1
|
Zhao G, Wang Y, Xing S, Jiang Y, Ding J, Cai Y, Ma P, Miao H, Fang Y, Jiang N, Cui D, Yu Y, Tang Q, Wang S, Li N. Exosome-based anticancer vaccines: From Bench to bedside. Cancer Lett 2024; 595:216989. [PMID: 38825162 DOI: 10.1016/j.canlet.2024.216989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/04/2024]
Abstract
Exosomes, a subset of extracellular vesicles, are released by all active cells and play a crucial role in intercellular communications. Exosomes could facilitate the transfer of various biologically active molecules, such as DNA, non-coding RNAs, and proteins, from donor to recipient cells, thereby participating in diverse biological and pathological processes. Besides, exosomes possess unique characteristics, including non-toxicity, low-immunogenicity, and stability within biological systems, rendering them highly advantageous for cancer drug development. Meanwhile, accumulating evidence suggests that exosomes originating from tumor cells and immune cells possess distinct composition profiles that play a direct role in anticancer immunotherapy. Of note, exosomes can transport their contents to specific cells, thereby exerting an impact on the phenotype and immune-regulatory functions of targeted cells. Therapeutic cancer vaccines, an emerging therapeutics of immunotherapy, could enhance antitumor immune responses by delivering a large number of tumor antigens, thereby augmenting the immune response against tumor cells. Therefore, the therapeutic rationale of cancer vaccines and exosome-based immunotherapy are almost similar to some extent, but some challenges have hindered their application in the clinical setting. Here, in this review, we first summarized the biogenesis, structure, compositions, and biological functions of exosomes. Then we described the roles of exosomes in cancer biology, particularly in tumor immunity. We also comprehensively reviewed current exosome-based anticancer vaccine development and we divided them into three types. Finally, we give some insights into clinical translation and clinical trial progress of exosome-based anticancer vaccines for future direction.
Collapse
Affiliation(s)
- Guo Zhao
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuning Wang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shujun Xing
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yale Jiang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiatong Ding
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuanting Cai
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Peiwen Ma
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Huilei Miao
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuan Fang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Jiang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dandan Cui
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yue Yu
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qiyu Tang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuhang Wang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Ning Li
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| |
Collapse
|
2
|
Harris DA, Chachlani P, Hayes KN, McCarthy EP, Wen KJ, Deng Y, Zullo AR, Djibo DA, McMahill-Walraven CN, Smith-Ray RL, Gravenstein S, Mor V. COVID-19 and Influenza Vaccine Coadministration Among Older U.S. Adults. Am J Prev Med 2024; 67:67-78. [PMID: 38401746 PMCID: PMC11193626 DOI: 10.1016/j.amepre.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Coadministering COVID-19 and influenza vaccines is recommended by public health authorities and intended to improve uptake and convenience; however, the extent of vaccine coadministration is largely unknown. Investigations into COVID-19 and influenza vaccine coadministration are needed to describe compliance with newer recommendations and to identify potential gaps in the implementation of coadministration. METHODS A descriptive, repeated cross-sectional study between September 1, 2021 to November 30, 2021 (Period 1) and September 1, 2022 to November 30, 2022 (Period 2) was conducted. This study included community-dwelling Medicare beneficiaries ≥ 66 years who received an mRNA COVID-19 booster vaccine in Periods 1 and 2. The outcome was an influenza vaccine administered on the same day as the COVID-19 vaccine. Adjusted ORs and 99% CIs were estimated using logistic regression to describe the association between beneficiaries' characteristics and vaccine coadministration. Statistical analysis was performed in 2023. RESULTS Among beneficiaries who received a COVID-19 vaccine, 78.8% in Period 1 (N=6,292,777) and 89.1% in Period 2 (N=4,757,501), received an influenza vaccine at some point during the study period (i.e., before, after, or on the same day as their COVID-19 vaccine), though rates were lower in non-White and rural individuals. Vaccine coadministration increased from 11.1% to 36.5% between periods. Beneficiaries with dementia (aORPeriod 2=1.31; 99%CI=1.29-1.32) and in rural counties (aORPeriod 2=1.19; 99%CI=1.17-1.20) were more likely to receive coadministered vaccines, while those with cancer (aORPeriod 2=0.90; 99%CI=0.89-0.91) were less likely. CONCLUSIONS Among Medicare beneficiaries vaccinated against COVID-19, influenza vaccination was high, but coadministration of the 2 vaccines was low. Future work should explore which factors explain variation in the decision to receive coadministered vaccines.
Collapse
Affiliation(s)
- Daniel A Harris
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
| | - Preeti Chachlani
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kaleen N Hayes
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Ellen P McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Katherine J Wen
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee
| | - Yalin Deng
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Andrew R Zullo
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Renae L Smith-Ray
- Walgreens Center for Health and Wellbeing Research, Walgreen Company, Deerfield, Illinios
| | - Stefan Gravenstein
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; Providence Medical Center Veterans Administration Research Service, Providence, Rhode Island
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island; Providence Medical Center Veterans Administration Research Service, Providence, Rhode Island
| |
Collapse
|
3
|
Dalu D, Ridolfo AL, Ruggieri L, Cona MS, Riva A, De Francesco D, Tricella C, Fasola C, Ferrario S, Gambaro A, Lombardi Stocchetti B, Smiroldo V, Rebecchi G, Piva S, Carrozzo G, Antinori S, La Verde N. Hospital-Based Influenza and Pneumococcal Vaccination for Cancer Patients on Active Treatment and Their Family Members during the COVID-19 Pandemic in Italy: A Single-Center Experience. Vaccines (Basel) 2024; 12:642. [PMID: 38932371 PMCID: PMC11209258 DOI: 10.3390/vaccines12060642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
In patients with cancer, tumor- and treatment-induced immunosuppression are responsible for a four-fold increase in morbidity and mortality caused by influenza and invasive Streptococcus pneumoniae infections compared to the general population. The main oncology societies strongly recommend vaccination in patients with cancer to prevent these infections. However, vaccine hesitancy is a main concern in this population. The aim of this study was to assess the feasibility of in-hospital vaccination for patients under anticancer treatment and their family members (FMs) against influenza and pneumococcal infections during the COVID-19 pandemic in order to increase vaccine coverage. This was a single-center, prospective, observational study conducted at the Department of Oncology of Luigi Sacco University Hospital (Milan, Italy) between October 2020 and April 2021. The main primary outcome was the incidence of influenza-like illness (ILI) and pneumococcal infections. The main secondary outcome was safety. A total of 341 subjects were enrolled, including 194 patients with cancer and 147 FMs. The incidence of ILI was higher among patients than among FMs (9% vs. 2.7%, OR 3.92, p = 0.02). Moreover, two subjects were diagnosed with pneumococcal pneumonia. The most frequent vaccine-related AEs were pain in the injection site (31%) and fatigue (8.7%). In conclusion, this hospital-based vaccination strategy was feasible during the COVID-19 pandemic, representing a potential model to maximize vaccine coverage during a public health emergency.
