When Will Things Return To Normal
The rates of infection from the virus have fluctuated since early 2020, but the virus has not gone away and it likely wont anytime soon. Overall, in the United States, the number of cases of COVID-19 and the number of deaths from the virus have continued to increase, though rates fluctuate in various communities and countries. With COVID-19 vaccines now widely available in the United States, a return to normal is expected, but access to vaccines varies from country to country. Also, unless a high percentage of people choose to be vaccinated, a return to normal will be significantly delayed and new variants, such as Omicron, will likely continue to appear. Masking and physical distancing continue to be important, especially indoors in areas of high COVID-19 transmission, for those who are at higher risk because of medical conditions or immune suppression, and for those who are not yet vaccinated or not fully vaccinated. Masks will likely continue to be required in health-care settings.
If your local community, county, or state allows nonessential businesses to be open and if you are not vaccinated against COVID-19, the safest approach is to continue to stay at home and avoid being in public as much as possible. Wear face masks and consider double masking when you leave your home. Stay at least 6 feet away from other people.
If you have questions about your personal risk due to your cancer or cancer treatment, be sure to speak with your doctor for their guidance.
Before Taking This Medicine
Tell your doctor if you have ever had:
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lung disease or a breathing disorder
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liver disease
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an autoimmune disorder such as lupus, Crohn’s disease, or ulcerative colitis or
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an organ transplant or stem cell transplant.
You may need to have a negative pregnancy test before starting this treatment. Do not use Keytruda if you are pregnant. Pembrolizumab could harm the unborn baby. Use effective birth control to prevent pregnancy while you are using this medicine and for at least 4 months after your last dose. Tell your doctor right away if you become pregnant.
Do not breastfeed while using pembrolizumab, and for at least 4 months after your last dose.
Why Might Some Cancer Patients Not Respond To Vaccines
In order for the vaccine to generate protective immunity functional host immunity is required. The host must be able to correctly present the antigen to the immune system so B and T cell activation can occur, and plasma B cell antibody generated. People lacking functional adaptive immune cells may be unable to generate a fully protective immune response to a SARS-CoV-2 vaccine.
According to the American Society of Hematology the following immunocompromised patients could have attenuated or absent response to a SARS-CoV-2 vaccine.4
- Immunodeficiencies involving adaptive immunity
- Splenectomy or functional asplenia
- B cell directed therapies against CD20 or CD22, bispecific agents like blinatumomab, CD19 or CD22-directed CAR-T cell therapies and BTK inhibitors)
- T cell directed therapies
- Many chemotherapy regimens
- High-dose corticosteroids
- Stem Cell Transplant patients – especially within the first 3-6 months after autologous and often longer after allogeneic.
- Graft-vs.-host disease
- Low white blood cell counts.
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How To Take And Store
Patients typically receive Keytruda every three weeks. Recently, it has also been approve d for use every six weeks. The medication is slowly infused into a vein in their arm through an IV .
You will need to go to the hospital, your healthcare provider’s office, a cancer care center, or an infusion clinic to receive your treatment. You will not need to store or prepare the medication at home.
The length of time you will have to get infusions will depend on the specifics of your cancer and how it responds to Keytruda. Unless there are complications, patients usually receive treatment for up to 24 months.
Can Other Medicines Lower Risk As Well
For people with moderately to severely weakened immune systems , the FDA has authorized a combination of the monoclonal antibodies tixagevimab and cilgavimab to help lower the risk of COVID-19 infection. These medicines can be used in people who do not have COVID-19 and who have not recently been exposed to the virus. Its important to note that they are meant to be given in addition to, not instead of getting the vaccine.
For more information, see Can other medicines lower the risk of COVID-19 infection? in Common Questions About the COVID-19 Outbreak.
If you are concerned about your risk of COVID-19 even after being fully vaccinated, its important to talk to your doctor about your immune status and if you should get additional doses of the vaccine, as well as what else you can do to help lower your risk of infection.
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How Does Alcohol Interact With Immunotherapy Medications
Many studies have shown that alcohol use can affect parts of the immune system. More specifically, it can suppress the immune system.
While more research is needed in this area, its possible that alcohols effect on your immune system may interact with how immunotherapy medications work. Immunotherapy usually works to stimulate the immune system. So alcohol could potentially have opposing effects against immunotherapy medications like Keytruda.
This may lead to immunotherapy treatment not being able to work as well as intended if combined with alcohol use.
Seasonal Influenza Vaccine Safe In Patients Receiving Immunotherapy
Rates of new-onset immune-related adverse events in patients newly treated with immunotherapy agents who also recently received the seasonal influenza vaccine were not significantly different from those of historical controls receiving a programmed cell death-1 inhibitor who were unselected for vaccination against influenza. These results were published in Clinical Infectious Diseases.
