Does Pluvicto (Lutetium Lu 177 vipivotide tetraxetan) affect the efficacy or increase the risk of adverse reactions when taking flu or Covid (Coronavirus) vaccines?

Pluvicto and Vaccination: Safety and Timing Recommendations

Patients taking Pluvicto (lutetium Lu 177 vipivotide tetraxetan) can safely receive both influenza and COVID-19 vaccines, as there are no absolute contraindications to vaccination in cancer patients receiving radiotherapy, and both vaccines can be administered concomitantly at separate anatomic sites. 1, 2

Key Principles for Vaccination During Pluvicto Treatment

No Absolute Contraindications

• Cancer patients undergoing radiotherapy, including radioligand therapy like Pluvicto, have no absolute contraindications to COVID-19 or influenza vaccination. 1
• The T-cell response induced by current vaccines is strong enough to recommend immunization in cancer patients, even those receiving active systemic therapies. 1
• COVID-19 vaccines are believed to be safe and effective in patients undergoing radiation therapy. 1

Optimal Timing Strategy

• For patients planning to start Pluvicto, administer the first vaccine dose at least two weeks before initiating the first treatment cycle to maximize immune response. 1
• For patients already receiving Pluvicto, vaccines can be administered between treatment cycles (Pluvicto is given every 6 weeks for up to six doses). 1, 3
• Carefully consider the timing and interval between the vaccine and the last cycle of therapy as an essential factor in adequate vaccine immune response. 1

Concurrent Administration of Flu and COVID-19 Vaccines

Safety Profile

• Both influenza and COVID-19 vaccines can be administered simultaneously at separate anatomic sites without safety concerns. 2
• When administering vaccines with increased reactogenicity (such as adjuvanted or high-dose influenza vaccines) along with COVID-19 vaccines, inject them into different limbs if possible. 1, 2
• A study of concurrent high-dose influenza vaccine and mRNA COVID-19 booster showed similar reactogenicity to COVID-19 vaccination alone, with no serious adverse events and similar immune response. 1, 2

Administration Guidelines

• Individual vaccines should not be mixed in the same syringe unless licensed for mixing by the FDA. 2
• Inactivated vaccines (both flu and COVID-19 vaccines are inactivated) do not interfere with the immune response to other inactivated vaccines. 2

Expected Vaccine Response in Cancer Patients

Immunogenicity Considerations

• The efficacy of mRNA COVID-19 vaccines in patients with solid tumors has been reported to be 83%. 1
• While cancer patients may mount a somewhat reduced antibody response compared to healthy individuals, the protection is still clinically meaningful and vaccination remains strongly recommended. 1
• Vaccinated cancer patients with COVID-19 are significantly less likely to experience hospitalization or death within 30 days compared with unvaccinated individuals (odds ratio 0.44). 1

Post-Vaccination Monitoring

• Any fever after vaccination should not automatically be attributed to vaccine response—consider other differential diagnoses including neutropenic fever, actual COVID-19 or influenza infection, or cancer-related complications. 1
• Most post-vaccination side effects, including fatigue, headache, myalgia, and injection site reactions, typically resolve within 2-3 days. 4
• Common adverse reactions are generally mild to moderate and include fatigue, headache, muscle pain, and fever beginning 6-12 hours after vaccination. 4, 5

Clinical Pitfalls to Avoid

• Do not delay vaccination waiting for an "optimal" time during Pluvicto treatment—the benefits of timely vaccination outweigh concerns about slightly reduced immunogenicity. 1
• Do not defer vaccination indefinitely due to concerns about immune response; some protection is better than no protection in this high-risk population. 1
• Do not assume post-vaccination fever is benign in cancer patients—maintain appropriate clinical vigilance for other causes. 1
• Do not separate flu and COVID-19 vaccines unnecessarily—concurrent administration is safe and improves vaccination completion rates. 2

Additional Protective Measures

• Vaccinated immunocompromised patients may still acquire SARS-CoV-2 or influenza despite vaccination. 1
• Continue adherence to preventive measures including hand hygiene, face coverings when appropriate, and social distancing. 1
• Consider additional COVID-19 vaccine doses after a 2-month interval for patients receiving cancer therapies known to weaken vaccine responses. 1