Shingles vaccine Shingrix ‘important’ for people with cancer
The shingles vaccine is recommended for adults aged older than 50 years; however, Zostax, a live-virus vaccine, may not be suitable for patients with immunodeficiency or immunosuppression, including those with cancer.
In October, the FDA approved the herpes zoster vaccine Shingrix (Zoster Vaccine Recombinant, Adjuvanted; GlaxoSmithKline), which is not made from a live virus. The vaccine combines glycoprotein E with an adjuvant system that enhances immunologic response.
It is administered in two doses intramuscularly. There is some risk for side effects with each injection.
In a phase 3 study of Shingrix, researchers found the vaccine to more than 90% effective among more than 38,000 individuals.
HemOnc Today spoke with Dale Shepard, MD, PhD, medical oncologist and director of the phase 1 and sarcoma programs at Cleveland Clinic’s Taussig Cancer Institute, about the role of Shingrix for people with cancer and how clinicians should discuss patients’ vaccinations.
Question: How has the FDA approval of Shingrix made shingles vaccination a viable option for individuals with cancer?
Answer: Previously, the only vaccination available for shingles was Zostavax (Zoster Vaccine Live, Merck), which is an attenuated live virus vaccine. This vaccine is contraindicated for patients with immunodeficiency or immunosuppression. As a result, patients with cancer who receive chemotherapy or radiation therapy or patients with leukemia or lymphoma affecting the bone marrow or lymphatics could not receive the shingles vaccination. The recently approved Shingrix vaccine is a recombinant protein and can be given to patients with cancer even if they are receiving or have recently received radiation or chemotherapy. Patients with lymphoma or leukemia also are eligible for the recombinant vaccine.
Q: Why is it important for people with cancer to get vaccinated against shingles?
A: Shingles is a reactivation of the herpes zoster virus in patients who previously had chicken pox. Reactivation may occur at a higher frequency among patients with a suppressed immune system. Both cancer and the treatment of cancer can suppress the immune system and lead to the development of shingles.
Q: Which groups of people with cancer should get this vaccine?
A: The development of shingles after a diagnosis of cancer has been observed with many hematologic malignancies and solid tumors. A recent study in British Journal of Cancer looked at the risk for shingles among nearly 200,000 patients with over 20 types of cancer. Shingles was more common among patients with hematologic malignancies than solid tumors. Shingrix is approved for prevention of shingles among patients aged 50 years or older.
The primary contraindication for Shingrix is a history of severe allergic reaction to components of the vaccine. There are no guidelines from either ASCO or ASH for this vaccination.
Q: Aside from shingles, why is it important that people with cancer stay up to date with all of their vaccines?
A: Both influenza and pneumococcal pneumonia can be very serious among patients with cancer due to their reduced immunity. Both of these infections are more likely to be serious in older patients, the population most likely to get many cancers.
Q: What advice would you offer to oncologists and other care team members to make sure their patients are current with their vaccinations?
A: The best way the health care team can ensure that patients have their proper vaccinations is to incorporate it into their practice in a standardized way. Put it on the intake questions by the rooming nurse, incorporate it into a health maintenance alert in the medical record or check on vaccine status for new consults. There are many ways.
Q: Would you like to add anything else?
A: The need for patients to be vaccinated for shingles is important for patients with cancer, but also for the general population. Ideally, patients who develop cancer have already received their shingles vaccination. The availability of a shingles vaccine that can be given to be patients with cancer is important for hematologists and oncologists, but also primary care providers because they are often helping with management of the patients’ other medical issues and health maintenance. – by Cassie Homer
Disclosure: Shepard reports no relevant financial disclosures.