Collapse
Affiliation(s)
- Davide Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
| | - Lorenzo Ruggieri
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Maria Silvia Cona
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Agostino Riva
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, 20157 Milan, Italy
| | | | - Chiara Tricella
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Cinzia Fasola
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Sabrina Ferrario
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Anna Gambaro
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Benedetta Lombardi Stocchetti
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Valeria Smiroldo
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Gaia Rebecchi
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Sheila Piva
- Department of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy;
| | - Giorgia Carrozzo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, 20157 Milan, Italy
| | - Nicla La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| |
Collapse
|
4
|
Bonanni P, Maio M, Beretta GD, Icardi G, Rossi A, Cinieri S. Improving Influenza Vaccination Coverage in Patients with Cancer: A Position Paper from a Multidisciplinary Expert Group. Vaccines (Basel) 2024; 12:420. [PMID: 38675802 PMCID: PMC11053698 DOI: 10.3390/vaccines12040420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with cancer can be immunocompromised because of their disease and/or due to anticancer therapy. In this population, severe influenza virus infections are associated with an elevated risk of morbidity and mortality. Influenza vaccination is therefore highly recommended in cancer patients, including those receiving anticancer therapy. However, vaccination coverage remains far below the recommended target for vulnerable subjects. Six specialists in oncology, hematology, immunology, and public health/vaccinology convened with the objective of developing strategies, based on evidence and clinical experience, for improving influenza vaccination coverage in cancer patients. This viewpoint provides an overview of current influenza vaccination recommendations in cancer patients, discusses barriers to vaccination coverage, and presents strategies for overcoming said barriers. New immunization issues raised by the COVID-19 pandemic are also addressed. Future directions include improving public education on influenza vaccination, providing the media with accurate information, improving knowledge among healthcare professionals, improving access to vaccines for cancer patients, co-administration of the influenza and COVID-19 vaccines, increased collaboration between oncologists and other health professionals, increased accessibility of digital vaccination registries to specialists, shared information platforms, and promoting immunization campaigns by healthcare systems with the support of scientific societies.
Collapse
Affiliation(s)
- Paolo Bonanni
- Department of Health Sciences, University of Florence, Viale G.B. Morgagni 48, 50134 Florence, Italy;
| | - Michele Maio
- Medical Oncology, Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
- Department of Oncology, Center for Immuno-Oncology, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
| | - Giordano D. Beretta
- Medical Oncology Unit Pescara Hospital, Via Fonte Romana 8, 65124 Pescara, Italy;
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy;
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS Genoa, Largo Benzi 10, 16132 Genoa, Italy
| | - Alessandro Rossi
- Giunta Esecutiva SIMG, Via del Sansovino 172, 50142 Florence, Italy;
| | - Saverio Cinieri
- Medical Oncology and Breast Unit, Ospedale Perrino, S.S. 7 per Mesagne, 72100 Brindisi, Italy;
| |
Collapse
|
5
|
Lasagna A, Brunello A, Silvestris N, Pedrazzoli P, Di Maio M, Cinieri S. Italian oncologists and vaccinations against infectious diseases: Results of a survey of the Italian Association of Medical Oncology. TUMORI JOURNAL 2024; 110:60-68. [PMID: 37586016 PMCID: PMC10851644 DOI: 10.1177/03008916231191547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Patients with cancer present a higher risk of vaccine-preventable diseases. Recommended vaccinations are the most cost-effective measure to reduce the risk of transmission and related complications. Nevertheless, vaccination rates are inadequate. Oncologists have a central role in tailored vaccine communication to their patients. We present the results of a survey conducted by AIOM in 2022, focusing on the perception of the problem by oncologists. MATERIALS AND METHODS An anonymous 31-item online questionnaire was shared on 15 September 2022 on the AIOM website. The objectives of this survey were to examine the perception of Italian oncologists on vaccine-preventable diseases and the main available vaccines, their attitude towards recommending vaccines and the COVID-19 pandemic impact on their habits regarding vaccine-preventable diseases. RESULTS Between September 2022 and January 2023, 114 medical oncologists (5% of the members) completed the anonymous questionnaire. At the first oncological visit, only 30% of respondents usually propose a vaccination schedule to all their patient, 41% do not usually discuss vaccinations at the first visit and 29% recommend vaccines exclusively to specific categories of patients. For 56% of respondents, patients are more aware of the benefits of vaccines, whereas 36% reported that patients are worried of receiving too many vaccines. CONCLUSION This is the first survey conducted among Italian oncologists to better understand the perception and attitudes towards the vaccination. It highlights the urgent issues of educating and training oncologists in vaccine-preventable diseases and vaccine awareness and the need to build (or implement) a network of multidisciplinary collaborations.
Collapse
Affiliation(s)
- Angioletta Lasagna
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Brunello
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Paolo Pedrazzoli
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| |
Collapse
|
6
|
Mubarak S, Alsmadi O, Tbakhi A, Ata OA, Hassan A, AlGhawrie H. Impact of the SARS-CoV-2 pandemic on the overall respiratory viruses' transmission in a cancer care setting. Immun Inflamm Dis 2023; 11:e1073. [PMID: 38018583 PMCID: PMC10664391 DOI: 10.1002/iid3.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/27/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE The emergence of the COVID-19 pandemic raised questions about the interaction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. The objective of this study is to validate the impact of the SARS-CoV-2 pandemic and its interventional measures on the respiratory viruses' transmission/infection rates. METHODS A retrospective chart review was conducted for cancer patients who underwent laboratory-confirmed respiratory virus polymerase chain reaction (PCR) testing from January 2018 to June 2022. COVID-19 PCR tests from March 2020 to June 2022 were also included. Joinpoint regression analysis was applied to evaluate trends in respiratory virus rates. Statistical analysis was performed using Statistical Package for Social Science software. RESULTS A total of 6298 respiratory virus PCRs and 40,000 COVID-19 PCRs were performed. Data showed a significant decrease in respiratory viruses' positive cases, total respiratory tests, and respiratory viruses' activity during the pandemic period compared with the pre-pandemic period (p = .0209, .026, and .028, respectively). The joinpoint regression analysis showed a significant decrease of 13.85% in the tested positive cases of respiratory viruses between the years 2018 and 2022. Monthly, the analysis indicated a significant decrease in the positive cases by 13.46% from December 2019 to May 2021. Weekly analysis following lockdown initiation showed a reduction in respiratory virus cases. CONCLUSION This study provides valuable insights into the interplay between COVID-19 and other respiratory viruses, suggesting that the measures taken for COVID-19 were effective in reducing the spread of viral respiratory infections, aiding future infection control strategies to protect vulnerable populations, including cancer patients, from seasonal respiratory infections.
Collapse
Affiliation(s)
- Sawsan Mubarak
- Infection Control ProgramKing Hussein Cancer CenterAmmanJordan
| | - Osama Alsmadi
- Department of Cell Therapy & Applied GenomicsKing Hussein Cancer CenterAmmanJordan
| | - Abdelghani Tbakhi
- Department of Cell Therapy & Applied GenomicsKing Hussein Cancer CenterAmmanJordan
| | - Osama Abu Ata
- Department of Internal MedicineKing Hussein Cancer CenterAmmanJordan
| | - Ala'a Hassan
- Department of Cell Therapy & Applied GenomicsKing Hussein Cancer CenterAmmanJordan
| | | |
Collapse
|
7
|
Galloway K, Lambert P, Bow EJ, Czaykowski P, Fatoye T, Goldenberg B, Kristjanson M, Singh H, Bucher O, Decker K. Evaluation of the Impact of the Urgent Cancer Care Clinic on Emergency Department Visits, Primary Care Clinician Visits, and Hospitalizations in Winnipeg, Manitoba. Curr Oncol 2023; 30:6771-6785. [PMID: 37504356 PMCID: PMC10378500 DOI: 10.3390/curroncol30070496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
The urgent cancer care (UCC) clinic at CancerCare Manitoba (CCMB) opened in 2013 to provide care to individuals diagnosed with cancer and serious blood disorders experiencing complications from the underlying disorder or its treatment. This study examined the impact of the UCC clinic on other health care utilization in Winnipeg, Manitoba, Canada. An interrupted time series study design was used to compare the rates of emergency department (ED) visits, primary care clinician (PCC) visits, and hospitalizations from 1 January 2010 to 31 December 2015. Rates of ED visits were also stratified by ED location, severity, and cancer type. We found a 6% (95% CI 1.00-1.13, p-value = 0.0389) increase in PCC visits, a 7% (95% CI 0.99-1.15, p-value = 0.0737) increase in hospitalizations, a 4% (95% CI 0.86-1.08, p-value = 0.5053) decrease in the rate of ED visits, and a 3% (95% CI 0.92-1.17, p-value = 0.5778) increase in the rate of ED visits during the UCC clinic hours after the UCC clinic opened. The implementation of the UCC clinic had minimal impact on health care utilization. Future work should examine the impact of the UCC clinic on other aspects of healthcare utilization (e.g., number of tests ordered and time spent waiting in CCMB's main clinics) and patient quality of life and patient and health care provider experience.
