Do Morning Immunotherapy Infusions Increase Survival?

Morning Infusion Increases Survival for Immunotherapy Patients

In the past 5 years, at least 30 studies have looked at how infusion timing affects immunotherapy survival. In the medical community, this means the research is young but moving fast. More importantly, many of these studies reached the same conclusion: Morning immunotherapy infusion improves survival.

Doctors have observed this in a variety of cancers, including:

• Head and neck cancer
• Liver cancer
• Non-small cell lung cancer (NSCLC)
• Skin cancer (melanoma)
• Stomach cancer
• Urothelial cancer

This phenomenon hasn't yet been studied in mesothelioma patients. But you can still get an idea of how strong the effect is from a recent study.

Doctors split 210 NSCLC patients into early (before mid-afternoon) and late (post mid-afternoon) infusion groups. They all received chemotherapy and immune checkpoint inhibitor (ICI) treatments. The early group had better results across the board, including nearly doubling:

• Overall survival time
• The time period during which tumors did not grow

The NSCLC results are the strongest evidence linking infusion timing to survival. This NSCLC trial deliberately controlled infusion timing for each patient. Earlier studies didn't. Still, doctors have many questions about this relationship, including:

• Could patient factors affect how beneficial early infusion might be for individuals?
• Does the optimal timing for infusion change for different types or combinations of immunotherapies?
• How early in the day does an immunotherapy infusion have to be given in order to provide survival benefits?

It may be years before these questions are answered. But researchers already have a few clues about the role of patient factors.

Optimal Infusion Timing May Differ Between Early Birds and Night Owls

Existing data says immunotherapy generally works better if received in the morning. This aligns with research into other conditions and treatments. For example, blood pressure drugs seem more effective when taken earlier in the day. But scientists recently showed that this isn't true for night owls.

Scientists refer to a person's innate waking-sleeping rhythm as their chronotype. And they've suggested that chronotypes may affect immunotherapy the way they do blood pressure drugs. In other words, early birds may benefit from morning infusion. Night owls might do better with later treatment times.

Early Birds Are More Common Than Night Owls

The studies discussed above found that earlier ICI drug infusion times were better. How is this possible if chronotype affects optimal medication timing? It probably comes down to the ratio of early risers to late risers.

In the general population in the United States, more adults have the early chronotype than the late one. And chronotypes tend to shift even earlier as we age. Mesothelioma, lung and other cancers tend to affect older people. So a study group would likely contain more patients who would benefit from morning treatment times.

Future studies may look at how chronotype and infusion timing affect immunotherapy results. A better understanding of these relationships could help countless cancer patients.

What Does This Mean for Mesothelioma Patients?

This research is still preliminary. Even so, scientists have reported better survival for non-mesothelioma cancer patients receiving immunotherapy earlier in the day. But the best treatment timing may differ between early birds and night owls.

If you're an early riser, you can ask your doctor if morning treatment times could benefit you. A mesothelioma specialist can help you understand how infusion timing might impact your prognosis.