Evidence map›Paper›PMID 30795818›Full record

ArticleJournal for immunotherapy of cancer2019

Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors.

Magid Awadalla, Doll Lauren Alexandra Golden, Syed S Mahmood, Raza M Alvi, Nathaniel D Mercaldo, Malek Z O Hassan, Dahlia Banerji, Adam Rokicki, Connor Mulligan, Sean P T Murphy and 27 more

Erratum issuedAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal for immunotherapy of cancer, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 50 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

37 authors.

Magid AwadallaCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA. mawadalla@mgh.harvard.edu.ORCID 0000-0002-7229-0903
Doll Lauren Alexandra GoldenCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Syed S MahmoodCardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
Raza M AlviCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Nathaniel D MercaldoCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Malek Z O HassanCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Dahlia BanerjiCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Adam RokickiCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Connor MulliganCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Sean P T MurphyCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Maeve Jones-O'ConnorCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
Justine V CohenDivision of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Lucie M HeinzerlingDepartment of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen, Germany.
Merna ArmaniousCardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA.
Ryan J SullivanDivision of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Rongras DamrongwatanasukCardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA.
Carol L ChenCardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
Dipti GuptaCardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
Michael C KirchbergerDepartment of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen, Germany.
Javid J MoslehiCardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA.
Sachin P ShahCardiology Division, Lahey Hospital & Medical Center, Burlington, MA, USA.
Sarju GanatraCardiology Division, Lahey Hospital & Medical Center, Burlington, MA, USA.
Paaladinesh ThavendiranathanTed Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Muhammad A RizviDivision of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, PA, USA.
Gagan SahniThe Mount Sinai Hospital, New York, NY, USA.
Alexander R LyonCardio-Oncology Program, Royal Brompton Hospital, London, UK.
Carlo G TocchettiDepartment of Translational Medical Sciences, Federico II University, Naples, Italy.
Valentina MercurioDepartment of Translational Medical Sciences, Federico II University, Naples, Italy.
Franck ThunyCardiovascular Division, Department of Medicine, Aix-Marseille Universite, Marseille, France.
Stephane EderhyCardio-Oncology Program, Division of Cardiology, Hopitaux Universitaires est Paris, Paris, France.
Michael MahmoudiDivision of Cardiology, Department of Medicine, Southampton General Hospital, Southampton, UK.
Donald P LawrenceDivision of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
John D GroarkeCardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Anju NohriaCardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Michael G FradleyCardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA.
Kerry L ReynoldsDivision of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Tomas G NeilanCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Nicholas D Socci · 1985 to 2026
$347.4M
The impact of HIV viral diversity and cellular immunity on HIV pathogenesisP30AI060354 · NIAID · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI ROBERT A. PARKER · 2004 to 2026
$94.4M
STOP-CA: Statins to prevent Cardiotoxicity from AnthracyclinesR01HL130539 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NEILAN, TOMAS G, SCHERRER-CROSBIE, MARIELLE · 2016 to 2020
$3.2M
Mechanisms of Cardiac Dysfunction in HIV and the Effect of StatinsR01HL137562 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NEILAN, TOMAS G, ZANNI, MARKELLA V. · 2017 to 2020
$2.7M
Promoting Bim-driven apoptosis through MAPK inhibition: A therapeutic strategy in advanced melanomaR01CA193970 · NCI · MASSACHUSETTS GENERAL HOSPITAL · PI MEHNERT, JANICE M., SULLIVAN, RYAN J · 2016 to 2020
$2.3M
Abbreviated targeted therapy to improve anti-PD-1 inhibitor efficacy in melanomaR01CA229851 · NCI · MASSACHUSETTS GENERAL HOSPITAL · PI SHARPE, ARLENE H., SULLIVAN, RYAN J · 2018 to 2021
$1.5M
Cardiovascular Imaging in Ischemic Heart DiseaseK24HL113128 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2012 to 2020
$1.1M
Clinical development of a blood based assay that detects the BRAF V600E mutation in melanoma and thyroid cancer patientsUH2CA207355 · NCI · MASSACHUSETTS GENERAL HOSPITAL · PI SULLIVAN, RYAN J · 2018 to 2019
$276k
CIHR FRN 147814NCI NIH HHS P30 CA008748NCI NIH HHS R01 CA193970NCI NIH HHS R01 CA229851NCI NIH HHS UH2 CA207355NHLBI NIH HHS K24 HL113128NHLBI NIH HHS R01 HL130539NHLBI NIH HHS R01 HL137562NIAID NIH HHS P30 AI060354
6 · The paper itself

Abstract

backgroundInfluenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious complication of ICIs and may also result from infection with influenza. There are no data testing the relationship between FV and the development of myocarditis on ICIs.

methodsPatients on ICIs who developed myocarditis (n = 101) (cases) were compared to ICI-treated patients (n = 201) without myocarditis (controls). A patient was defined as having the FV if they were administered the FV from 6 months prior to start of ICI to anytime during ICI therapy. Alternate thresholds for FV status were also tested. The primary comparison of interest was the rate of FV between cases and controls. Patients with myocarditis were followed for major adverse cardiac events (MACE), defined as the composite of cardiogenic shock, cardiac arrest, hemodynamically significant complete heart block and cardiovascular death.

resultsThe FV was administered to 25% of the myocarditis cases compared to 40% of the non-myocarditis ICI-treated controls (p = 0.01). Similar findings of lower rates of FV administration were noted among myocarditis cases when alternate thresholds were tested. Among the myocarditis cases, those who were vaccinated had 3-fold lower troponin levels when compared to unvaccinated cases (FV vs. No FV: 0.12 [0.02, 0.47] vs. 0.40 [0.11, 1.26] ng/ml, p = 0.02). Within myocarditis cases, those administered the FV also had a lower rate of other irAEs when compared to unvaccinated cases (36 vs. 55% p = 0.10) including lower rates of pneumonitis (12 vs. 36%, p = 0.03). During follow-up (175 [IQR 89, 363] days), 47% of myocarditis cases experienced a MACE. Myocarditis cases who received the FV were at a lower risk of cumulative MACE when compared to unvaccinated cases (24 vs. 59%, p = 0.002).

conclusionThe rate of FV among ICI-related myocarditis cases was lower than controls on ICIs who did not develop myocarditis. In those who developed myocarditis related to an ICI, there was less myocardial injury and a lower risk of MACE among those who were administered the FV.

Indexed as

AgedAged, 80 and overAntineoplastic Agents, ImmunologicalFemaleHumansInfluenza, HumanInfluenza VaccinesMaleMiddle AgedMyocarditisNeoplasmsRegistriesVaccinationAntineoplastic Agents, ImmunologicalInfluenza VaccinesCancerCardiovascular diseaseImmune checkpoint inhibitorsImmune-related adverse eventsInfluenza vaccinationMajor adverse cardiac eventsMyocarditis

Identifiers

PMID30795818
PMCPMC6387531

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.