Collapse
Affiliation(s)
- Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
| | - Pascal Lambert
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Eric J Bow
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, MB R3E 0J9, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Tunji Fatoye
- Department of Primary Care Oncology, Cancer Care Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
| | - Benjamin Goldenberg
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Mark Kristjanson
- Department of Primary Care Oncology, Cancer Care Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Harminder Singh
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Kathleen Decker
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| |
Collapse
|
8
|
Bersanelli M, Verzoni E, Cortellini A, Giusti R, Calvetti L, Ermacora P, Di Napoli M, Catino A, Guadalupi V, Guaitoli G, Scotti V, Mazzoni F, Veccia A, Guglielmini PF, Perrone F, Maruzzo M, Rossi E, Casadei C, Montesarchio V, Grossi F, Rizzo M, Travagliato Liboria MG, Mencoboni M, Zustovich F, Fratino L, Accettura C, Cinieri S, Camerini A, Sorarù M, Zucali PA, Ricciardi S, Russo A, Negrini G, Banzi MC, Lacidogna G, Fornarini G, Laera L, Mucciarini C, Santoni M, Mosillo C, Bonetti A, Longo L, Sartori D, Baldini E, Guida M, Iannopollo M, Bordonaro R, Morelli MF, Tagliaferri P, Spada M, Ceribelli A, Silva RR, Nolè F, Beretta G, Giovanis P, Santini D, Luzi Fedeli S, Nanni O, Maiello E, Labianca R, Pinto C, Clemente A, Tognetto M, De Giorgi U, Pignata S, Di Maio M, Buti S, Giannarelli D. Impact of influenza vaccination on survival of patients with advanced cancer receiving immune checkpoint inhibitors (INVIDIa-2): final results of the multicentre, prospective, observational study. EClinicalMedicine 2023; 61:102044. [PMID: 37434748 PMCID: PMC10331809 DOI: 10.1016/j.eclinm.2023.102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background The prospective multicentre observational INVIDIa-2 study investigated the clinical effectiveness of influenza vaccination in patients with advanced cancer receiving immune checkpoint inhibitors (ICI). In this secondary analysis of the original trial, we aimed to assess the outcomes of patients to immunotherapy based on vaccine administration. Methods The original study enrolled patients with advanced solid tumours receiving ICI at 82 Italian Oncology Units from Oct 1, 2019, to Jan 31, 2020. The trial's primary endpoint was the time-adjusted incidence of influenza-like illness (ILI) until April 30, 2020, the results of which were reported previously. Secondary endpoints (data cut-off Jan 31, 2022) included the outcomes of patients to immunotherapy based on vaccine administration, for which the final results are reported herein. A propensity score matching by age, sex, performance status, primary tumour site, comorbidities, and smoking habits was planned for the present analysis. Only patients with available data for these variables were included. The outcomes of interest were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease-control rate (DCR). Findings The original study population consisted of 1188 evaluable patients. After a propensity score matching, 1004 patients were considered (502 vaccinated and 502 unvaccinated), and 986 of them were evaluable for overall survival (OS). At the median follow-up of 20 months, the influenza vaccination demonstrated a favourable impact on the outcome receiving ICI in terms of median OS [27.0 months (CI 19.5-34.6) in vaccinated vs. 20.9 months (16.6-25.2) in unvaccinated, p = 0.003], median progression-free survival [12.5 months (CI 10.4-14.6) vs. 9.6 months (CI 7.9-11.4), p = 0.049], and disease-control rate (74.7% vs. 66.5%, p = 0.005). The multivariable analyses confirmed the favourable impact of influenza vaccination in terms of OS (HR 0.75, 95% C.I. 0.62-0.92; p = 0.005) and DCR (OR 1.47, 95% C.I. 1.11-1.96; p = 0.007). Interpretation The INVIDIa-2 study results suggest a favourable immunological impact of influenza vaccination on the outcome of cancer patients receiving ICI immunotherapy, further encouraging the vaccine recommendation in this population and supporting translational investigations about the possible synergy between antiviral and antitumour immunity. Funding The Federation of Italian Cooperative Oncology Groups (FICOG), Roche S.p.A., and Seqirus.
Collapse
Affiliation(s)
| | - Elena Verzoni
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant’Andrea, Roma, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS)8 Berica, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy
| | - Marilena Di Napoli
- Department of Uro Gynecological Oncology, Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Valentina Guadalupi
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giorgia Guaitoli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vieri Scotti
- SODc Radioterapia Oncologica, DAI Oncologia, AOU Careggi, Firenze, Italy
| | | | | | | | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Maruzzo
- Oncologia Medica 1, Dipartimento di Oncologia, Istituto Oncologico Veneto IOV–IRCCS, Padova, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera Specialistica dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Francesco Grossi
- Università degli Studi dell’Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Manlio Mencoboni
- SSD Oncologia, Villa Scassi Hospital, ASL3 Regione Liguria, Genova, Italy
| | | | | | | | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital - Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, ULSS 6 Euganea, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Serena Ricciardi
- UOSD Pneumologia Oncologica, Az. Ospedal. San Camillo Forlanini, Roma, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giorgia Negrini
- Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Banzi
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gaetano Lacidogna
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Letizia Laera
- UOC di Oncologia e Oncoematologia Ente Ecclesiastico Ospedale Generale Regionale “Miulli” Acquaviva delle Fonti (BA), Italy
| | | | - Matteo Santoni
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Claudia Mosillo
- Department of Oncology, Medical & Translational Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Verona, Legnago, Italy
| | - Lucia Longo
- UOSD Oncologia Area Sud Azienda AUSL Modena, Sassuolo (MO), Italy
| | | | | | - Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto dei Tumori “Giovanni Paolo II”, Bari, Italy
| | - Mauro Iannopollo
- SOC Oncologia, Dipartimento di Oncologia, Azienda Usl Toscana Centro, Presidio Ospedaliero SS. Cosma e Damiano - Pescia e San Jacopo, Pistoia, Italy
| | | | | | | | - Massimiliano Spada
- UOC Oncologia, Fondazione Istituto G. Giglio - C.da Pietrapollastra-Pisciotto SNC, Cefalù (PA), Italy
| | - Anna Ceribelli
- Department of Oncology, San Camillo De Lellis Hospital, Rieti, Italy
| | - Rosa Rita Silva
- Medical Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head & Neck Tumours IEO, European Institute of Oncology IRCCS, Milano, Italy
| | | | - Petros Giovanis
- UOC Oncologia, Ospedale Santa Maria del Prato, Feltre, AULSS1 Dolomiti, Feltre, Italy
| | - Daniele Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università di Roma, Romaa, Italy
| | - Stefano Luzi Fedeli
- Department of Medical Oncology, AOU Ospedali Riuniti, Presidio San Salvatore, Pesaro, Italy
| | - Oriana Nanni
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Evaristo Maiello
- Department of Oncology, Fondazione “Casa Sollievo della Sofferenza” IRCCS Hospital, San Giovanni Rotondo, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Roberto Labianca
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
- Medical Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Alberto Clemente
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Michele Tognetto
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Sandro Pignata
- Department of Uro Gynecological Oncology, Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Diana Giannarelli
- Facility of Epidemiology & Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | |
Collapse
|
9
|
Pedrazzoli P, Lasagna A, Cassaniti I, Piralla A, Squeri A, Bruno R, Sacchi P, Baldanti F, Di Maio M, Beretta GD, Cinieri S, Silvestris N. Vaccination for seasonal flu, pneumococcal infection, and SARS-CoV-2 in patients with solid tumors: recommendations of the Associazione Italiana di Oncologia Medica (AIOM). ESMO Open 2023; 8:101215. [PMID: 37104930 PMCID: PMC10067463 DOI: 10.1016/j.esmoop.2023.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Patients with cancer have a well-known and higher risk of vaccine-preventable diseases (VPDs). VPDs may cause severe complications in this setting due to the immune system impairment, malnutrition and oncological treatments. Despite this evidence, vaccination rates are inadequate. The Italian Association of Medical Oncology (AIOM) has been involved in vaccination awareness since 2014. Based on a careful review of the available data about the immunogenicity, effectiveness and safety of flu, pneumococcal and anti-SARS-CoV-2 vaccines, we report the recommendations of the Associazione Italiana di Oncologia Medica about these vaccinations in adult patients with solid tumors. AIOM recommends comprehensive education on the issue of VPDs. We believe that a multidisciplinary care model may improve the vaccination coverage in immunocompromised patients. Continued surveillance, implementation of preventive practices and future well-designed immunological prospective studies are essential for a better management of our patients with cancer.
