Drug Interactions between nivolumab and rabies vaccine, human diploid cell

MONITOR: The administration of inactivated, killed, or otherwise noninfectious vaccines during immune checkpoint inhibitor (ICI) therapy (e.g., programmed cell death-1 (PD-1), programmed death ligand-1 inhibitors (PD-L1), and anti-CTLA-4 monoclonal antibodies) is generally safe but may be associated with an increased risk of immune-related adverse events (irAEs). However, available data highlighting this risk are conflicting. In a study involving over 400 patients at a cancer center who received an mRNA COVID-19 vaccine before or after treatment with an ICI, the overall incidence of irAEs was 7%, with no increased risk of severe toxicity or new irAEs, including among those newly starting ICI therapy. Conversely, in a case report from Japan, a patient undergoing immune checkpoint inhibitor (ICI) therapy with nivolumab for stage IIIC malignant melanoma developed type 1 diabetes mellitus (T1D) following his second dose of an mRNA-based SARS-CoV-2 vaccine. In another case report, 3 weeks after receiving a flu vaccination, a patient experienced a severe and fatal relapse of post-vaccination Guillain-Barré syndrome (GBS) following treatment with nivolumab. Although the risk of developing irAEs after vaccination remains uncertain, multiple studies suggest that ICIs do not impair the body's humoral response to vaccines and may even enhance the rate of seroconversion.

MANAGEMENT: Caution and closer monitoring are advised if inactivated, killed or noninfectious vaccines are administered during treatment with immune checkpoint inhibitor (ICI) therapy. Patients should be monitored for the development of immune-related adverse events (irAEs) such as immune-mediated colitis, hepatitis, endocrinopathies (e.g., adrenal insufficiency, thyroid disorders, hypophysitis), dermatologic adverse reactions (e.g., Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis), nephritis and renal dysfunction, and solid organ transplant rejection. Local immunization guidelines and prescribing information for individual vaccines as well as the coadministered ICI therapy should be consulted for further guidance.