What are the recommendations for administering a high dose flu shot, specifically Fluzone High-Dose (influenza vaccine), to a breast cancer patient on treatment?

High-Dose Influenza Vaccination for Breast Cancer Patients on Treatment

While high-dose influenza vaccine (Fluzone High-Dose) is safe for patients with cancer and may show increased immunogenicity compared to standard-dose vaccines, there are currently insufficient data to recommend high-dose over standard-dose influenza vaccination for breast cancer patients on treatment. 1

General Recommendations for Influenza Vaccination in Cancer Patients

• Annual vaccination against influenza with inactivated influenza virus is recommended for all individuals at increased risk due to immunosuppression, including breast cancer patients on treatment 1
• Cancer patients should not receive the live attenuated influenza vaccine (LAIV) due to potential risk of infection in immunocompromised individuals 1, 2
• Influenza infections in cancer patients who are immunosuppressed are associated with higher rates of hospitalization, treatment delays, and mortality compared to healthy individuals 1

High-Dose vs. Standard-Dose Vaccine in Cancer Patients

• Preliminary data show that high-dose influenza vaccine is safe for cancer patients and may demonstrate increased immunogenicity compared to standard-dose vaccines 1
• However, the National Comprehensive Cancer Network (NCCN) guidelines state there are not yet sufficient data to recommend high-dose influenza vaccine over standard-dose vaccine for cancer patients 1
• Further clinical data are needed to determine whether high-dose influenza vaccine provides a clinical benefit over standard-dose vaccine in this population 1

Timing of Vaccination for Breast Cancer Patients

• Influenza vaccination can be administered at any point during chemotherapy treatment for breast cancer patients 2, 3
• For patients on cyclical chemotherapy regimens, evidence suggests that vaccination early in the cycle (around day 4-5 after chemotherapy) may produce better antibody responses than later in the cycle (day 16) 3, 4
• Breast cancer patients, including those undergoing chemotherapy, can develop adequate serological responses to influenza vaccination 5, 6

Special Considerations

• Patients receiving rituximab or other anti-B cell therapies may have impaired immune responses to influenza vaccination due to B-cell depletion 1, 7
• For patients with solid tumors receiving targeted therapies, standard influenza vaccination appears safe and effective, with patients on targeted therapy alone (especially multikinase inhibitors) showing better immune responses than those on other treatment regimens 1
• Vaccination of household contacts and healthcare personnel is highly recommended to increase herd immunity and reduce the likelihood of infection transmission to cancer patients 1, 2

Alternative Strategies to Improve Vaccine Efficacy

• Some studies suggest that adjuvanted vaccines or a two-dose vaccination strategy may improve immunoprotection in cancer patients on treatment 1
• A study of cancer patients receiving cytotoxic and/or targeted therapies found that two doses of adjuvanted vaccine resulted in higher seroprotection rates (73%) compared to a single dose (48%) 1

Common Pitfalls to Avoid

• Do not delay vaccination if high-dose vaccine is not available; standard-dose influenza vaccine should be administered rather than postponing vaccination 7
• Do not assume that one vaccination strategy fits all cancer patients; response may vary based on cancer type, treatment regimen, and timing within treatment cycle 1, 2
• Do not withhold vaccination due to concerns about reduced efficacy; even a suboptimal response provides some protection against influenza infection 2