Department of Oncology, Örebro University, Örebro, Sweden.
School of Medical Sciences, Örebro University, Örebro, Sweden.
Oncoimmunology. 2021 Feb 17;10(1):1886725. doi: 10.1080/2162402X.2021.1886725.
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 ( = .041 and 0.028, respectively). Furthermore, the incidence of any IRAE grade was comparable between vaccinated and non-vaccinated group ( = .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.
在国际指南中，建议正在接受抗肿瘤治疗的癌症患者接种流感疫苗。但是否应该将接受最近引入并广泛使用的检查点抑制剂（CPI）治疗的患者纳入其中还不清楚。在接受 CPI 治疗的患者中，接种疫苗后的免疫过度激活可能会增强抗肿瘤免疫力并改善患者的预后。另一方面，这种过度激活可能会增加免疫相关不良反应（IRAEs）的风险。此外，由于抗原竞争现象，还存在抗肿瘤效果降低的风险。只有少数研究报告了关于生存的结果，而关于 IRAEs 的研究结果则存在矛盾。我们在瑞典的三个中心进行了一项多中心回顾性队列研究，纳入了之前未接受过 CPI 治疗且在 2016 年 1 月 1 日至 2019 年 5 月 31 日期间接受 PD-1 或 PD-L1 阻滞剂单药治疗的转移性癌症患者。最常见的恶性肿瘤类型是黑色素瘤（47.8%），其次是非小细胞肺癌（31.0%）。在多变量分析中，调整年龄、性别、合并症、表现状态、CNS 转移和治疗线后，在 6 个月时间标志时，接种疫苗组的 PFS 和 OS 明显长于未接种疫苗组（分别为 = 0.041 和 0.028）。此外，接种疫苗组和未接种疫苗组的任何 IRAE 分级发生率无差异（ = 0.85）。总之，本研究表明，在接受检查点抑制剂治疗的癌症患者中，流感疫苗接种可提高生存率，而不会增加副作用的风险。因此，我们的结果强烈支持在接受检查点抑制剂治疗的癌症患者中接种流感疫苗。
