112P_PR - Immune response and adverse events to influenza vaccine in cancer patients undergoing PD-1 blockade

Date 07 May 2017
Event ELCC 2017
Session Poster Display Session
Topics Thoracic malignancies
Presenter Sacha Rothschild
Citation Annals of Oncology (2017) 28 (suppl_2): ii28-ii51. 10.1093/annonc/mdx091
Authors S.I. Rothschild1, C. Balmelli1, L. Kaufmann2, M. Stanczak2, M. Syedbasha2, D. Vogt2, O. Gautschi3, A. Egli4, A. Zippelius1, H. Laeubli1
  • 1Department Internal Medicine, Medical Oncology, Universitätsspital Basel, 4031 - Basel/CH
  • 2Department Of Biomedicine, University of Basel, Basel/CH
  • 3Department Of Medical Oncology, Cantonal Hospital Lucerne, Luzern/CH
  • 4Clinical Microbiology, Universitätsspital Basel, 4031 - Basel/CH

Abstract

Background

Immune checkpoint inhibitors have been introduced into standard clinical practice. Since cancer patients are at risk to develop complications when infected with seasonal influenza viruses – in particular patients with lung cancer that often have pre-existing lung disorders – it is recommended to vaccinate oncological patients. Concerns have been raised about the safety of influenza vaccination in patients undergoing checkpoint blockade. It is feared that immune stimulation via PD-1/PD-L1 blockade might induce an overshooting immune response.

Methods

Patients undergoing checkpoint blockade were vaccinated with a trivalent influenza vaccination between October and November 2015. For an age-matched control cohort, the partners of the patients were vaccinated and included in our analysis as healthy controls. Safety and frequency of immune-related adverse events were evaluated. Antibody titers against antigens and strains that were included in the trivalent influenza vaccination were measured by hemagglutination inhibition assay in patients undergoing PD-1 blockade and age-matched controls. Cytokine/chemokine profile and changes in peripheral immune cells in a cohort of cancer patients undergoing immunotherapy with PD-1/PD-L1 blockade were also studies.

Results

We included 23 patients at two institutions in Switzerland (University Hospital Basel and Cantonal Hospital Lucerne). Most patients have been treated with PD-1 blocking antibodies for at least 6 weeks at the time of vaccination. The frequency of irAEs was at 52.2% and 6 of 23 patients (26.1%) hat severe grade 3 or 4 irAEs. This frequency is significantly higher than in our general experience at our center (all grades 25.49%, grade 3 or 4 9.8%). There was no major difference over time in the generation of antibody titers in all three viral lines tested. Peripheral leukocyte counts and also cytokine/inflammatory chemokine levels did not change significantly shortly after vaccination.

Conclusions

While the vaccination against seasonal influenza viruses seems to produce good serological protection and no short term toxicity of the vaccination could be observed, the increased rate of immunological toxicity is concerning and should be studied in a larger patient population.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

University Hospital Basel

Disclosure

All authors have declared no conflicts of interest.