Table 2.

Cancer therapies and implications for vaccination

CANCER THERAPY	CONSIDERATIONS FOR VACCINATION
Corticosteroids	Immunosuppressive dose of steroids: prednisone equivalent of ≥2 mg/kg/d or ≥20 mg/d if weight >10 kg, for ≥14 days
Endocrine therapy	No impact on vaccination No considerations for timing of vaccination
Radiotherapy	Radiation can cause immunosuppression when radiation fields encompass substantial bone marrow, such as the pelvis or craniospinal axis Immunosuppression is dose dependent and more likely to be seen in the setting of curative radiation treatment Clinically significant immunosuppression can be seen in the treatment of prostate, cervical, and anal cancers
Chemotherapy	The nadir for leukocytes generally occurs 7 to 14 d after each treatment. If a vaccine is given during a leukopenic period, there will be an inadequate immune response If immunization is necessary while receiving chemotherapy, give immediately before next cycle of treatment to allow for optimal immune system recovery and vaccine response
Targeted therapy	Some targeted agents (eg, sunitinib, palbociclib) can cause immunosuppression with leukopenia or decreased humoral immunity If patient is receiving a targeted therapy that causes immunosuppression, the timing of vaccination should be adjusted accordingly If patient is receiving anti-B-cell therapy (eg, rituximab), vaccinate at least 4 wk before therapy or a minimum of 6 mo after cessation of treatment
Immunotherapy	Live vaccines are not recommended in patients receiving immunotherapy as safety data are inadequate at this time Non-live vaccines are safe in patients receiving immunotherapy Vaccination has not been shown to increase the incidence of immune-mediated adverse effects

Data from the Advisory Committee on Immunization Practices,⁴ Pollard and Bijker,⁵ the Government of Canada,⁶ Ariza-Heredia and Chemaly,¹⁴ Hwang et al,¹⁵ Waissengrin et al,¹⁶ Keam et al,¹⁷ Groeneveld et al,¹⁸ Desage et al,¹⁹ Spagnolo et al,²⁰ Chen et al,²¹ Hoffmann et al.²²