Immune related adverse events in NSCLC patients treated with immune checkpoint therapy who received the influenza vaccination versus no vaccination.

Abstract

e20657 Background: Influenza vaccination is recommended by the CDC for cancer patients to reduce the risk of influenza-related complications. There is concern that the incidence of immune-related adverse events (irAEs) may be greater in vaccinated patients receiving immune checkpoint inhibitors (ICPI). We sought to interrogate if influenza vaccination in patients with NSCLC receiving ICPI therapy had an increased incidence of irAEs compared to non-vaccinated patients. Methods: We conducted a single-center retrospective analysis of patients with advanced NSCLC who received PD-1 or PD-L1 inhibitor monotherapy between 3/2015 – 12/2018. Influenza immunization records from both institutional and state-wide registries were obtained from 2014 -2019. Comparisons of adverse event incidence between flu vaccinated and control patients were tested using chi-square statistics. Results: 117 patients were included in our analysis, 33 (28%) were vaccinated during ICPI therapy, 19 (58%) received quadrivalent influenza vaccine, 13 (39%) received trivalent influenza vaccine and 1 (3%) was undetermined. 22 (67%) vaccinated patients had an irAE vs 53 (63%) patients who were not vaccinated during ICPI therapy (p = 0.720). 8 (24%) vaccinated patients had an irAE leading to discontinuation of therapy vs 12 (14%) patients who were not vaccinated during ICPI therapy (p = 0.198). The most frequent irAE in both groups was fatigue 16 (48%) vs 28 (33%) (p = 0.128). Notable irAEs included colitis (0 vs 1), pneumonitis (3 vs 3), hepatitis (1 vs 4) in vaccinated patients vs without vaccine, respectively. There were no statistically significant differences in baseline demographics between both groups including age, race, gender, tumor histology or ECOG performance status. Conclusions: Our study suggests that irAEs are not significantly increased with vaccination for influenza during ICPI therapy. However, there is a slight trend toward increased incidence of irAE warranting ICPI discontinuation for which further investigation is needed. Limitations of this study include a small sample size and inability to grade irAE retrospectively.

Influenza Vaccination in Cancer Patients Treated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis

“…Safety outcomes : three studies reported data regarding vaccine-related adverse events, however, not comparing influenza vaccinated versus nonvaccinated patients29,34,36; thus, a meta-analysis was not feasible. Regarding irAEs, 6 studies (n=1285, weighted age 60 y, men 59%, influenza vaccinated 48%) reported relevant data 30,33,38,44–46. Meta-analysis of these studies showed pooled OR for any irAEs in influenza vaccinated versus nonvaccinated patients at 0.82 (95% CI: 0.63–1.08, P =NS) (Fig.…”

“…Among 1046 articles initially retrieved, 25 were found to fulfill the inclusion criteria and were included in the systematic review 19,20,29–50. Fourteen studies were peer-reviewed19,20,29–40 and 11 nonpeer-reviewed (conference abstracts) 41–50.…”

“…Among 1046 articles initially retrieved, 25 were found to fulfill the inclusion criteria and were included in the systematic review 19,20,29–50. Fourteen studies were peer-reviewed19,20,29–40 and 11 nonpeer-reviewed (conference abstracts) 41–50. Main characteristics along with schematic presentation of main results of studies included in the systematic review are presented in Supplementary Table 1 and Supplementary Table 2, Supplemental Digital Content 1, http://links.lww.com/JIT/A670.…”

“…19,20, Fourteen studies were peer-reviewed 19,20,[29][30][31][32][33][34][35][36][37][38][39][40] and 11 nonpeer-reviewed (conference abstracts). [41][42][43][44][45][46][47][48][49][50] Main characteristics along with schematic presentation of main results of studies included in the systematic review are presented in Supplementary Table 1 and Supplementary Table 2, Supplemental Digital Content 1, http://links.lww.com/JIT/A670. Most studies were conducted in the USA (10 articles/conference abstracts) and Italy (5 articles/conference abstracts).…”

“…Regarding irAEs, 6 studies (n = 1285, weighted age 60 y, men 59%, influenza vaccinated 48%) reported relevant data. 30,33,38,[44][45][46] Metaanalysis of these studies showed pooled OR for any irAEs in influenza vaccinated versus nonvaccinated patients at 0.82 (95% CI: 0.63-1.08, P = NS) (Fig. 2).…”