Guidelines: Optimizing vaccinations a ‘critical component’ of effective cancer care
Click Here to Manage Email Alerts
Key takeaways:
- Vaccination of adults newly diagnosed with cancer essential for care.
- Timing of vaccinations paramount for patients receiving newer treatments like CAR-T and B-cell therapies.
New guidelines for vaccinating adults with solid or hematologic cancers detailed the importance of vaccination optimization, multidisciplinary coordination and vaccination of household members.
The ASCO recommendations, published in Journal of Clinical Oncology, also detailed how clinicians should handle patients receiving newer treatments such as chimeric antigen receptor T-cell therapy and B-cell therapies.
“It’s crucial to emphasize the role of vaccinations, not just in preventing infections, but in reducing complications that can exacerbate cancer outcomes,” Amar H. Kelkar, MD, MPH, a stem cell transplantation physician in the department of medical oncology at Dana-Farber Cancer Institute, told Healio. “Effective vaccination strategies are a critical component of comprehensive cancer care.”
Infections cause the second most noncancer deaths among patients during treatment, Kelkar said.
Researchers used 102 publications posted between 2013 and 2023 to create the guidelines, which address various vaccines, including those for influenza, COVID-19, hepatitis B and human papillomavirus, among several others.
“The need for these guidelines arose due to the variability in clinical practices and the high infection risks among patients with cancer,” Kelkar said. “The systematic review process, which built on a previous 2013 guideline by the Infectious Disease Society of America, highlighted the need to update and refine vaccination strategies based on new evidence, especially given the emergence of COVID-19 and other evolving health risks.”
Vaccination optimization for patients, household
The authors strongly recommend clinicians determine the vaccination status of newly diagnosed adults with cancer for seasonal and age- and risk-based vaccines.
They also strongly recommend vaccinations should occur 2 to 4 weeks before any cancer treatment, although non-live vaccines can be given during or after chemotherapy, immunotherapy, hormonal treatment, radiation or surgery.
“It’s critical to document and optimize vaccination status at the initial patient visit to ensure timely and appropriate vaccinations, including revaccinations after certain therapies like hematopoietic stem-cell transplantation and CAR-T,” Kelkar said.
Individuals who live in the same household as an adult with newly diagnosed cancer, as well as close contacts, should be up to date on vaccinations, if possible, he added.
Additionally, decisions should be made by a patient’s medical team.
“Active interaction among health care providers, including primary care practitioners and pharmacists, is essential for managing the complex vaccination needs of patients with cancer,” Kelkar said.
Kelkar noted the importance of individualized vaccination plans as well.
“Due to the altered immune responses in patients with cancer, vaccination strategies must be tailored based on their immune status and the specific anticancer therapies they receive,” he said.
Catch-up dosing could be performed on certain adults for many vaccines, Kelkar said, “except for certain live vaccines like varicella where timing is critical.”
Stem cells, CAR-T, B-cell therapies
The guidelines panel strongly recommends adults who undergo hematopoietic stem cell transplantation be offered complete revaccination beginning 6 months to 1 year following treatment.
Live and live-attenuated vaccines should be given not earlier than 2 years after treatment and only to those without active graft-versus-host disease or immunosuppression.
Patients can receive COVID-19, influenza and pneumococcal vaccines 3 months following treatment.
The panel strongly recommend adults who receive B-cell therapies get the COVID-19 vaccine no earlier than 6 months after treatment completion.
The authors gave a “weak” recommendation to adults who receive CAR-T targeting B-cell antigens get influenza and COVID-19 vaccines no earlier than 3 months after treatment completion. Non-live vaccines should be given no sooner than 6 months after the end of treatment.
“Compared with past guidelines, the new recommendations place a greater emphasis on the timing of vaccinations relative to cancer treatment and the specific needs of patients undergoing novel therapies like CAR-T and B-cell-depleting therapy,” Kelkar said. “Vaccinations should be scheduled based on the anticipated reconstitution of the immune system — generally 3 to 6 months post-treatment — and only non-live vaccines are recommended during this period to avoid the risk for infection from live vaccines.”
Future research
Kelkar believes immunogenicity of vaccines must be studied more to understand how various treatments affect vaccine response.
He also stressed the need for vaccine trials to include more patients with cancer to better understand the safety and efficacy in the population.
“Recent examples where this was not done include [respiratory syncytial virus] and COVID-19 vaccine trials,” he said.
Finally, timing of vaccines following transplant and cell therapies needs further examination.
“There is notable center-specific variation in vaccine selection and timing after allogeneic and autologous transplant, as well as after cell therapies like CAR-T and B-cell-depleting therapies,” Kelkar said. “Future studies should focus on the sequence and timing of these in these unique populations to maximize benefit to these patients.”
For more information:
Amar H. Kelkar, MD, MPH, can be reached at amarh_kelkar@dfci.harvard.edu.
Collapse
Kamboj M, et al. J Clin Oncol. 2024;doi:10.1200/JCO.24.00032.
Click Here to Manage Email Alerts