title: Response to influenza virus vaccination during chemotherapy in patients with breast cancer.
abstract: BACKGROUND
  Patients receiving chemotherapy are at increased risk for influenza virus infection. Little is known about the preferred moment of vaccination during chemotherapy.
  
  
  METHODS
  Breast cancer patients received influenza vaccination during FEC (5-fluorouracil, epirubicin and cyclophosphamide)-containing chemotherapy regimens. Patients were randomised for early (day 4) or late (day 16) vaccination during the chemotherapy cycle. Influenza virus-specific antibody titres were determined before and 3 weeks after vaccination by haemagglutination inhibition.
  
  
  RESULTS
  We included 38 breast cancer patients (20 in the early and 18 in the late group) and 21 healthy controls. The overall patient group had significant lower responses to the vaccine compared with healthy controls. Patients vaccinated at day 4 tended to have higher antibody titres as compared with patients vaccinated at day 16, although the difference in post-vaccination titres is not statistically significant. Geometric mean titres post-vaccination for day 4 versus day 16 were 63.7 versus 29.5 (H3N2), 28.2 versus 19.6 (H1N1) and 29.8 versus 16.0 (B/Brisbane), respectively.
  
  
  CONCLUSIONS
  Patients on chemotherapy have significantly lower responses to influenza virus vaccination compared with healthy controls. Vaccination early during the chemotherapy cycle induces better responses than does vaccination at day 16 of the cycle. Follow-up studies are needed to confirm this effect.
authors.affiliation: Department of Internal Medicine, St Antonius Hospital Nieuwegein, Nieuwegein. Electronic address: a.eggink@antoniusziekenhuis.nl.
authors.forename: A
authors.initials: A
authors.lastname: Meerveld-Eggink
authors.affiliation: Department of Internal Medicine, St Antonius Hospital Nieuwegein, Nieuwegein.
authors.forename: O
authors.initials: O
authors.lastname: de Weerdt
authors.affiliation: Department of Internal Medicine, Tergooi Hospitals Blaricum, Blaricum.
authors.forename: A M T
authors.initials: AMT
authors.lastname: van der Velden
authors.affiliation: Department of Internal Medicine, St Antonius Hospital Nieuwegein, Nieuwegein.
authors.forename: M
authors.initials: M
authors.lastname: Los
authors.affiliation: Department of Internal Medicine, Martini Hospital Groningen, Groningen.
authors.forename: A W G
authors.initials: AWG
authors.lastname: van der Velden
authors.affiliation: Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam.
authors.forename: J M L
authors.initials: JML
authors.lastname: Stouthard
authors.affiliation: Department of Internal Medicine, Máxima Medical Centre Eindhoven, Eindhoven.
authors.forename: M R
authors.initials: MR
authors.lastname: Nijziel
authors.affiliation: Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar.
authors.forename: M
authors.initials: M
authors.lastname: Westerman
authors.affiliation: Department of Internal Medicine, Spaarne Hospital Hoofddorp, Hoofddorp.
authors.forename: A
authors.initials: A
authors.lastname: Beeker
authors.affiliation: Department of Virology, Erasmus Medical Centre Rotterdam, Rotterdam.
authors.forename: R
authors.initials: R
authors.lastname: van Beek
authors.affiliation: Department of Virology, Erasmus Medical Centre Rotterdam, Rotterdam.
authors.forename: G F
authors.initials: GF
authors.lastname: Rimmelzwaan
authors.affiliation: Department of Medical Microbiology and Immunology, St Antonius Hospital Nieuwegein, Nieuwegein.
authors.forename: G T
authors.initials: GT
authors.lastname: Rijkers
authors.affiliation: Department of Internal Medicine, St Antonius Hospital Nieuwegein, Nieuwegein; Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: D H
authors.initials: DH
authors.lastname: Biesma
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007115:Immunization Schedule; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil