Morning versus afternoon administration of immune checkpoint inhibitors in metastatic non-small-cell lung cancer - PubMed
3 days ago
- #immunotherapy
- #circadian rhythm
- #lung cancer
- Morning administration of immune checkpoint inhibitors (ICI) in metastatic non-small-cell lung cancer was associated with improved overall survival compared to afternoon administration.
- The study emulated a randomized trial using Veterans Health Administration data from 2010–2024, involving 4688 patients, with 1171 receiving morning infusions and 794 afternoon infusions.
- Median survival was 10.3 months for morning infusions versus 8.1 months for afternoon infusions, with a hazard ratio of 1.15 for afternoon versus morning, indicating worse outcomes for afternoon dosing.
- No time-of-day effect was observed in a control cohort of 7951 chemotherapy patients, suggesting the survival benefit is specific to immunotherapy and supports a causal chronotherapeutic effect.
- Scheduling ICI infusions before noon is proposed as a low-cost, actionable strategy that warrants prospective confirmation for improving clinical outcomes.