High-Dose Influenza Vaccination for Breast Cancer Patients on Treatment

General Recommendations for Influenza Vaccination in Cancer Patients

Annual vaccination against influenza with inactivated influenza virus is recommended for all individuals at increased risk due to immunosuppression, including breast cancer patients on treatment 1, 2
Cancer patients should not receive the live attenuated influenza vaccine (LAIV) due to potential risk of infection in immunocompromised individuals 1, 2
Influenza infections in cancer patients who are immunosuppressed are associated with higher rates of hospitalization, treatment delays, and mortality compared to healthy individuals 1, 2

Preliminary data show that high-dose influenza vaccine is safe for cancer patients and may demonstrate increased immunogenicity compared to standard-dose vaccines 1, 2
However, the National Comprehensive Cancer Network (NCCN) guidelines state there are not yet sufficient data to recommend high-dose influenza vaccine over standard-dose vaccine for cancer patients 1, 2
Further clinical data are needed to determine whether high-dose influenza vaccine provides a clinical benefit over standard-dose vaccine in this population 1, 2

Patients receiving rituximab or other anti-B cell therapies may have impaired immune responses to influenza vaccination due to B-cell depletion 3
For patients with solid tumors receiving targeted therapies, standard influenza vaccination appears safe and effective, with patients on targeted therapy alone (especially multikinase inhibitors) showing better immune responses than those on other treatment regimens 3
Vaccination of household contacts and healthcare personnel is highly recommended to increase herd immunity and reduce the likelihood of infection transmission to cancer patients 4

Some studies suggest that adjuvanted vaccines or a two-dose vaccination strategy may improve immunoprotection in cancer patients on treatment 5, 6, 7
A study of cancer patients receiving cytotoxic and/or targeted therapies found that two doses of adjuvanted vaccine resulted in higher seroprotection rates (73%) compared to a single dose (48%) 7, 3

Do not assume that one vaccination strategy fits all cancer patients; response may vary based on cancer type, treatment regimen, and timing within treatment cycle 3

The Italian Society of Medical Oncology (AIOM) recommends influenza vaccination for cancer patients, including those undergoing radiotherapy, as it is safe and effective in preventing influenza infection in this high-risk group 8, 9
Influenza vaccination is particularly important for cancer patients, who are at significant risk of morbidity and mortality from influenza infections, and vaccination represents the most effective method for preventing influenza infection in this population 10

Cancer patients may experience disease- or treatment-related immunosuppression, potentially resulting in a suboptimal serologic response to influenza vaccination, but a considerable number of patients still reach protective antibody levels 10, 11

For patients undergoing radiotherapy for breast cancer, there are no specific contraindications to receiving the flu shot during treatment, and the optimal timing for administration is not clearly defined, but vaccination should be given mid-cycle of treatment or at the furthest possible time point away from treatment during a given cycle 8, 10, 11

Cancer patients should receive the trivalent inactivated vaccine rather than live attenuated influenza vaccine (LAIV) due to their potentially compromised immune system, and some data suggest increased seroprotection rates with vaccines containing adjuvants, higher doses of antigen, or potentially a second dose of vaccine 12

Vaccination of household contacts and healthcare personnel is highly recommended to increase herd immunity in the patient's environment and reduce the likelihood of infection, and strict preventive measures should be adopted in oncology wards when hospitalized patients develop influenza-like illness 8

The American College of Physicians and other guideline societies implicitly support the notion that one should not withhold vaccination due to concerns about efficacy, as even a suboptimal response provides some protection, and one should not administer live attenuated influenza vaccines to cancer patients due to their potentially compromised immune systems, and one should not assume that one vaccination strategy fits all cancer patients 8, 10, 12