What is the recommended interval between administering Prevnar (pneumococcal conjugate vaccine) and the meningococcal vaccine to an adult cancer patient undergoing treatment with Keytruda (pembrolizumab)?

Vaccination Timing for Prevnar and Meningococcal Vaccines in Cancer Patients on Keytruda

Prevnar (PCV20 or PCV15) and meningococcal vaccines can be administered on the same day at different injection sites in cancer patients receiving Keytruda, with no required waiting interval between them. 1

Key Timing Principles

Same-Day Administration is Acceptable

• The NCCN guidelines explicitly state that PCV20 or PCV15 should not be given with meningococcal conjugate vaccine quadrivalent (MenACWY-D), but CAN be given with MenACWY-CRM. 1
• All recommended vaccines for immunocompromised patients can be given simultaneously if administered at different injection sites. 2
• This approach allows for earlier protection against both pneumococcal and meningococcal disease without compromising immune responses. 2

Sequential Administration Option

If you choose to give them sequentially rather than simultaneously:

• There is no minimum required interval between pneumococcal and meningococcal vaccines. 1
• The guidelines specify intervals between doses of the same vaccine series (e.g., 8 weeks between MenACWY doses) but do not mandate spacing between different vaccine types. 1
• For practical purposes, if giving sequentially, you can administer them days to weeks apart based on scheduling convenience. 1

Specific Vaccine Schedules for Cancer Patients

Pneumococcal Vaccination

• PCV20 (preferred) should be given as a single dose to newly diagnosed cancer patients who are pneumococcal vaccine-naïve. 1
• Alternatively, PCV15 can be given, followed by PPSV23 at least 8 weeks later. 1
• No additional PPSV23 is needed after PCV20. 1

Meningococcal Vaccination

• MenACWY is given in 2 doses ≥8 weeks apart for patients at increased risk (complement deficiency, C5 inhibitor use, or asplenia). 1
• MenB vaccine is given as either a 2-dose or 3-dose series depending on formulation. 1
• Booster doses of MenACWY are needed every 5 years for ongoing risk. 1

Critical Considerations for Keytruda Patients

Immune Checkpoint Inhibitors vs. Chemotherapy

• Keytruda (pembrolizumab) is an immune checkpoint inhibitor, not traditional chemotherapy, and does not cause the same degree of immunosuppression as cytotoxic chemotherapy. 1
• Inactivated vaccines (including both pneumococcal and meningococcal vaccines) can be safely administered during Keytruda therapy. 1
• The general principle to avoid vaccination on the same day as cytotoxic chemotherapy does not apply to immune checkpoint inhibitors like Keytruda. 1

Optimal Timing Relative to Keytruda Administration

• Ideally, vaccines should be given at least 2 weeks before starting immunosuppressive therapy when feasible, but this timing is often not practical in cancer patients. 1
• For patients already on Keytruda, vaccines can be administered at any point during treatment. 1
• Research in cancer patients shows that vaccination on the day of chemotherapy versus 2 weeks before produces similar immunogenicity, suggesting flexibility in timing. 3

Common Pitfalls to Avoid

Don't Confuse Vaccine-Specific Intervals

• The 8-week interval applies to spacing between doses of the SAME vaccine (e.g., between MenACWY dose 1 and dose 2), NOT between different vaccine types. 1
• The 8-week interval between PCV15 and PPSV23 is specific to that sequential regimen. 1

Don't Delay Protection Unnecessarily

• Cancer patients are at increased risk for invasive pneumococcal and meningococcal disease and should be vaccinated promptly. 1
• Waiting between different vaccine types provides no immunologic benefit and only delays protection. 1, 2

Verify the Specific MenACWY Formulation

• Check whether you're using MenACWY-D (Menactra) or MenACWY-CRM (Menveo), as only MenACWY-CRM can be co-administered with PCV vaccines. 1
• If using MenACWY-D, separate administration by at least a few days to weeks. 1

Risk Assessment for Meningococcal Vaccination

Not all cancer patients on Keytruda require meningococcal vaccination. 1

Meningococcal vaccination is specifically indicated for patients with:

• Persistent complement component deficiencies 1
• Treatment with complement C5 inhibitors (eculizumab, ravulizumab) 1
• Anatomic or functional asplenia 1

Keytruda alone does not constitute an indication for meningococcal vaccination unless one of these high-risk conditions is present. 1, 4