Patients with lung cancer who are treated with immunotherapy may be at increased risk of severe adverse events after receiving the seasonal influenza vaccination, according to results of a study presented at the European Lung Cancer Conference (April 25, 2017; abstract 112P_PR).
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Immune checkpoint inhibitors – such as programmed cell death protein 1/programmed cell death ligand 1 (PD-1/PD-L1) – are standard treatment strategies for patients with lung cancer. Routine influenza vaccination is recommended for patients with cancer – especially lung cancer – but there are concerns that the vaccination may produce an exaggerated immune response in patients receiving checkpoint inhibitors.
Sacha Rothschild, MD, PhD, department of medicine, division of oncology, University Hospital Basel (Switzerland), and colleagues conducted a prospective study to analyze the effects of the flu vaccination with immune checkpoint inhibitors in patients with cancer. A total of 23 patients with various types of cancer were included in the study: non-small cell lung cancer (n = 16), renal cell carcinoma (n = 4), and melanoma (n = 3). More than half of the patients had previously received at least 2 lines of chemotherapy and all were receiving nivolumab or pembrolizumab.
Patients were vaccinated with the influenza vaccination in 2015 and were followed for safety, efficacy, and frequency of immune-related adverse events. Ten health partners who received the same vaccination were used as a control group.
Within the first 30 days of vaccination, all patients demonstrated adequate immune response to the vaccine and no severe events attributable to the vaccine were reported. However, immune-related adverse events were significantly high among patients with cancer (52.2%), 6 of whom experienced severe grade 3 or 4 side effects including skin rashes and arthritis (13% each), followed by colitis and encephalitis (8.7% each) and hypothyroidism, pneumonitis, and neuropathy (4.3% each).
“Although the observed rate of [immune-related adverse events] in our cohort is alarming, we believe that there is a particular concern for severe complications of an influenza infection including pneumonia and respiratory failure for patients with lung cancer under immunotherapy because of concomitant structural lung disorders,” said Dr Rothschild in his presentation.
Until further data on a larger cohort in a controlled prospective setting is procured, influenza vaccination with immune checkpoint inhibitors is still recommended for patients with cancer. – Zachary Bessette
