Safety of Influenza Vaccine in Patients With Cancer Receiving Pembrolizumab

Abstract

<jats:sec><jats:title>PURPOSE:</jats:title><jats:p> There is a concern that influenza vaccination could increase the incidence of immune-related adverse events (irAEs) in patients with cancer receiving immune checkpoint inhibitors. The aim of our study was to determine the safety of influenza vaccination in this patient population. </jats:p></jats:sec><jats:sec><jats:title>PATIENTS AND METHODS:</jats:title><jats:p> We retrospectively identified patients who received at least 1 dose of pembrolizumab during any influenza season from September 2014 to August 2017 and reviewed medical records for irAEs. The primary endpoint was the incidence of irAEs. We used multivariable logistic regression and cumulative incidence curve with competing risks for comparison. </jats:p></jats:sec><jats:sec><jats:title>RESULTS:</jats:title><jats:p> Among 162 patients with cancer included in this study, 70 patients (43.2%) received at least 1 influenza vaccination. The vaccinated group was significantly older ( P = .002) and received more cycles of pembrolizumab ( P = .006). The incidence of any grade irAEs in the vaccinated group trended toward being lower (25.7% v 40.2%; P = .07) compared with the nonvaccinated group. Influenza vaccination was independently associated with fewer irAEs, with an odds ratio of 0.4 (95% CI, 0.2 to 0.9; P = .03) in multivariable analyses. The vaccinated group was less likely to have irAEs compared with the nonvaccinated group (24.7% v 34.4% at 12 months; P = .05), with death as a competing risk. The median irAE-free duration in the vaccinated group was longer than the nonvaccinated group (not reached v 28 months; P = .037). </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION:</jats:title><jats:p> Influenza vaccination in patients with cancer receiving immune checkpoint inhibitor therapy was not associated with increased irAEs. This supports the safety of influenza vaccination in this patient population. </jats:p></jats:sec>

EASL position paper on the use of COVID-19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipients

“…12 However, recent studies investigating the safety of seasonal influenza vaccination in patients receiving ICI showed no safety concerns with comparable rates of immune-related adverse events to those seen in clinical trials. 13,14 In addition, therapeutic RNA cancer vaccines are being tested in early clinical trials in patients with various cancers, including patients treated with ICI, and no safety concerns have been raised to date. [15][16][17] As a final note, there is no confirmed information yet on the tolerability, immunogenicity and safety of novel COVID-19 vaccines in patients with CLD, including patients with hepatobiliary cancer.…”

Considerations for cancer immunotherapy during theCOVID‐19 pandemic

“…Numerous retrospective series support the safety of inactivated influenza vaccine in recipients of anti‐PD‐1 monotherapy, with no increase in irAEs observed 15 . Reassuringly, influenza vaccination had no adverse impact on the anticancer effect of ICI therapy 14,15 . However, there may be heightened concerns for influenza vaccination in combination immunotherapy (anti‐PD‐1 with anti‐CTLA‐4) recipients, as they are more prone to irAEs, including rarer, but potentially fatal, complications such as immune‐mediated myocarditis.…”

“…Controversy surrounds whether influenza vaccination in patients receiving cancer immunotherapy heightens the risk of irAEs 14 . Numerous retrospective series support the safety of inactivated influenza vaccine in recipients of anti‐PD‐1 monotherapy, with no increase in irAEs observed 15 . Reassuringly, influenza vaccination had no adverse impact on the anticancer effect of ICI therapy 14,15 .…”

Influenza Vaccination and Myo-Pericarditis in Patients Receiving Immune Checkpoint Inhibitors: Investigating the Likelihood of Interaction through the Vaccine Adverse Event Reporting System and VigiBase

“…To the best of our knowledge, this is the first real-world study investigating the potential interactions between influenza vaccines and ICIs resulting in myocarditis or pericarditis in cancer patients, by assessing spontaneous reports submitted to the VAERS and VigiBase ® . This global post-marketing safety study stems from recent conflicting realworld evidence surrounding the possible exacerbation of irAEs with influenza vaccines in patients treated with ICIs [14,15,[24][25][26][27][28][29], thus joining in the wider debate on the bidirectional relationship between immunotherapy and the influenza vaccination, potentially affecting the clinical and humoral efficacy of the vaccine, performance of ICIs, and safety [14].…”