Collapse
Affiliation(s)
- P Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - I Cassaniti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Squeri
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy; School of Specialization in Medical Oncology, University of Messina, Messina, Italy
| | - R Bruno
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Sacchi
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Baldanti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - G D Beretta
- Medical Oncology Unit, Santo Spirito Hospital, Pescara, Italy
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| |
Collapse
|
10
|
Lopez-Olivo MA, Valerio V, Karpes Matusevich AR, Brizio M, Kwok M, Geng Y, Suarez-Almazor ME, Colmegna I. Safety and Efficacy of Influenza Vaccination in Patients Receiving Immune Checkpoint Inhibitors. Systematic Review with Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10081195. [PMID: 36016085 PMCID: PMC9412390 DOI: 10.3390/vaccines10081195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 12/24/2022] Open
Abstract
The potential increased risk of immune-related adverse events (irAEs) post-influenza vaccine is a concern in patients receiving immune checkpoint inhibitors (ICI). We conducted a systematic review with meta-analysis of studies reporting the effects of influenza vaccination in patients with cancer during ICI treatment. We searched five electronic databases until 01/2022. Two authors independently selected studies, appraised their quality, and collected data. The primary outcome was the determination of pooled irAE rates. Secondary outcomes included determination of immunogenicity and influenza infection rates and cancer-related outcomes. Nineteen studies (26 publications, n = 4705) were included; 89.5% were observational. Vaccinated patients reported slighter lower rates of irAEs compared to unvaccinated patients (32% versus 41%, respectively). Seroprotection for influenza type A was 78%-79%, and for type B was 75%. Influenza and irAE-related death rates were similar between groups. The pooled proportion of participants reporting a laboratory-confirmed infection was 2% (95% CI 0% to 6%), and influenza-like illness was 14% (95% CI 2% to 32%). No differences were reported on the rates of laboratory-confirmed infection between vaccinated and unvaccinated patients. Longer progression-free and overall survival was also observed in vaccinated compared with unvaccinated patients. Current evidence suggests that influenza vaccination is safe in patients receiving ICIs, does not increase the risk of irAEs, and may improve survival.
Collapse
Affiliation(s)
- Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-563-0020
| | - Valeria Valerio
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada; (V.V.); (I.C.)
| | | | - Marianela Brizio
- Division of Experimental Medicine, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Michelle Kwok
- Department of Clinical Immunology and Allergy, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX 77030, USA;
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ines Colmegna
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada; (V.V.); (I.C.)
| |
Collapse
|
11
|
Bersanelli M, Giannarelli D, De Giorgi U, Pignata S, Di Maio M, Clemente A, Verzoni E, Giusti R, Di Napoli M, Aprile G, Ermacora P, Catino A, Scotti V, Mazzoni F, Guglielmini PF, Veccia A, Maruzzo M, Rossi E, Grossi F, Casadei C, Ficorella C, Montesarchio V, Verderame F, Rizzo M, Guaitoli G, Fratino L, Accettura C, Mencoboni M, Zustovich F, Baldessari C, Cinieri S, Camerini A, Laera L, Sorarù M, Zucali PA, Guadalupi V, Leonardi F, Tiseo M, Tognetto M, Di Costanzo F, Pinto C, Negrini G, Russo A, Migliorino MR, Filetti M, Buti S. INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors: a multicenter prospective observational study (INVIDIa-2). J Immunother Cancer 2021; 9:jitc-2021-002619. [PMID: 34016723 PMCID: PMC8141439 DOI: 10.1136/jitc-2021-002619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background Until now, no robust data supported the efficacy, safety and recommendation for influenza vaccination in patients with cancer receiving immune checkpoint inhibitors (ICIs). Methods The prospective multicenter observational INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors (INVIDIa-2) study investigated the clinical effectiveness of influenza vaccination in patients with advanced cancer receiving ICIs, enrolled in 82 Italian centers from October 2019 to January 2020. The primary endpoint was the time-adjusted incidence of influenza-like illness (ILI) until April 30, 2020. Secondary endpoints regarded ILI severity and vaccine safety. Results The study enrolled 1279 patients; 1188 patients were evaluable for the primary endpoint analysis. Of them, 48.9% (581) received influenza vaccination. The overall ILI incidence was 8.2% (98 patients). Vaccinated patients were significantly more frequently elderly (p<0.0001), males (p=0.004), with poor European Cooperative Oncology Group performance status (p=0.009), affected by lung cancer (p=0.01), and by other non-cancer comorbidities (p<0.0001) when compared with unvaccinated. ILI incidence was not different basing on influenza vaccination: the time-to-ILI was similar in vaccinated and unvaccinated patients (p=0.62). ILI complications were significantly less frequent for patients receiving the vaccination (11.8% vs 38.3% in unvaccinated, p=0.002). ILI-related intravenous therapies were significantly less frequent in vaccinated patients than in unvaccinated (11.8% vs 29.8%, p=0.027). ILI lethality was, respectively, 0% in vaccinated and 4.3% in unvaccinated patients. Vaccine-related adverse events were rare and mild (1.5%, grades 1–2). Conclusion The INVIDIa-2 study results support a positive recommendation for influenza vaccination in patients with advanced cancer receiving immunotherapy.
Collapse
Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, Parma, Italy .,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- UC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Torino, Italy.,Medical Oncology, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Alberto Clemente
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elena Verzoni
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marilena Di Napoli
- UC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria integrata Friuli Centrale, Udine, Italy
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Grossi
- Medical Oncology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Corrado Ficorella
- Department of Biotechnological and Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Vincenzo Montesarchio
- UOC Oncologia, Azienda Ospedaliera Specialistica dei Colli, Ospedale Monaldi, Napoli, Italy
| | | | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Giorgia Guaitoli
- Medical Oncology Unit, Universita degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Lucia Fratino
- Medical Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S.Martino, Belluno, Italy
| | - Cinzia Baldessari
- Medical Oncology Unit, Universita degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, Brindisi, Italy
| | - Andrea Camerini
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Letizia Laera
- Medical Oncology, Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Puglia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, ULSS 6 Euganea, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Oncology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Valentina Guadalupi
- UC Oncologia Medica Uro-Ginecologica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marcello Tiseo
- Medicine and Surgery Department, University of Parma, Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Michele Tognetto
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.,Presidency of the Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | | | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | | | - Marco Filetti
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | |
Collapse
|
12
|
Silvestris N, Di Maio M, Russo A, Chiari R, De Giorgi U, Del Mastro L, Giuffrida D, La Verde N, Perrone F, Tucci M, Beretta GD, Cinieri S. COVID-19 infection in cancer patients: what has been the contribution of Associazione Italiana Oncologia Medica (AIOM) to oncological care since the beginning of the first pandemic wave? ESMO Open 2021; 6:100100. [PMID: 33819751 PMCID: PMC7973080 DOI: 10.1016/j.esmoop.2021.100100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
High mortality rates in elderly patients or in those with underlying chronic illnesses and/or a compromised immune system is a peculiar feature of COVID-19 infection. The possible coexistence of a cancer and COVID-19 infection in the same individual prompted concerns regarding their synergistic effect on prognosis. In order to balance patients’ needs with the risks related to the infection, the question oncologists have asked from the beginning of the first wave of the pandemic has been: ‘how can we deal with COVID-19 infection in cancer patients?’ In pursuing its mission, the Associazione Italiana Oncologia Medica (AIOM) has made every possible effort to support cancer patients, health care professionals and institutions in the decision-making processes the pandemic has engendered within this scenario. The relevant documents as well as the educational and institutional initiatives the AIOM has taken are reported in this article. AIOM made all efforts to support cancer patients, health care professionals and institutions during the COVID-19 pandemic. ConFederazione degli Oncologi, Cardiologi e Ematologi is the first technical round table in the world bringing together oncologists, cardiologists and hematologists. In November 2020, AIOM, COMU and CIPOMO updated specific COVID-19 recommendations for medical oncology. AIOM has recommended that authorities include cancer patients receiving therapy in the high priority group for vaccination.
