New ASCO Guideline Recommendations Answer Key Questions About Vaccinating Adults with Cancer

March 26, 2024

The American Society of Clinical Oncology (ASCO) issued a new Clinical Practice Guideline, “Vaccination of Adults with Cancer,” which recommends several vaccinations (e.g., seasonal, herpes zoster, HPV, and others) for adult patients with solid or hematologic malignancies because of their heightened infection risks from vaccine-preventable illnesses. The guideline covers the essential questions of which vaccines to give, to whom, when, and which ones to avoid due to potential risks.

“We want to document vaccination status at the first patient visit and provide recommended vaccines that might be needed as quickly as possible within the parameters of optimal oncology care…recognizing that we do not want to impede or impinge upon care,” said Elise C. Kohn, MD, of the Cancer Therapy Evaluation Program at the National Cancer Institute, and guideline co-chair. “These vaccinations have very limited if no potential harm, but the potential benefits are significant.”

Types of Vaccines Patients with Cancer Should Receive

Vaccines discussed in the guideline include seasonal vaccines such as influenza, COVID-19, and respiratory syncytial virus, and vaccines against pneumococcal infection, herpes zoster (shingles), hepatitis B, tetanus-diphtheria-pertussis, and HPV. The guideline recommends that patients continue to receive the most current COVID-19 vaccinations per the most recent Centers for Disease Control and Prevention (CDC) guidance, and it notes that live vaccines can provide heightened risk and should be avoided, if possible, in people with cancer.

The guideline also addresses vaccines for patients who have received allogeneic or autologous hematopoietic stem cell transplants (since transplant recipients gradually lose immunity to previous immunizations), travel-related vaccines, and vaccination of household members, close contacts, or primary caregivers.

Additional Recommendations

Vaccination recommendations for patients receiving CAR-T cell treatments or B-cell depleting therapies are outlined separately in the guideline. The recommendations also address the needs of long-term cancer survivors, including those who have received B cell-depleting therapies.

Additionally, the guideline notes that it is important that any vaccinations for patients with cancer are coordinated with the entire care team. It also highlights that there is still a need a need for vaccination trials in patients with cancer for some vaccines and in different treatment areas, such as transplantation, CAR T-cell therapy, and B-cell depleting therapies.

The guideline was developed as part of ASCO’s participation in the Specialty Societies Advancing Adult Immunization (SSAAI) project, in which the Association—and six other subspecialty organizations—has partnered with CDC, the Council of Medical Specialty Societies (CMSS), and eight participating healthcare systems to incorporate CDC’s Standards for Adult Immunization Practice into clinical care and drive adult immunization through outreach, education, and quality improvement efforts.

Additional coverage of the guideline is available in ASCO Daily News.

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