Controlled non-randomised before-after study evaluating the impact of a focused recommendation card on vaccination rates of oncological patients-The Easy Vaccination in Oncology (EVO) strategy.

OBJECTIVE: By implementing a focused must-have vaccination strategy (Easy Vaccination in Oncology [EVO]), we aimed to increase rates for high-impact vaccinations (Streptococcus pneumoniae, influenza, herpes zoster and hepatitis B) in the at-risk population of oncological patients. METHODS: In this German multicentre interventional non-randomised controlled two-arm open trial with repeated cross-sectional data collection, we evaluated the EVO strategy as an easy to implement approach. Vaccination rates were assessed in the outpatient setting and re-assessed after 3 months. A generalised linear mixed model (GLMM) was used to assess the primary endpoint (Streptococcus pneumoniae vaccination rates according to recommendations), taking clustering within clinics into account. RESULTS: Vaccination rates substantially increased in the intervention group; Streptococcus pneumoniae +21.5% (+16.7% according to recommendations), influenza +12.2%, herpes zoster +13.3% (+13.6% age group 50+), and hepatitis B +11%. Vaccination rates in the control group tended to decrease or increase only moderately (-5.8% [-3.8%], +7.4%, +2.1% [1.4%], and -1.7%, respectively). GLMM showed significant effect of the intervention (OR 7.50, 95% CI 2.18-25.80, p = 0.001). CONCLUSION: This easy-to-implement and resource-saving approach has the potential to increase vaccination rates in oncological patients and to have a considerable impact protecting oncological patients from preventable infectious diseases. CLINICAL TRIAL REGISTRATION: The study was registered at the German Resister for Clinical Studies (DRKS) under DRKS00020118.

Immunochemotherapy - A Missed Opportunity for Metastasized Malignant Melanoma? Reporting a Therapeutic Success with Checkpoint Inhibitor Rechallenge after Cytotoxic Immuno-Priming in a Heavily Pretreated Patient.

Treatment of metastasized malignant melanoma still has very limited therapeutic options. After exhaustion of immuno-checkpoint inhibition (ICI) and potentially targeted therapy, no promising alternatives are currently available. We report on an 83-year-old patient suffering from disseminated metastatic melanoma who showed an almost complete response to ICI following chemotherapy, after repeated failure of different regimens including two nonresponsive regimens of ICI. The presented outcome suggests a cytotoxic immuno-priming, facilitating a response to prior nonresponsive ICI. As this concept has not been established until now for malignant melanoma, in contrast to multiple other cancer entities, our case report corroborates previous evidence and therefore suggests a new treatment option, which should be researched further.

Herpes Zoster Vaccination Rates in Hematological and Oncological Patients-Stock Taking 2 Years after Market Approval.

BACKGROUND: Vaccinations have the potential to significantly lower the burden of disease for many major infections in the high-risk population of hematological and oncological patients. In this regard Shingrix®, an inactivated Varicella Zoster Virus vaccine, received market approval in the European Union in March 2018, after prior US approval in October 2017, and recommendations specifically state immunocompromised, including oncological, patients. As vaccination rates are considered to be poor in oncological patients, determining the current vaccination rates for Shingrix® two years after market approval is important in defining the need for intervention to bring this potentially high-impact vaccine to the patients. METHODS: We analyzed data of the EVO Study to provide data for Herpes zoster vaccination rates in oncological patients. The EVO Study was an interventional study evaluating the potential of increasing vaccination rates of specified must-have vaccinations by an instructional card in the oncological setting. Numbers presented in this publication merged baseline data and follow-up data of the control group; hence data not affected by the intervention. RESULTS: Data of 370 patients were analyzed; 21.1% with hematological malignancies and 78.9% with solid cancer. Only 3.0% were vaccinated with Shingrix®. Patients with hematological malignancy were more likely to be vaccinated than those with solid cancer (7.7 vs. 1.7%). CONCLUSION: Despite clear recommendations and a pressing need in the high-risk population of hematological and oncological patients, the vast majority of patients are still left without vaccine protection against Herpes zoster by Shingrix®.