Patients with cancer are at increased risk for influenza-related complications. Previous studies have shown that although patients receiving chemotherapy have an attenuated immune response to the influenza vaccine, the influenza-related immune response in those undergoing immune checkpoint inhibitor therapy is similar to that observed in healthy persons. However, results from some recent studies have suggested that administering the influenza vaccine to patients also receiving an immune checkpoint inhibitor may result in expansion of T cell clones that recognize both vaccine and self, thereby causing a high rate of irAEs.
All 370 patients included in this study were treated with a PD-1 inhibitor or a cytotoxic T lymphocyte-associated protein 4 inhibitor for advanced cancer mostly lung cancer or melanoma at the Memorial Sloan Cancer Center, in New York City. These patients received inactivated influenza vaccine within 65 days of any dose of immune checkpoint inhibitor therapy, either before after ICI administration. The study was conducted over 3 consecutive flu seasons .
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Should Rituxan Maintenance Be Held During Covid Vaccination
The answer to this is unknown but B-cell suppression typically lasts for at least 9 months after the completion of Rituxan. I would discuss with your oncologist whether Rituxan can be held safely for a prolonged period of time. If not, I would proceed with the COVID-19 vaccine whenever you can get it. Unfortunately, we still do not know the efficacy of the COVID vaccine for lymphoma patients who are actively receiving therapy.
According To A Study Moderna Vaccine Combined With Mercks Blockbuster Immune Drug Keytruda Helped Shrink Tumors In 5 Of 10 Patients With Of Advanced Head And Neck Cancer
Berlin/Washington: The first vaccines against Covid-19 arent just a landmark in the fight against the pandemic. Theyre also the stepping stone for an unconventional technology that could one day defeat other ailments that have eluded doctors, from cancer to heart disease.
The shots from Moderna Inc. and a partnership of Pfizer Inc. and BioNTech SE use genetic material called messenger RNA to effectively transform the bodys own cells into vaccine factories. The approach had never been used outside of clinical experiments, and just how well it worked against the coronavirus stunned even some of its most enthusiastic backers.
Now, with one vaccine vaccine having gained U.S. clearance and the other close behind, the pandemic validation could wrench open a whole new field of medicine.
We are now entering the age of mRNA therapeutics, said Derrick Rossi, a former Harvard University stem-cell biologist who helped found Moderna in 2010. The whole world has seen this. There is going to be increased investment and increased resources.
In some ways, the global pandemic was the perfect proving ground for the new technology as deep-pocketed backers including Pfizer became more willing to take a risk. But the effort was only possible because BioNTech and Moderna Inc. had worked on messenger RNA for years.
The resulting ability to assess multiple candidates in parallel was really beautiful, Sahin said in an interview.
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How Long Does Immunity Last
The answer to this question has long been awaited and the early evidence looks good. Top line data from the phase 3 study evaluating the Pfizer-BioNTech COVID-19 vaccine released in April 2021 shows that it is highly effective beyond 6 months after the second dose – vaccine efficacy was observed to be 91.3%. The vaccine was 100% effective at preventing severe COVID-19 disease and 100% effective in preventing the COVID-19 B.1.351 South Africa variant.19
Antibodies elicited by the Moderna COVID-19 vaccine also persisted through 6 months after the second dose, according to new data published in The New England Journal of Medicine. According to Moderna the vaccine may be effective up to one year.
Single dose vaccination with Pfizer was found to be 63% effective in residents of nursing homes suggesting the importance of getting both vaccine doses.21
Do I Still Need To Take Precautions If I Get The Covid
The COVID-19 vaccines are still being studied, as there are things we dont yet know about them. For example, researchers are still trying to determine how long the COVID-19 vaccines will help protect against the virus. And while the vaccines can clearly lower the risk of getting serious disease from COVID, its not yet clear how well they can prevent the spread of the virus to others.
For people who are fully vaccinated , the CDC has guidance on things you can now do , as well as what types of precautions you should still be taking. This guidance is being updated regularly, so check the CDC website for details. The CDC guidance may not apply if you have a weakened immune system , so its important to talk with your health care provider about which precautions you still need to take.
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When To Get A Flu Shot
Since the timing of the onset, peak, and end of flu season changes from year to year and cannot be predicted, it is difficult to pinpoint the best time for getting vaccinated.
For people taking these or other drugs that suppress the immune system, the optimum time to receive a flu shot is from October to mid-November.
Flu shots are generally available in early September. The flu shot should be scheduled well before the flu season starts to get busy because it can take one to two weeks for the shot to take effect.
Flu activity usually peaks between December and February, with some activity as late as May. Therefore, the vaccination could be given even later, if necessary, because receiving a shot late is better than not getting one at all.
