Vaccination in Cancer Patients Receiving Pluvicto

Key Principles for Vaccination

Cancer patients undergoing radiotherapy, including radioligand therapy like Pluvicto, have no absolute contraindications to COVID-19 or influenza vaccination, according to the American College of Physicians 1, 2
The T-cell response induced by current vaccines is strong enough to recommend immunization in cancer patients, even those receiving active systemic therapies, with a reported efficacy of mRNA COVID-19 vaccines in patients with solid tumors of 83% 1, 2
COVID-19 vaccines are believed to be safe and effective in patients undergoing radiation therapy, with vaccinated cancer patients being significantly less likely to experience hospitalization or death within 30 days compared with unvaccinated individuals (odds ratio 0.44) 2, 5

For patients planning to start Pluvicto, administer the first vaccine dose at least two weeks before initiating the first treatment cycle to maximize immune response, as recommended by the American Society of Clinical Oncology 1, 2
For patients already receiving Pluvicto, vaccines can be administered between treatment cycles (Pluvicto is given every 6 weeks for up to six doses), with careful consideration of the timing and interval between the vaccine and the last cycle of therapy 1, 2

Both influenza and COVID-19 vaccines can be administered simultaneously at separate anatomic sites without safety concerns, according to the Centers for Disease Control and Prevention 3, 4
When administering vaccines with increased reactogenicity (such as adjuvanted or high-dose influenza vaccines) along with COVID-19 vaccines, inject them into different limbs if possible, as recommended by the Advisory Committee on Immunization Practices 4

While cancer patients may mount a somewhat reduced antibody response compared to healthy individuals, the protection is still clinically meaningful and vaccination remains strongly recommended, with a strength of evidence rated as high by the National Comprehensive Cancer Network 1, 2
Vaccinated cancer patients with COVID-19 are significantly less likely to experience hospitalization or death within 30 days compared with unvaccinated individuals (odds ratio 0.44), according to the Journal of Clinical Oncology 5

Any fever after vaccination should not automatically be attributed to vaccine response—consider other differential diagnoses including neutropenic fever, actual COVID-19 or influenza infection, or cancer-related complications, as recommended by the American Society of Clinical Oncology 1, 2
Most post-vaccination side effects, including fatigue, headache, myalgia, and injection site reactions, typically resolve within 2-3 days, with a strength of evidence rated as moderate by the Centers for Disease Control and Prevention 6

Do not delay vaccination waiting for an "optimal" time during Pluvicto treatment—the benefits of timely vaccination outweigh concerns about slightly reduced immunogenicity, according to the National Comprehensive Cancer Network 1, 2, 5
Do not defer vaccination indefinitely due to concerns about immune response; some protection is better than no protection in this high-risk population, as recommended by the American College of Physicians 1, 2

Vaccinated immunocompromised patients may still acquire SARS-CoV-2 or influenza despite vaccination, and should continue adherence to preventive measures including hand hygiene, face coverings when appropriate, and social distancing, as recommended by the Centers for Disease Control and Prevention 1, 2
Consider additional COVID-19 vaccine doses after a 2-month interval for patients receiving cancer therapies known to weaken vaccine responses, according to the Journal of Clinical Oncology 5