Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in patients with solid tumors, vaccinated before or during chemotherapy: A randomized trial.

BACKGROUND: The adjuvanted recombinant zoster vaccine (RZV) has demonstrated >90% efficacy against herpes zoster in adults ≥50 years of age and 68% efficacy in autologous hematopoietic stem cell transplant recipients ≥18 years of age. We report the immunogenicity and safety of RZV administered to patients with solid tumors (STs) before or at the start of a chemotherapy cycle. METHOD: In this phase 2/3 observer-blind, multicenter study (NCT01798056), patients with STs who were ≥18 years of age were randomized (1:1) to receive 2 doses of RZV or placebo 1-2 months apart and stratified (4:1) according to the timing of the first dose with respect to the start of a chemotherapy cycle (first vaccination 8-30 days before the start or at the start [±1 day] of a chemotherapy cycle). Anti-glycoprotein E (gE) antibody concentrations, gE-specific CD4+ T cell frequencies, and vaccine response rates (VRRs) were assessed 1 month after dose 1 and 1 and 12 months after dose 2. Reactogenicity and safety were assessed in the total vaccinated cohort through 12 months after dose 2. RESULTS: There were 232 participants in the total vaccinated cohort, 185 participants in the according-to-protocol cohort for humoral immunogenicity, and 58 participants in the according-to-protocol cohort for cell-mediated immunogenicity. Postvaccination anti-gE antibody concentrations, gE-specific CD4+ T cell frequencies and VRRs were higher in RZV recipients than in placebo recipients. Solicited adverse events (AEs) were more frequent among RZV recipients than placebo recipients. Incidence of unsolicited AEs, serious AEs, fatalities, and potential immune-mediated diseases were similar between RZV and placebo recipients. CONCLUSION: RZV was immunogenic in patients with STs receiving immunosuppressive chemotherapies. Humoral and cell-mediated immune responses persisted 1 year after vaccination. No safety concerns were identified.

Diagnóstico: pautas diagnósticas y la adecuada gestión del dolor basal y del dolor irruptivo / Diagnosis: diagnostic criteria and adequate management of background and breakthrough pain

Hasta hace unos años, el dolor oncológico se consideraba una condición clínica única, pero estudios recientes nos han permitido diferenciar entre dolor basal y dolor irruptivo. Estos tipos de dolor difieren claramente en su forma de inicio, intensidad y duración, lo que condiciona un manejo específico para cada uno de ellos. Una correcta evaluación de las características del dolor, así como de sus causas, nos permitirá un adecuado diagnóstico y un óptimo tratamiento. La ausencia de consenso unánime respecto a la definición de dolor irruptivo ha llevado a dificultades a la hora de estimar su prevalencia real. Se ha descrito en el 33-95% de los pacientes con dolor crónico oncológico. El dolor irruptivo tiene un impacto negativo en la calidad de vida de los pacientes, por lo que es imprescindible que los profesionales sanitarios sepan identificarlo y tratarlo adecuadamente

Until a few years ago, cancer pain was considered a unique clinical entity. However, recent studies have allowed a distinction to be made between background and breakthrough pain. These types of pain clearly differ in their form of onset, intensity and duration, leading to specific management for each. Adequate assessment of the characteristics of the pain and its causes allows correct diagnosis and optimal treatment. Because of the lack of consensus on the definition of breakthrough pain, it is difficult to estimate its true prevalence. Breakthrough pain has been described in 33%-95% of patients with chronic cancer pain. This type of pain impairs quality of life and it is therefore essential that health professionals are well versed in its correct identification and treatment