Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of influenza vaccine (Fluvax) in cancer patients on treatment: a prospective single arm, open-label study

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Influenza virus infection has significant morbidity and mortality in patients with medical co-morbidities who are also immunosuppressed. The efficacy of the seasonal influenza vaccine has not been well studied in patients receiving chemotherapy. We assessed the efficacy of seasonal influenza vaccine in patients with non-haematological malignancy on active treatment (chemotherapy and targeted therapy).

Methods

A prospective single arm, open label study with 53 patients with non-haematological cancers recruited during the 2011 and 2012 influenza seasons. Participants had one dose of 2011/2012 trivalent vaccine containing strains A/California/7/2009(H1N1), A/Perth/16/2009 (H3N2) and B/Brisbane/60/2008 (Fluvax) prior to or in-between treatment cycles. Haemagglutination inhibition antibody (HIA) titres in serum were measured at baseline 3, 6 and 24 weeks.

Primary endpoint: seroconversion rate (SCR) at 3 weeks.

Secondary endpoints:

  • late SCR at 6 weeks.

  • rate of sustained sero-protection titres (SPR) at 24 weeks.

Seroconversion was defined as postvaccination ≥ 4-fold increase in HIA titre and sero-protection defined as a HIA ≥ 1:40.

Results

The SCR at 3 weeks were 35%, 30% and 22.5% to the H1N1, H3N2 and B/Bris strains, respectively. There were no new cases of late SC at 6 weeks or 24 weeks.

The SPR at 3 weeks were 72.5%, 65% and 40%, respectively, to H1N1, H3N2 and B/Bris. The SPR at 24 weeks to H1N1, H3N2 and B/Bris were 40%, 52.5% and 17.5%, respectively.

Conclusions

Patients on various solid tumour treatments achieve sero-protection rate congruent with the general population. The sero-protection HIA titres were not sustained at 24 weeks postvaccination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. prevention Cfdca (2010) Estimates of deaths associated with seasonal influenza — United States, 1976–2007. MMWR. Morbidity and Mortality Weekly Report 59(33):1056–1092

    Google Scholar 

  2. Newall AT, Wood JG, Macintyre CR (2008) Influenza-related hospitalisation and death in Australians aged 50 years and older. Vaccine 26(17):2135–2141

    Article  Google Scholar 

  3. Cheng AC (2013) Influenza epidemiology, vaccine coverage and vaccine effectiveness in sentinel Australian hospitals in 2012: the influenza complications alert network (FluCAN). Communicable Diseases Intelligence 37(3):E246–EE52

    PubMed  Google Scholar 

  4. CPMP (1997) Note for guidance on harmonisation of requirements for influenza vaccines. BWP 214(96):1–18

    Google Scholar 

  5. Gordon DL, Sajkov D, Woodman RJ, Honda-Okubo Y, Cox MM, Heinzel S, Petrovsky N (2012) Randomized clinical trial of immunogenicity and safety of a recombinant H1N1/2009 pandemic influenza vaccine containing Advax polysaccharide adjuvant. Vaccine 30(36):5407–5416

    Article  CAS  Google Scholar 

  6. Beck CR, McKenzie BC, Hashim AB et al (2012) Influenza vaccination for immunocompromised patients: systematic review and meta-analysis by etiology. The Journal of Infectious Diseases 206(8):1250–1259. https://doi.org/10.1093/infdis/jis487

    Article  PubMed  Google Scholar 

  7. Schafer AI, Churchill WH, Ames P, Weinstein L (1979) The influence of chemotherapy on response of patients with hematologic malignancies to influenza vaccine. Cancer 43(1):25–30

    Article  CAS  Google Scholar 

  8. Gross PA, Lee H, Wolff JA, Hall CB, Minnefore AB, Lazicki ME (1978) Influenza immunization in immunosuppressed children. The Journal of Pediatrics 92(1):30–35

    Article  CAS  Google Scholar 

  9. Pollyea DA, Brown JM, Horning SJ (2010) Utility of influenza vaccination for oncology patients. Journal of Clinical Oncology 28(14):2481–2490

    Article  Google Scholar 

  10. Brydak LB, Guzy J, Starzyk J, Machala M, Gozdz SS (2001) Humoral immune response after vaccination against influenza in patients with breast cancer. Supportive Care in Cancer 9(1):65–68

    Article  CAS  Google Scholar 

  11. Berglund A, Willen L, Grodeberg L, Skattum L, Hagberg H, Pauksens K (2014) The response to vaccination against influenza A(H1N1) 2009, seasonal influenza and Streptococcus pneumoniae in adult outpatients with ongoing treatment for cancer with and without rituximab. Acta Oncologica 53(9):1212–1220

    Article  CAS  Google Scholar 

  12. Chu CS, Boyer JD, Jawad A, McDonald K, Rogers WT, Luning Prak ET, Sullivan KE (2013) Immunologic consequences of chemotherapy for ovarian cancer: impaired responses to the influenza vaccine. Vaccine 31(46):5435–5442

