Can patients on Ketruda (pembrolizumab) receive the flu and COVID-19 vaccines?

COVID-19 and Influenza Vaccination for Patients on Keytruda (Pembrolizumab)

Yes, patients on Keytruda (pembrolizumab) should receive both flu and COVID-19 vaccines, as there are no contraindications to vaccination in cancer patients receiving immunotherapy. 1

Vaccination Recommendations for Cancer Patients on Immunotherapy

COVID-19 Vaccination

• The National Comprehensive Cancer Network (NCCN) strongly recommends COVID-19 vaccination for all persons with cancer or who have been previously treated for cancer 1
• There are no absolute contraindications to COVID-19 vaccines in cancer patients undergoing immunotherapy, including checkpoint inhibitors like pembrolizumab 1
• Patients should receive the most current COVID-19 vaccine formulation available to them 2

Influenza Vaccination

• Annual influenza vaccination is recommended for all patients with hematologic or solid tumor malignancies 1
• Inactivated influenza vaccines are safe for patients on immunotherapy 1
• Vaccination helps prevent pulmonary comorbidities during respiratory virus seasons 1

Timing Considerations

For optimal immune response:

• If starting a new course of pembrolizumab, ideally administer vaccines at least 2 weeks before initiating therapy 1, 2
• For patients already on pembrolizumab, vaccines can be administered at any time during treatment 1
• Do not delay or adjust pembrolizumab treatment timing due to vaccination 1

Potential Concerns and Monitoring

Immune-Related Adverse Events (IRAEs)

• While theoretically possible, there is limited data showing increased risk of immune-related adverse events following vaccination in patients on checkpoint inhibitors 1
• Any post-vaccination fever should not automatically be attributed to the vaccine, as other causes (neutropenic fever, COVID-19 infection, cancer relapse) should be considered 1

Vaccine Efficacy

• Patients on immunotherapy may have somewhat reduced but still meaningful immune responses to vaccination 1, 2
• The T-cell response induced by vaccines remains strong enough to recommend vaccination in these patients 1

Additional Considerations

• Both vaccines can be administered concomitantly (on the same day) without significant interference with immune responses 3
• Household members and close contacts should also be vaccinated to create a "cocooning effect" to protect the cancer patient 1
• Patients should continue preventive measures such as hand hygiene, masking in high-risk settings, and social distancing 1

Practical Approach

1. Discuss vaccination with all patients on Keytruda
2. Administer both COVID-19 and influenza vaccines according to standard schedules
3. No need to adjust Keytruda dosing or timing around vaccination
4. Monitor for any unusual symptoms following vaccination
5. Continue standard precautions against respiratory infections

Remember that the benefits of vaccination in preventing severe disease far outweigh the theoretical risks in patients receiving immunotherapy like Keytruda.