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Review
. 2022 Jul 27;10(8):1195.
doi: 10.3390/vaccines10081195.

Safety and Efficacy of Influenza Vaccination in Patients Receiving Immune Checkpoint Inhibitors. Systematic Review with Meta-Analysis

Maria A Lopez-Olivo  1 , Valeria Valerio  2 , Aliza R Karpes Matusevich  3 , Marianela Brizio  4 , Michelle Kwok  5 , Yimin Geng  6 , Maria E Suarez-Almazor  1   7 , Ines Colmegna  2
Affiliations
Review

Safety and Efficacy of Influenza Vaccination in Patients Receiving Immune Checkpoint Inhibitors. Systematic Review with Meta-Analysis

Maria A Lopez-Olivo et al. Vaccines (Basel). .

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.

Keywords: cancer; immune checkpoint inhibitors; influenza vaccine; meta-analysis; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagram of study selection. CT.gov, ClinicalTrials.gov (accessed on 22 April 2022).
Figure 2
Figure 2
Proportion of patients receiving immune checkpoint inhibitors who were vaccinated and reported an immune-related adverse event. * Awadalla et al., 2019 reported rates of any type of irAEs in patients who already had myocarditis due to the immune checkpoint inhibitor.
Figure 3
Figure 3
Risk of developing an immune-related adverse event in patients receiving immune checkpoint inhibitors who were vaccinated compared with those who were not vaccinated. * Awadalla et al., 2019 reported rates of any type of irAEs in patients who already had myocarditis due to the immune checkpoint inhibitor.
Figure 4
Figure 4
Proportion of patients receiving immune checkpoint inhibitors with influenza infection (confirmed or unconfirmed) after vaccination. For Bersanelli 2020 [23,24,25], numbers account only for patients without COVID infection.
Figure 5
Figure 5
Risk of developing an influenza infection in patients receiving immune checkpoint inhibitors after vaccination compared with unvaccinated patients.
See this image and copyright information in PMC

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