    Article  CAS  Google Scholar 

  13. Loulergue P, Alexandre J, Iurisci I, Grabar S, Medioni J, Ropert S, Dieras V, le Chevalier F, Oudard S, Goldwasser F, Lebon P, Launay O (2011) Low immunogenicity of seasonal trivalent influenza vaccine among patients receiving docetaxel for a solid tumour: results of a prospective pilot study. British Journal of Cancer 104(11):1670–1674

    Article  CAS  Google Scholar 

  14. Mulder SF, Jacobs JF, Olde Nordkamp MA, Galama JM, Desar IM, Torensma R, Teerenstra S, Mulders PF, Vissers KC, Punt CJ, de Vries IJ, van Herpen C (2011) Cancer patients treated with sunitinib or sorafenib have sufficient antibody and cellular immune responses to warrant influenza vaccination. Clinical Cancer Research 17(13):4541–4549

    Article  CAS  Google Scholar 

  15. Wumkes ML, van der Velden AM, Los M, Leys MB, Beeker A, Nijziel MR, van der Velden A, Westerman M, Meerveld-Eggink A, Rimmelzwaan GF, Rijkers GT, Biesma DH (2013) Serum antibody response to influenza virus vaccination during chemotherapy treatment in adult patients with solid tumours. Vaccine 31(52):6177–6184

    Article  CAS  Google Scholar 

  16. Gross PA, Gould AL, Brown AE (1985) Effect of cancer chemotherapy on the immune response to influenza virus vaccine: review of published studies. Reviews of Infectious Diseases 7(5):613–618

    Article  CAS  Google Scholar 

  17. Sommer AL, Wachel BK, Smith JA (2006) Evaluation of vaccine dosing in patients with solid tumors receiving myelosuppressive chemotherapy. Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 12(3):143–154

    Article  CAS  Google Scholar 

  18. Waqar SN, Boehmer L, Morgensztern D, Wang-Gillam A, Sorscher S, Lawrence S, Gao F, Guebert K, Williams K, Govindan R (2018) Immunogenicity of influenza vaccination in patients with cancer. American Journal of Clinical Oncology 41(3):248–253

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Meerveld-Eggink A, de Weerdt O, van der Velden AM, Los M, van der Velden A, Stouthard JM, Nijziel MR, Westerman M, Beeker A, van Beek R, Rimmelzwaan GF, Rijkers GT, Biesma DH (2011) Response to influenza virus vaccination during chemotherapy in patients with breast cancer. Annals of Oncology 22:2031–2035

    Article  CAS  Google Scholar 

  20. Mazza JJ, Yale SH, Arrowood JR, Reynolds CE, Glurich I, Chyou PH, Linneman JG, Reed KD (2005) Efficacy of the influenza vaccine in patients with malignant lymphoma. Clinical Medicine & Research 3(4):214–220

    Article  Google Scholar 

  21. Matsuzaki A, Suminoe A, Koga Y, Kinukawa N, Kusuhara K, Hara T (2005) Immune response after influenza vaccination in children with cancer. Pediatric Blood & Cancer 45(6):831–837

    Article  Google Scholar 

  22. Steinherz PG, Brown AE, Gross PA, Braun D, Ghavimi F, Wollner N, Rosen G, Armstrong D, Miller DR (1980) Influenza immunization of children with neoplastic diseases. Cancer 45(4):750–756

    Article  CAS  Google Scholar 

  23. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I, Infectious Diseases Society of America (2014) 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America 58(3):309–318

    Article  Google Scholar 

  24. Keam B, Kim M-K, Choi Y (2017) Optimal timing of influenza vaccination during 3-week cytotoxic chemotherapy cycles. Cancer 123:841–848

    Article  CAS  Google Scholar 

  25. Sanada Y, Yakushijin K, Nomura T (2016) A prospective study on the efficacy of two-dose influenza vaccinations in cancer patients receiving chemotherapy. Japanese Journal of Clinical Oncology 46(5):448–452

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia

    A. Ayoola, S. Sukumaran, K. Jain, R. Kumar, A. Roy, S. Vatandoust, B. Koczwara, G. Kichenadasse, A. Richards, K. Mead & C. Karapetis

  2. Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia

    S. Sukumaran, A. Roy, S. Vatandoust, B. Koczwara, G. Kichenadasse & C. Karapetis

  3. Department of Microbiology and Infectious Diseases, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia

    D. Gordon

  4. Department of Endocrinology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia

    Y. Honda-Okubo

  5. Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, 3122, Australia

    S. Quinn

Authors
  1. A. Ayoola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Sukumaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y. Honda-Okubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Quinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Vatandoust
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. B. Koczwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. G. Kichenadasse
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A. Richards
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. K. Mead
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. C. Karapetis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Ayoola.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The primary data is the intellectual property of Flinders Centre for Innovation in Cancer Care; the data is available for the journal review (per the trial institution policies) if requested.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ayoola, A., Sukumaran, S., Jain, K. et al. Efficacy of influenza vaccine (Fluvax) in cancer patients on treatment: a prospective single arm, open-label study. Support Care Cancer 28, 5411–5417 (2020). https://doi.org/10.1007/s00520-020-05384-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05384-2

Keywords

Search

Navigation