysis is to determine the efficacy and safety of COVID-19 vaccination in this population.…”

Section: Open Accessmentioning

confidence: 99%

“… 6 Prior literature on the use of influenza vaccination in patients with cancer receiving ICI, suggests that it is safe. 9 …”

Section: Introductionmentioning

confidence: 99%

COVID-19 vaccination in patients with cancer receiving immune checkpoint inhibitors: a systematic review and meta-analysis

Ruiz

López-Olivo

Geng

et al. 2023

J Immunother Cancer

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BackgroundImmune checkpoint inhibitors (ICI) can cause off-target inflammatory and immune-related adverse events (irAE). Conceivably, COVID-19 vaccination could trigger an inflammatory and immune response that could induce or aggravate irAE.MethodsThe objective of this systematic review is to appraise the efficacy and safety of COVID-19 vaccination in patients with cancer treated with ICI. The literature search was performed in PubMed and Embase in English from December 2019 to February 2022. The review included clinical trials, observational cohort studies, case series, and case reports reporting on the clinical efficacy and safety of COVID-19 vaccines on patients with cancer treated with ICI. Outcomes of interest included seroconversion, SARS-CoV-2 infection rate, severe COVID-19, COVID-19 mortality rate. Incidence of ICI irAEs was also ascertained as well as vaccine adverse events. A meta-analysis was conducted to estimate the pooled effect sizes of the outcomes when possible, using random effects models.ResultsOverall, 19 studies were included for the analysis (n=10 865 with 2477 receiving ICI). We analyzed 15 cohort studies, 1 cross-sectional study, and 3 case reports. There were no statistically significant differences in seroconversion rates after the second dose of the vaccine when comparing patients with cancer receiving ICI with patients without cancer (risk ratio, RR 0.97, 95% CI 0.92 to 1.03) or with patients with cancer without active treatment (RR 1.00, 95% CI 0.96 to 1.04). There was a higher probability of seroconversion in patients with cancer treated with ICI compared with patients with cancer treated with chemotherapy (RR 1.09, 95% CI 1.00 to 1.18). In a single study in patients receiving ICI, no differences were observed in risk of irAE between those receiving inactivated vaccine and those unvaccinated (pneumonitis RR 0.88, 95% CI 0.33 to 2.3; rash RR 1.03, 95% CI 0.66 to 1.62; arthralgia RR 0.94, 95% CI 0.51 to 1.75). There were no studies for other types of vaccines comparing vaccinated vs not vaccinated in patients treated with ICI. The most common vaccine-related adverse events were local pain or fatigue. Overall, the quality of evidence was rated as very low.ConclusionCOVID-19 vaccination appears to be effective and safe in patients with cancer receiving ICI.

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Safety and Efficacy of Influenza Vaccination in Patients Receiving Immune Checkpoint Inhibitors. Systematic Review with Meta-Analysis

Cited by 12 publications

References 47 publications

Impact of COVID-19 Pandemic on Frontline Pembrolizumab-Based Treatment for Advanced Lung Cancer

Impact of COVID-19 Pandemic on Frontline Pembrolizumab-Based Treatment for Advanced Lung Cancer

Vaccination for seasonal influenza, pneumococcal infection and SARS-CoV-2 in patients with solid tumors: recommendations of the Associazione Italiana di Oncologia Medica (AIOM)

COVID-19 vaccination in patients with cancer receiving immune checkpoint inhibitors: a systematic review and meta-analysis

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