What If I Have A History Of Allergies
The American College of Allergy, Asthma, and Immunology released a statement offering guidance to patients with allergies7 and updated its guidelines regarding the risk for allergic reactions with COVID-19 vaccines on March 25th, 2021.
All individuals planning to be vaccinated should be screened to determine the possible risk for allergic reaction and those with a history of severe allergic reaction to other vaccines should be referred to an allergist/immunologist for further evaluation. Anyone with a severe or immediate allergic reaction of any severity within 4 hours of receiving the first COVID-19 shot should not receive the second dose and may be referred to an allergist/immunologist.
People who have received dermal fillers may develop swelling at or near the site of filled injection following mRNA COVID-19 vaccination this occurs infrequently and seems to be temporary. Individuals receiving the mRNA COVID-19 vaccine should expect local and systemic post vaccination symptoms, which are expected side effects and not allergic reactions.
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How Soon Can Vaccination Occur After Completion Of Chemotherapy Or Immunotherapy
There have been conflicting results regarding the immunogenicity of immunization on the first day of the chemotherapy cycle, with one study showing poor immune protection but another study showing good protection from the flu vaccine. Since there is not enough data for the COVID vaccine, we assume similarities and recommend vaccination at the one-week mark from the start of the chemotherapy cycle.
Regarding immunotherapy, studies are relatively conflicting, but a recent study suggests that the flu vaccine does not worsen the toxicities of this type of therapy. Since COVID-19 infection can be very severe and potentially lethal for patients undergoing chemotherapy or immunotherapy, we will be recommending vaccination for all patients with cancer as we continue to study this question further.
Is Having One Or Two Drinks Ok
In general, its recommended that alcohol use should be kept to a minimum, or avoided completely, while on treatment with immunotherapy like Keytruda.
As covered above, alcohol can raise your risk of cancer. Research has found this to be the case with certain cancers, even in people who have one drink per day. This risk also applies to people who binge drink. Binge drinking is defined as five or more drinks for men and four or more drinks for women in one sitting.
Before having a drink, its best to talk to your cancer specialist first. They can give you guidance about whats safe and how alcohol may affect your cancer treatment.
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Can You Still Get Ill With Covid
The Covid-19 vaccines are very good but theyre not perfect. Estimates of peak efficacy are above 90%, but not quite 100%. Therefore, vaccinated individuals can still become infected. If you do get ill, its much less likely to be as severe. Immunity takes at least 2-3 weeks to properly develop after getting your first vaccine dose. New coronavirus variants are also emerging that might be able to avoid immunity.
When Should Patients On Immunosuppressive Therapy By Vaccinated
Vaccination is recommended at least 2-4 weeks prior to the planned immunosuppressive therapy, transplant or splenectomy. If the patient is receiving or has received immunosuppressive therapy, consider vaccination 6 months after the patient has been taken off therapy to increase the likelihood of developing immunity. After hematopoietic cell transplantation vaccines are generally started after 3-6 months.
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Is It Safe For Cancer Patients To Get Any Type Of Vaccine
People with cancer can get some vaccines, but this depends on many factors, such as the type of vaccine, the type of cancer a person has , if they are still being treated for cancer, and if their immune system is working properly. Because of this, its best to talk with your doctor before getting any type of vaccine. To learn more, see Vaccinations and Flu Shots for People with Cancer.
For Patients Who Do Not Report A Prior Episode Of Varicella
When vaccinating adults age 50 years and older, there is no need to screen for a history of varicella infection or to conduct laboratory testing for serologic evidence of prior varicella infection. More than 99% of adults age 50 years and older worldwide have been exposed to varicella zoster virus, and the Advisory Committee on Immunization Practices considers people born in the United States prior to 1980 immune to varicella. Therefore, even if a person does not recall having chickenpox, serologic testing for varicella immunity is not recommended. It is often a barrier to herpes zoster vaccination, and false negatives are common. However, if serologic evidence of varicella susceptibility becomes available to the healthcare provider, providers should follow ACIP guidelines for varicella vaccination. Shingrix has not been evaluated in persons who are seronegative to varicella, and it is not indicated for the prevention of varicella.
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More Common Side Effects Of Keytruda
Keytruda can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days or weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
These are just a few of the more common side effects reported by people who took Keytruda in clinical trials:
Its important to note that these side effects can vary depending on whether you are using Keytruda in combination with other drugs to treat your condition. Its also important to note that side effects of Keytruda arent known to vary depending on the type of cancer its treating, such as lung cancer.
Mild side effects can occur with Keytruda use. This list doesnt include all possible mild side effects of the drug. For more information, you can refer to Keytrudas medication guide.
Mild side effects that have been reported with Keytruda include:
These side effects may be temporary, lasting a few days or weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
Note: After the Food and Drug Administration approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Keytruda and want to tell the FDA about it, visit MedWatch.