Collapse
Affiliation(s)
- N Silvestris
- IRCCS Istituto Tumori 'Giovanni Paolo II' of Bari, Bari, Italy; DIMO Università degli Studi di Bari, Bari, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - R Chiari
- UOC Oncologia Padova Sud, Azienda ULSS 6 Euganea, Padua, Italy
| | - U De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori 'Dino Amadori' (IRST) IRCCS, Meldola, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - D Giuffrida
- Department of Experimental Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Italy
| | - N La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - F Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Naples, Italy
| | - M Tucci
- Medical Oncology, Cardinal Massaia Hospital, Asti, Italy
| | - G D Beretta
- Medical Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | - S Cinieri
- Medical Oncology Unit, Antonio Perrino Hospital, Brindisi, Italy.
| |
Collapse
|
13
|
Valachis A, Rosén C, Koliadi A, Digkas E, Gustavsson A, Nearchou A, Ullenhag GJ. Improved survival without increased toxicity with influenza vaccination in cancer patients treated with checkpoint inhibitors. Oncoimmunology 2021; 10:1886725. [PMID: 33643697 PMCID: PMC7894446 DOI: 10.1080/2162402x.2021.1886725] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
In international guidelines, influenza vaccination is recommended to cancer patients receiving antitumor treatment. Whether this recommendation should include patients treated with the recently introduced and now widely used checkpoint inhibitors (CPIs) is unclear. The immune hyperactivation after vaccination in a patient on CPI treatment may strengthen the antitumor immunity and improve patients´ prognosis. On the other hand, the hyperactivation might increase the risk for immune-related adverse events (IRAEs). Furthermore, there is a risk for decreased antitumor effect by the phenomenon of antigenic competition. Only results from few studies addressing survival have been reported and the results from studies on IRAEs are contradictory. We performed a multi-center retrospective cohort study at three Swedish centers in patients with metastatic cancer. All patients previously not treated with CPIs and who received monotherapy with a PD-1 or PD-L1 blocker between January 1st, 2016 until May 31st, 2019 were included. The most common type of malignancy was melanoma (47.8%) followed by non-small cell lung cancer (31.0%). Statistically significant longer PFS and OS were observed in multivariate analyses at 6-month landmark time in the vaccinated compared to the non-vaccinated group after adjustment for age, gender, comorbidity, performance status, CNS metastasis and line of treatment (p = .041 and 0.028, respectively). Furthermore, the incidence of any IRAE grade was comparable between vaccinated and non-vaccinated group (p = .85). In conclusion, the current study indicates that survival improves with influenza vaccination while not increasing the risk for side effects in cancer patients treated with checkpoint inhibitors. Hence, our results strongly support influenza vaccination in cancer patients receiving checkpoint inhibitors.
Collapse
Affiliation(s)
| | - Camilla Rosén
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anthoula Koliadi
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | | | | | | | - Gustav J Ullenhag
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
14
|
Maeda T, Sasaki H, Togawa A, Tanaka T, Arima H, Takata T, Takamatsu Y. Surveillance of the current situation regarding influenza vaccination according to medical oncologists in Japan. Cancer Sci 2021; 112:433-443. [PMID: 33215475 PMCID: PMC7780033 DOI: 10.1111/cas.14742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022] Open
Abstract
This study aimed to clarify the attitude of oncologists toward influenza vaccination and the current situation and issues regarding influenza vaccination for patients on chemotherapy in Japan. A web-based survey of medical oncologists certified by the Japanese Society of Medical Oncology was conducted between November 1 and December 31, 2019. Of the 1369 medical oncologists who were invited to participate, 415 (30.3%) responded to our survey. The questionnaire comprised 4 sections: "oncologist characteristics," "oncologist attitude toward influenza vaccines and the current status of influenza vaccination for cancer patients undergoing chemotherapy," "incidence of influenza infection and associated treatment complications," and "treatment policy for influenza infection." In total, 153 (36.9%) physicians replied that they did not actively encourage influenza vaccination for patients undergoing chemotherapy. The primary reasons given were lack of evidence (48/153, 31.4%) and uncertainty of appropriate timing (46/153, 30.1%). There was diverse variation in the timing of vaccination and in the levels of encouragement based on the cancer location and medication type. Two hundred eighty-three (68.2%) oncologists reported that their cancer patients had experienced influenza infection while undergoing chemotherapy, and 169 (40.7%) responded that their patients had experienced an administration delay or discontinuation of medication because of influenza infection. Our surveillance revealed some oncologists considered evidence regarding the administration of influenza vaccine to cancer patients undergoing chemotherapy (particularly the optimal timing and level of recommendation by cancer location and medication) to be lacking. It also exposed the adverse impact of influenza infection in cancer patients.
Collapse
Affiliation(s)
- Toshiki Maeda
- Department of Preventive Medicine and Public HealthFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Hidenori Sasaki
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Atsushi Togawa
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Toshihiro Tanaka
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public HealthFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Tohru Takata
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Yasushi Takamatsu
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| |
Collapse
|
15
|
Bersanelli M, Buti S, Banna GL, De Giorgi U, Cortellini A, Rebuzzi SE, Tiseo M, Fornarini G, Mazzoni F, Panni S, Tursi MD, Marino PD, Rossetti S, Rossi E, Tomao S, Luca ED, Sorarù M, Mucciarini C, Atzori F, Torre LL, Vitale MG, Martelli V, Sepe P, Mollica V, Vaccaro V, Schinzari G, Ficorella C, Massari F, Maestri A, Sabbatini R, Sava T, Maio MD, Verzoni E, Procopio G, Giannarelli D. Impact of influenza syndrome and flu vaccine on survival of cancer patients during immunotherapy in the INVIDIa study. Immunotherapy 2020; 12:151-159. [PMID: 32089035 DOI: 10.2217/imt-2019-0180] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: INVIDIa was a retrospective, multicenter study, exploring the clinical efficacy of influenza vaccine in 300 cancer patients undergoing immunotherapy. Overall survival (OS) was immature at the initial report. Methods: We reported the final OS analysis from the original study population and within subgroups. Results: Both at the univariate and multivariate analysis, the occurrence of influenza syndrome (IS) was significantly related to better OS in the overall population (OR: 0.53 [95% CI: 0.32-0.88]; p = 0.01). In the lung cancer subgroup, receiving flu vaccine and/or developing IS was related to better OS (p = 0.04). Within elderly patients, the flu vaccine was the main variable for the relative OS advantage (p = 0.05). Conclusion: Receiving the flu vaccine and/or developing IS was related to better OS within the INVIDIa population.
