Drug Interactions between cholera vaccine, live and durvalumab

GENERALLY AVOID: The administration of vaccines or therapies containing live, attenuated virus or bacteria during treatment with immune checkpoint inhibitors (ICIs) such as anti-CTLA-4 monoclonal antibodies and/or inhibitors of programmed cell death-1 (PD-1) or programmed death ligand-1 (PD-L1) may be associated with a risk of disseminated infection due to enhanced replication of live, attenuated virus or bacteria and/or a decreased or suboptimal immunologic response to the vaccine(s) or immunotherapy. In general, ICIs alter T-cell activity and may influence the immune system's response to vaccination in ways that have not been fully elucidated. Clinical data specific to ICIs in the presence of live, attenuated virus or bacteria are not readily available.

MANAGEMENT: Until more information is available, administration of vaccines or therapies containing live, attenuated virus or bacteria should generally be avoided in combination with immune checkpoint inhibitors (ICIs). Product labeling for certain ICIs such as atezolizumab, dostarlimab, and durvalumab specify that patients who received live vaccines were excluded from clinical trials; whereas other ICI product labels provide no specific information or guidance. Guidelines on the use of vaccines in adults with cancer by the American Society of Clinical Oncology (ASCO) recommends patients receive live vaccines 2-4 weeks before initiating cancer treatment. The U.S. Centers for Disease Control and Prevention (CDC) advise that, due to limited research on vaccination following immunotherapy with ICIs, live, attenuated vaccines should be avoided for patients receiving these treatments for 3-6 months post-treatment, or until immune recovery is confirmed. While not discussed in vaccine guidelines, it may be advisable to review these recommendations when concomitant treatment with other therapies that contain live, attenuated virus or bacteria are being considered in patients using ICIs. Local guidelines and individual product labeling for each medication involved should be consulted for more specific recommendations.