From the Guidelines
Yes, getting the Prevnar 20 vaccine before starting Kisqali (ribociclib) is generally a good idea. Kisqali is a CDK4/6 inhibitor used to treat breast cancer that can potentially suppress the immune system, making patients more susceptible to infections. Prevnar 20 is a pneumococcal vaccine that protects against 20 strains of Streptococcus pneumoniae bacteria, which can cause serious infections like pneumonia, meningitis, and bloodstream infections.
Key Points to Consider
- The vaccine should be administered at least two weeks before starting Kisqali to allow the immune system to develop an adequate response, as stated in the guidelines 1.
- If immediate Kisqali treatment is necessary, the vaccine can still be given, but the protective antibody response might not be optimal.
- Patients should discuss their complete vaccination status with their oncologist, as other vaccines may also be recommended before starting cancer treatment to provide comprehensive protection during therapy.
Recommendations for Pneumococcal Vaccination
- According to the Advisory Committee on Immunization Practices (ACIP) recommendations 1, adults aged 19-64 years with certain underlying medical conditions or other risk factors should receive a pneumococcal conjugate vaccine (PCV20 or PCV15) followed by a dose of pneumococcal polysaccharide vaccine (PPSV23) at least 1 year later.
- The ACIP also recommends that adults aged 65 years and older receive a pneumococcal vaccine, with options for PCV20 or PCV15 followed by PPSV23.
Importance of Vaccination Timing
- The timing of vaccination is crucial, as the immune response to vaccines may be diminished once the patient starts Kisqali treatment.
- The guidelines emphasize the importance of shared clinical decision-making between healthcare providers and patients to determine the best vaccination strategy 1.
From the Research
Pneumococcal Vaccination and Kisqali
- The decision to administer Prevnar 20 (PCV20) before starting Kisqali should be based on the individual's risk factors and vaccination history 2, 3, 4, 5, 6.
- PCV20 is a 20-valent pneumococcal conjugate vaccine that provides protection against 20 serotypes of Streptococcus pneumoniae, including the 13 serotypes covered by PCV13 2, 3.
- Studies have shown that PCV20 is well-tolerated and immunogenic in adults, including those with prior pneumococcal vaccination 2, 3, 5, 6.
- The Advisory Committee on Immunization Practices (ACIP) recommends the use of PCV20 for all adults aged ≥50 years, as well as for those aged 19-49 years with risk conditions for pneumococcal disease 4.
Immunogenicity and Safety of PCV20
- PCV20 has been shown to induce robust immune responses to all 20 vaccine serotypes, with geometric mean fold rises ranging from 6.0 to 113.4 6.
- The safety profile of PCV20 is similar to that of PCV13, with local reaction and systemic event rates being similar between the two vaccines 2, 3, 5, 6.
- PCV20 has been found to be well-tolerated in adults, with no serious vaccine-related adverse events reported in clinical trials 2, 3, 5, 6.
Recommendations for Use of PCV20
- The ACIP recommends a single dose of PCV20 for all PCV-naïve adults aged ≥50 years 4.
- PCV20 may be used in adults who have previously received PCV13, as it provides additional protection against 7 serotypes not covered by PCV13 2, 3.
- The decision to administer PCV20 should be based on individual risk factors and vaccination history, and should be made in consultation with a healthcare provider 2, 3, 4, 5, 6.