Collapse
Affiliation(s)
- Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine & Surgery, University of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessio Cortellini
- Medical Oncology Unit, St Salvatore Hospital, L'Aquila, Italy.,Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine & Surgery, University of Parma, Parma, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | | | - Stefano Panni
- Medical Oncology Unit, ASST - Istituti Ospitalieri Cremona Hospital, Cremona, Italy
| | - Michele De Tursi
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Pietro Di Marino
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Sabrina Rossetti
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, S.S.D Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silverio Tomao
- Department of Medical & Surgical Sciences & Biotechnology, University "La Sapienza", Latina, Italy
| | - Emmanuele De Luca
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | | | | | - Francesco Atzori
- Medical Oncology, Department of Medical Sciences "M. Aresu", University Hospital & University of Cagliari, Cagliari, Italy
| | - Leonardo La Torre
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | | | - Valentino Martelli
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Pierangela Sepe
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Veronica Mollica
- Division of Oncology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Corrado Ficorella
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | | | - Antonio Maestri
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | | | - Teodoro Sava
- Medical Oncology, Camposampiero Hospital, Padova, Italy
| | - Massimo Di Maio
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | - Elena Verzoni
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Giuseppe Procopio
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| |
Collapse
|
16
|
Joona TB, Digkas E, Wennstig AK, Nyström K, Nearchou A, Nilsson C, Pauksens K, Valachis A. Influenza vaccination in breast cancer patients during subcutaneous trastuzumab in adjuvant setting. Breast Cancer Res Treat 2020; 184:45-52. [PMID: 32737713 PMCID: PMC7568724 DOI: 10.1007/s10549-020-05815-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/17/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite the current recommendation for influenza vaccination in cancer patients with active oncological therapy, limited data are available on the efficacy of vaccination in cancer patients receiving targeted therapies. We aimed to investigate the immunogenicity and tolerability of influenza vaccination in breast cancer patients treated with trastuzumab in adjuvant setting. METHODS A prospective open-label multicenter study was performed including patients with breast cancer during trastuzumab treatment in adjuvant setting and healthy controls. Blood samples were taken before, 4 weeks after, and 12 weeks after a single dose of trivalent influenza vaccine containing inactivated A/California/7/2009 (H1N1) pdm09, A/Hongkong4801/2014 (H3N2), and B/Brisbane/60/2008. Levels of serum antibody titers to hemagglutinin for H1N1 and influenza B strains were measured. RESULTS Twenty breast cancer patients and 37 controls were included in the study. No difference in seroprotection rate between trastuzumab-treated patients and controls was observed for either H1N1 (100% in both groups) or B strain (78.9% vs. 89.2%, p value = 0.423). A statistically significant increase in geometric mean titers from baseline was seen in both groups and was evident both 4 weeks and 12 weeks after vaccination. Adverse events in the trastuzumab-treated group were uncommon and mild with only one serious adverse event not related to vaccination. CONCLUSION Breast cancer patients treated with trastuzumab in adjuvant setting seem to benefit from influenza vaccination in terms of immunogenicity without increasing the risk for adverse events. The current data support the recommendation to offer influenza vaccination in breast cancer patients treated with this type of targeted therapy.
Collapse
Affiliation(s)
| | | | | | - Karin Nyström
- Department of Oncology, Faculty of Medicine & Health, Örebro University, 70182, Örebro, SE, Sweden
| | | | - Cecilia Nilsson
- Department of Oncology, Västerås Central Hospital, Västerås, Sweden
| | - Karlis Pauksens
- Department of Infectious Diseases, Uppsala University Hospital, Uppsala, Sweden
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine & Health, Örebro University, 70182, Örebro, SE, Sweden.
| |
Collapse
|
17
|
El Ramahi R, Freifeld A. Epidemiology, Diagnosis, Treatment, and Prevention of Influenza Infection in Oncology Patients. J Oncol Pract 2020; 15:177-184. [PMID: 30970229 DOI: 10.1200/jop.18.00567] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Influenza infection causes increased morbidity and higher mortality in patients receiving treatment of underlying cancer, particularly in those with hematological malignancy or patients who have undergone hematopoietic stem-cell transplantation. The illness is characterized by seasonality and nonspecific clinical manifestations of upper respiratory infection at a time when other respiratory illnesses are common in the community, making the diagnosis challenging. However, accurate and timely diagnosis by new molecular techniques is crucial in the management of immunocompromised patients, because delays in initiating appropriate therapy can have devastating consequences. Emergence of viral resistance to currently used antiviral agents is of concern, particularly in immunocompromised hosts, and warrants continued monitoring and surveillance. Early and effective treatment improves outcomes, but optimal therapeutic strategies in patients with cancer are not well defined. Health care and research efforts should focus on defining treatment guidelines in patients with cancer and attempt to improve on current vaccination strategies.
Collapse
|
18
|
Alhejazi A, Motabi I, Sagheir A, Alzahrani M, Dada R, Al-Mansour M, Alhashmi H, Kandil M. Primary Mediastinal Large B-Cell Lymphoma: Saudi Lymphoma Group's Clinical Practice Guidelines for Diagnosis, Management and Follow-up. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:231-233. [PMID: 31543751 PMCID: PMC6734725 DOI: 10.4103/sjmms.sjmms_106_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/12/2019] [Accepted: 07/23/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Central Region, Riyadh, Saudi Arabia
| | - Ibraheem Motabi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Sagheir
- Oncology Institute, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Reyad Dada
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Magdy Kandil
- Medical Oncology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Clinical Oncology Department, Cairo University, Giza, Egypt
| |
Collapse
|
19
|
Alzahrani M, Sagheir A, Motabi I, Dada R, Al-Mansour M, Alhashmi H, Kandil M, Alhejazi A. Mantle Cell Lymphoma: Saudi Lymphoma Group's Clinical Practice Guidelines for Diagnosis, Management and Follow-up. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:226-230. [PMID: 31543750 PMCID: PMC6734733 DOI: 10.4103/sjmms.sjmms_105_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/09/2019] [Accepted: 07/24/2019] [Indexed: 12/03/2022]
Affiliation(s)
- Musa Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Sagheir
- Oncology Institute, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Ibraheem Motabi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Reyad Dada
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, Saudi Arabia
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Magdy Kandil
- Oncology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Clinical Oncology Department, Cairo University, Giza, Egypt
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Central Region, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Bersanelli M, Giannarelli D, Castrignanò P, Fornarini G, Panni S, Mazzoni F, Tiseo M, Rossetti S, Gambale E, Rossi E, Papa A, Cortellini A, Lolli C, Ratta R, Michiara M, Milella M, De Luca E, Sorarù M, Mucciarini C, Atzori F, Banna GL, La Torre L, Vitale MG, Massari F, Rebuzzi SE, Facchini G, Schinzari G, Tomao S, Bui S, Vaccaro V, Procopio G, De Giorgi U, Santoni M, Ficorella C, Sabbatini R, Maestri A, Natoli C, De Tursi M, Di Maio M, Rapacchi E, Pireddu A, Sava T, Lipari H, Comito F, Verzoni E, Leonardi F, Buti S. INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors: a transversal challenge. The INVIDIa study. Immunotherapy 2019; 10:1229-1239. [PMID: 30326787 DOI: 10.2217/imt-2018-0080] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
AIM Considering the unmet need for the counseling of cancer patients treated with immune checkpoint inhibitors (CKI) about influenza vaccination, an explorative study was planned to assess flu vaccine efficacy in this population. METHODS INVIDIa was a retrospective, multicenter study, enrolling consecutive advanced cancer outpatients receiving CKI during the influenza season 2016-2017. RESULTS Of 300 patients, 79 received flu vaccine. The incidence of influenza syndrome was 24.1% among vaccinated, versus 11.8% of controls; odds ratio: 2.4; 95% CI: 1.23-4.59; p = 0.009. The clinical ineffectiveness of vaccine was more pronounced among elderly: 37.8% among vaccinated patients, versus 6.1% of unvaccinated, odds ratio: 9.28; 95% CI: 2.77-31.14; p < 0.0001. CONCLUSION Although influenza vaccine may be clinically ineffective in advanced cancer patients receiving CKI, it seems not to negatively impact the efficacy of anticancer therapy.
