Manhattan, NY—Vaccination of adults with cancer can be confusing for patients and clinicians. That is why the American Society of Clinical Oncology published guidance on the issue this year, including an article that answers some of the common questions accompanying the new guideline.
“This companion piece addresses some of the key questions that clinicians may have as they implement the guideline recommendations. Vaccination against infection is a key preventative measure in people undergoing cancer treatment,” the Memorial Sloan Kettering Cancer Center–led researchers wrote. “After a cancer diagnosis, taking early steps to ensure that patients are protected against vaccine-preventable illnesses is a crucial component of good oncologic care.”
The article in the Journal of Clinical Oncology also noted that infections can cause unexpected treatment delays that ultimately affect cancer-related outcomes and, therefore, should be avoided however possible.
Recommended vaccinations for cancer patients include:
• Influenza: at all ages 6 months and older
• Respiratory syncytial virus: once after age 60 years
• COVID-19: as per the latest CDC schedule for the immunocompromised at any age
• Tdap (tetanus, diphtheria, and acellular pertussis) or Td (tetanus and diphtheria): at age 19 years or older, with one dose of Tdap, followed by Td or Tdap booster every 10 years
• Hepatitis B: at age 19 to 59 years or those eligible aged 60 years or older, immunizing those with other risk factors. For adults aged 20 years or older, use high antigen (40 µg) and administer as a three-dose Recombivax HB series (0, 1, 6 months) or four-dose Engerix-B series (0, 1, 2, 6 months)
• Recombinant zoster vaccine: aged 19 years and older get two doses at least 5 weeks apart
• Pneumococcal: aged 19 years and older should receive one dose of pneumococcal conjugate vaccine 15 (PCV15), followed by pneumococcal polysaccharide vaccine 23 (PPSV23) 8 weeks later, or one dose of PCV20
• Human papillomavirus: at age 19 to 26 years, with eligible adults aged 27 to 45 years using shared decision-making to receive three doses (0, 1-2, and 6-months).
One example is that hospitalization for pneumonia is among the most common infectious complications of cancer treatment but can be reduced by vaccines. “Therefore, patients should remain current with the pneumococcal and seasonal respiratory vaccines, including influenza, respiratory syncytial virus (RSV), and COVID-19,” the authors emphasized. “The risk of herpes zoster is heightened after a cancer diagnosis in adults regardless of age; thus, patients aged ≥19 years should receive the recombinant zoster vaccine (RZV) to prevent shingles and its associated complications. Hepatitis B vaccine is recommended for all adults aged 19-59 years who have never been immunized. Similarly, tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is a universally recommended vaccine, and patients should be encouraged to stay up to date. Finally, the human papillomavirus (HPV) vaccine offers vital protection for adults younger than 45 years.”
The guidance recommended that the vaccines “should ideally be given before starting cancer treatment to achieve the best possible protection before a patient’s immune system is affected by the cancer treatment. Influenza, RSV, and COVID-19 vaccines should be received before temporal spread of these viruses regionally.”
The article noted that it is okay to administer seasonal vaccines concurrently with chemotherapy, immunotherapy, or radiation treatment. “Modifying the timing of influenza vaccine to avoid immunizing during treatment or with cytopenias is not advised and may result in missed immunization opportunities without a clear benefit,” the researchers added.
The guidance also emphasized that once vaccination has commenced, cancer treatment should not be delayed to complete the remaining vaccine doses. “A few strategies can be applied for multiple-dose vaccines to ensure the best possible protection with ongoing cancer treatment,” the authors advised. “For example, the second dose of the RZV can be given at 4 weeks instead of the recommended 2-6-month interval between doses.”
They added that Hepatitis B vaccine schedules include higher antigen and additional doses to improve immune responses in immunocompromised patients. In the case of hepatitis B, antibody levels should be checked after the series is completed to assess the need for revaccination if the antibody levels required for clinical protection are not met.
“COVID-19 vaccine doses can be repeated at a 2-month interval for people receiving treatments that are expected to attenuate vaccine responses and should be strongly considered if the community spread of the virus poses a continued risk,” according to the researchers.
In some cases, according to the report, “live vaccines are avoided in people with cancer because of the potential risk of uncontrolled and severe infection. Examples of routinely used live vaccines in U.S. children and adults include varicella, mumps, measles, and rubella (MMR) and the live attenuated influenza vaccine (LAIV).”
The researchers advised, “It is worth noting that the currently licensed herpes zoster vaccine in the United States is a non-live vaccine (RZV) that is safe to administer to people undergoing cancer treatment. The previous herpes zoster vaccine was a live virus formulation that has not been available in the United States since 2020. People who may have previously received the live vaccine before a cancer diagnosis should still receive the non-live herpes zoster vaccine. All currently licensed non-live vaccines are safe for patients with cancer.”
The guidance also addressed concerns about the safety of immune checkpoint inhibitors (ICIs) with influenza and COVID-19 vaccines because of the potential worsening of immune-related adverse events. That response is unproven with the current evidence, the researchers pointed out, adding, “Both vaccines are safe and effective in patients receiving ICI therapies.”
The report also endorsed coadministration of the recommended nonlive vaccines during the same visit or at close intervals, calling the practice, “safe and a highly encouraged strategy to increase vaccine uptake. Patients should be reassured that this is a safe approach and immune interference between vaccines is not expected. Separate vaccination sites can be used to minimize local side effects.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
