Addressing Greater Risk of Shingles in Cancer Patients

Cancer patients are at increased risk of developing shingles and related complications, possibly because some cancer types or chemotherapy’s immunity suppression make them more vulnerable to the herpes zoster virus (HZV). Two recently-published studies shed some new light on the subject and what can be done to lower patients’ risk of shingles. 

The first study was conducted by Australian researchers and published in The Journal of Infectious Diseases in December 2018. After analyzing medical records of more than 240,000 adults to compare cancer and shingles diagnoses, they found that the risk of contracting shingles was 41% higher overall for cancer patients compared to patients without cancer. 

Specifically, patients with hematological (blood and bone) cancers faced a 374% higher risk, while patients with solid organ cancers were at 30% greater risk.

“Possible explanations for the association between cancer and subsequent zoster could be the immune system dysfunction caused by the cancer itself, which is likely in hematological cancers, or the immunocompromising effects of treatments that cancer patients receive,” the researchers note. 

They conclude that the increased risk for hematological cancer patients is apparent in the two years preceding diagnosis and treatment. In cases of solid organ cancers, the increased risk appears to be largely associated with receipt of chemotherapy. 

The second study was based in the United States and funded by GlaxoSmithKline (GSK) Biologicals SA, manufacturer of the Shingrix vaccine. It evaluated the safety and immunogenicity of the vaccine in adults with hematological malignancies at 77 centers worldwide who were receiving immunosuppressive cancer treatments. 

Senior clinical researcher and development lead at GSK Alemnew F. Dagnew, MD, MSc, told Infectious Disease News that despite the patients’ immunosuppression, Shingrix “elicited robust and persistent immune responses and showed an acceptable safety profile.” He further concluded that the study’s results support the use of Shingrix in immunocompromised adults, including those with hematological cancers. 

Dale Shepard, MD, PhD is a medical oncologist at Cleveland Clinic not associated with either study. He advocates for Shingrix over Zostavax when vaccinating cancer patients against shingles.

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“Zostavax is from a live, attenuated virus and is specifically contraindicated in people who are immunocompromised for fear that when you give the vaccine they may actually contract the disease,” he explains. “By comparison, Shingrix is a recombinant vaccine. They took the antigenic part of the vaccine but not the virulent part, so people can’t get shingles from this vaccine if they’re immunocompromised. It doesn’t carry the same contraindication in immunocompromised patients.” 

In addition to oncologists accepting the value of shingles vaccination of their patients, Shepherd says primary care physicians and pharmacists can also be on the frontline when it comes to lowering the risk of shingles for those patients. 

“They’re oftentimes the ones who are keeping an eye on making sure that all the boxes are checked in terms of all the health maintenance kinds of issues,” he says. “Without the availability of a way to give vaccines for shingles to patients who have cancer, they may be in the mindset of just avoiding it.”