Collapse
Affiliation(s)
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Stefano Panni
- Medical Oncology Unit, ASST - Istituti Ospitalieri Cremona Hospital, Cremona, Italy
| | | | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sabrina Rossetti
- SSD Oncologia Clinica Sperimentale Uro-Andrologica, Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Elisabetta Gambale
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Ernesto Rossi
- Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Anselmo Papa
- Department of Medical & Surgical Sciences & Biotechnology, University "La Sapienza", Latina, Italy
| | - Alessio Cortellini
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Cristian Lolli
- Medical Oncology, Scientific Institute of Romagna for the Study & Treatment of Tumors (IRST) IRCCS, Meldola, Italy
| | - Raffaele Ratta
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Maria Michiara
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Michele Milella
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Emmanuele De Luca
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | | | | | - Francesco Atzori
- Department of Medical Sciences "M. Aresu", Medical Oncology, University Hospital & University of Cagliari, Cagliari, Italy
| | | | - Leonardo La Torre
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | | | | | - Sara Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Gaetano Facchini
- SSD Oncologia Clinica Sperimentale Uro-Andrologica, Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | | | - Silverio Tomao
- Department of Medical & Surgical Sciences & Biotechnology, University "La Sapienza", Latina, Italy
| | - Simona Bui
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Procopio
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Ugo De Giorgi
- Medical Oncology, Scientific Institute of Romagna for the Study & Treatment of Tumors (IRST) IRCCS, Meldola, Italy
| | | | - Corrado Ficorella
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Antonio Maestri
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Clara Natoli
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Michele De Tursi
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Massimo Di Maio
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Annagrazia Pireddu
- Department of Medical Sciences "M. Aresu", Medical Oncology, University Hospital & University of Cagliari, Cagliari, Italy
| | - Teodoro Sava
- Medical Oncology, Camposampiero Hospital, Padova, Italy
| | - Helga Lipari
- Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Francesca Comito
- Division of Oncology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Verzoni
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| |
Collapse
|
21
|
Bersanelli M, Buti S, De Giorgi U, Di Maio M, Giannarelli D, Pignata S, Banna GL. State of the art about influenza vaccination for advanced cancer patients receiving immune checkpoint inhibitors: When common sense is not enough. Crit Rev Oncol Hematol 2019; 139:87-90. [DOI: 10.1016/j.critrevonc.2019.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/04/2019] [Accepted: 05/05/2019] [Indexed: 12/16/2022] Open
|
22
|
Heo J, Chun M, Oh YT, Noh OK, Kim L. Influenza Among Breast Cancer Survivors in South Korea: A Nationwide Population-Based Study. ACTA ACUST UNITED AC 2018; 31:967-972. [PMID: 28882967 DOI: 10.21873/invivo.11155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/02/2017] [Accepted: 07/04/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM In this study, we analyzed the prevalence of influenza disease in breast cancer survivors using claims data from the Health Insurance Review and Assessment Service (HIRA) in South Korea. PATIENTS AND METHODS We defined influenza among a nationwide cohort of 87,843 patients who were diagnosed with breast cancer and underwent surgery from January 1, 2010 to December 31, 2014, based on HIRA claim data. Descriptive statistics were calculated to estimate the frequency of influenza disease using diagnostic code and utilization pattern at medical institutions. RESULTS Two thousand four hundred breast cancer survivors (2.7%) were diagnosed with influenza. The overall frequency of influenza increased from November (n=98) and peaked in February (n=1,745). Over 60% (2,693) of claims for influenza disease treatment were in the clinic, whereas general hospitals accounted for 22.0% (873). Among 3,967 claims, admission rate was 7.6% (n=301) and the average length of hospitalization was 4.7 days. Elderly breast cancer survivors over 70 years old had the longest length of hospitalization at 5.9 days. CONCLUSION Breast cancer survivors are more susceptible to influenza than non-cancer survivors. It is important not only to raise the vaccination rate among young cancer survivors, but also to quickly identify symptoms and begin treatment for flu in elderly cancer survivors.
Collapse
Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Logyoung Kim
- Health Insurance Review and Assessment Service, Seoul, Republic of Korea
| |
Collapse
|
23
|
Pedrazzoli P, Piralla A, Valentino F, Cinieri S, Baldanti F. Update of the recommendations of the Italian Society of Medical Oncology on vaccination for seasonal influenza and pneumococcal infection in patients with cancer: Focus on prevention of pneumonia. Eur J Cancer Care (Engl) 2018; 27:e12817. [PMID: 29575267 DOI: 10.1111/ecc.12817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- P. Pedrazzoli
- Medical Oncology; Department of Oncology and Precision Medicine; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - A. Piralla
- Molecular Virology Unit, Microbiology and Virology Department; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - F. Valentino
- Medical Oncology; Department of Oncology and Precision Medicine; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - S. Cinieri
- Medical Oncology Division; Antonio Perrino Hospital; Brindisi Italy
| | - F. Baldanti
- Molecular Virology Unit, Microbiology and Virology Department; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
- Department of Clinical; Surgical, Diagnostic and Pediatric Sciences; University of Pavia; Pavia Italy
| |
Collapse
|
24
|
Bitterman R, Eliakim‐Raz N, Vinograd I, Zalmanovici Trestioreanu A, Leibovici L, Paul M. Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database Syst Rev 2018; 2:CD008983. [PMID: 29388675 PMCID: PMC6491273 DOI: 10.1002/14651858.cd008983.pub3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND This is an update of the Cochrane review published in 2013, Issue 10.Immunosuppressed cancer patients are at increased risk of serious influenza-related complications. Guidelines, therefore, recommend influenza vaccination for these patients. However, data on vaccine effectiveness in this population are lacking, and the value of vaccination in this population remains unclear. OBJECTIVES To assess the effectiveness of influenza vaccine in immunosuppressed adults with malignancies. The primary review outcome is all-cause mortality, preferably at the end of the influenza season. Influenza-like illness (ILI, a clinical definition), confirmed influenza, pneumonia, any hospitalisations, influenza-related mortality and immunogenicity were defined as secondary outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and LILACS databases up to May 2017. We searched the following conference proceedings: ICAAC, ECCMID, IDSA (infectious disease conferences), ASH, ASBMT, EBMT (haematological), and ASCO (oncological) between the years 2006 to 2017. In addition, we scanned the references of all identified studies and pertinent reviews. We searched the websites of the manufacturers of influenza vaccine. Finally, we searched for ongoing or unpublished trials in clinical trial registry databases. SELECTION CRITERIA Randomised controlled trials (RCTs), prospective and retrospective cohort studies and case-control studies were considered, comparing inactivated influenza vaccines versus placebo, no vaccination or a different vaccine, in adults (16 years and over) with cancer. We considered solid malignancies treated with chemotherapy, haematological cancer patients treated or not treated with chemotherapy, cancer patients post-autologous (up to six months after transplantation) or allogeneic (at any time) haematopoietic stem cell transplantation (HSCT). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias and extracted data from included studies adhering to Cochrane methodology. Meta-analysis could not be performed because of different outcome and denominator definitions in the included studies. MAIN RESULTS We identified six studies with a total of 2275 participants: five studies comparing vaccination with no vaccination, and one comparing adjuvanted vaccine with non-adjuvanted vaccine. Three studies were RCTs, one was a prospective observational cohort study and two were retrospective cohort studies.For the comparison of vaccination with no vaccination we included two RCTs and three observational studies, including 2202 participants. One study reported results in person-years while the others reported results per person. The five studies were performed between 1993 and 2015 and included adults with haematological diseases (three studies), patients following bone marrow transplantation (BMT) (two studies) and solid malignancies (three studies).One RCT and two observational studies reported all-cause mortality; the RCT showed similar mortality rates in both arms (odds ratio (OR) 1.25 (95% CI 0.43 to 3.62; 1 study, 78 participants, low-certainty evidence)); and the observational studies demonstrated a significant association between vaccine receipt and lower risk of death, adjusted hazard ratio 0.88 (95% CI 0.78 to 1; 1 study, 1577 participants, very low-certainty evidence) in one study and OR 0.42 (95% CI 0.24 to 0.75; 1 study, 806 participants, very low-certainty evidence) in the other. One RCT reported a reduction in ILI with vaccination, while no difference was observed in one observational study. Confirmed influenza rates were lower with vaccination in one RCT and the three observational studies, the difference reaching statistical significance in one. Pneumonia was observed significantly less frequently with vaccination in one observational study, but no difference was detected in another or in the RCT. One RCT showed a reduction in hospitalisations following vaccination, while an observational study found no difference. No life-threatening or persistent adverse effects from vaccination were reported. The strength of evidence was limited by the low number of included studies and by their low methodological quality and the certainty of the evidence for the mortality outcome according to GRADE was low to very low.For the comparison of adjuvanted vaccine with non-adjuvanted vaccine, we identified one RCT, including 73 patients. No differences were found for the primary and all secondary outcomes assessed. Mortality risk ratio was 0.54 (95% CI 0.05 to 5.73; low-certainty evidence) in the adjuvanted vaccine group. The quality of evidence was low due to the small sample size and the large confidence intervals for all outcomes. AUTHORS' CONCLUSIONS Observational data suggest lower mortality and infection-related outcomes with influenza vaccination. The strength of evidence is limited by the small number of studies and low grade of evidence. It seems that the evidence, although weak, shows that the benefits overweigh the potential risks when vaccinating adults with cancer against influenza. However, additional placebo or no-treatment controlled RCTs of influenza vaccination among adults with cancer is ethically questionable.There is no conclusive evidence regarding the use of adjuvanted versus non-adjuvanted influenza vaccine in this population.
Collapse
Affiliation(s)
- Roni Bitterman
- Rambam Health Care CampusDivision of Infectious DiseasesHaifaIsrael
| | - Noa Eliakim‐Raz
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E; and Sackler Faculty of Medicine, Tel‐Aviv University, Israel39 Jabotinski StreetPetah TikvaIsrael49100
| | - Inbal Vinograd
- Schneider Children's Medical Centre of IsraelPharmacyPetah‐TikvaIsrael49100
| | | | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine EKaplan StreetPetah TikvaIsrael49100
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHaifaIsrael
| | | |
Collapse
|
25
|
Influenza vaccination in adult patients with solid tumours treated with chemotherapy. Eur J Cancer 2017; 76:134-143. [PMID: 28324748 DOI: 10.1016/j.ejca.2017.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 01/04/2023]
Abstract
Patients with solid tumours receiving chemotherapy are at risk for influenza complications. Yearly influenza vaccination is recommended to patients treated with chemotherapy. However, adherence to vaccination is low, most likely due to lack of data on efficacy, optimal timing and safety of vaccination. There is scarce evidence for the effectiveness of the influenza vaccine in adult patients with solid tumours and chemotherapy on reduction of pneumonia, decreased mortality and fewer interruptions of oncological treatment. A review of 20 non-randomised serological studies in adult patients with different cancer types and chemotherapy provides insight in general trends of response to vaccination. Overall, the magnitude of the antibody response after influenza vaccination (i.e. seroconversion) can be lower than in healthy controls, but the majority of patients with solid tumours is able to mount a timely, protective immunological response (i.e. seroprotection) regardless of chemotherapy schedule, similar to healthy controls. Small sample sizes, patient heterogeneity and lack of comparable study designs limit more specific recommendations related to cancer type and optimal timing of vaccination. The inactivated influenza vaccine is safe to administer to immunosuppressed patients; side-effects are similar to those in healthy individuals. Although vaccination before start of chemotherapy is preferred to ensure optimal protection in adults with solid tumours, also vaccination during chemotherapy can reduce influenza-related complications considering the overall trends in serological response. Given the increased morbidity and mortality of influenza, influenza vaccination should be advocated as an inexpensive and safe preventive measure in patients with solid tumours receiving chemotherapy.
Collapse
|
26
|
Eibl MM, Wolf HM. Vaccination in patients with primary immune deficiency, secondary immune deficiency and autoimmunity with immune regulatory abnormalities. Immunotherapy 2015; 7:1273-92. [PMID: 26289364 DOI: 10.2217/imt.15.74] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Vaccination has been an important healthcare measure in preventing infectious diseases. The response to vaccination is reduced in immunocompromised patients, primary immune deficiency (PID) and secondary immune deficiency (SID), but vaccination studies still demonstrated a protective effect resulting in reducing complications, hospitalization, treatment costs and even mortality. The primary physician and the specialist directing patient care are responsible for vaccination. Live vaccines are contraindicated in patients with severe immune impairment, killed vaccines are highly recommended in PID and SID. Criteria have been defined to distinguish high- or low-level immune impairment in the different disease entities among PID and SID patients. For patients who do not respond to diagnostic vaccination as characterized by antibody failure immunoglobulin replacement is the mainstay of therapy.
Collapse
Affiliation(s)
- Martha M Eibl
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
| | - Hermann M Wolf
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
| |
Collapse
|
27
|
Antiviral prophylaxis in patients with solid tumours and haematological malignancies--update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol 2015; 94:1441-50. [PMID: 26193852 PMCID: PMC4525190 DOI: 10.1007/s00277-015-2447-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/06/2015] [Indexed: 01/17/2023]
Abstract
Reactivation of viral infections is common in patients with solid tumour or haematological malignancy. Incidence and severity depend on the extent of cellular immunosuppression. Antiviral prophylaxis may be effective to prevent viral reactivation. In 2006, the Infectious Diseases Working Party of German Society for Hematology and Medical Oncology (DGHO) published guidelines for antiviral prophylaxis in these patient populations. Here, we present an update of these guidelines for patients with solid and haematological malignancies undergoing antineoplastic treatment but not allogeneic stem cell transplantation. Relevant literature for reactivation of different viruses (herpes simplex virus (HSV), varicella zoster virus (VZV), hepatitis B virus (HBV) and respiratory viruses) is discussed to provide evidence-based recommendations for clinicians taking care of this patient population. We recommend a risk-adapted approach with (val)acyclovir against HSV and VZV in patients treated with alemtuzumab, bortezomib or purine analogues. Seasonal vaccination against influenza is recommended for all patients with solid or haematological malignancies regardless of antineoplastic therapy. Hepatitis B screening is recommended in lymphoproliferative disorders, acute leukaemia, and breast cancer, and during treatment with monoclonal anti-B-cell antibodies, anthracyclines, steroids and in autologous stem cell transplantation. In those with a history of hepatitis B prophylactic lamivudine, entecavir or nucleotide analogues as adefovir are recommended to prevent reactivation.
Collapse
|
28
|
Influenza vaccination in patients with cancer: factors associated with vaccination practices for patients and their household members. Infect Control Hosp Epidemiol 2015; 36:1239-41. [PMID: 26132392 DOI: 10.1017/ice.2015.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Presented in part: IDWeek 2014; Philadelphia, PA; October 8-12, 2014 (Poster 1120).
Collapse
|
29
|
Fontanella C, Bolzonello S, Lederer B, Aprile G. Management of breast cancer patients with chemotherapy-induced neutropenia or febrile neutropenia. ACTA ACUST UNITED AC 2014; 9:239-45. [PMID: 25404882 DOI: 10.1159/000366466] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chemotherapy-induced neutropenia (CIN) is a common toxicity caused by the administration of anticancer drugs. This side effect is associated with life-threatening infections and may alter the chemotherapy schedule, thus impacting on early and long-term outcomes. Elderly breast cancer patients with impaired health status or advanced disease as well as patients undergoing dose-dense anthracycline/taxane- or docetaxel-based regimens have the highest risk of CIN. A careful assessment of the baseline risk for CIN allows the selection of patients who need primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) and/or antimicrobial agents. Neutropenic cancer patients may develop febrile neutropenia and CIN-related severe medical complications. Specific risk assessment scores, along with comprehensive clinical evaluation, are able to define a group of febrile patients with low risk for complications who can be safely treated as outpatients. Conversely, patients with higher risk of severe complications should be hospitalized and should receive intravenous antibiotic therapy with or without G-CSF.
Collapse
Affiliation(s)
- Caterina Fontanella
- Department of Oncology, University Hospital of Udine, Italy ; German Breast Group, Neu-Isenburg, Germany
| | | | | | | |
Collapse
|