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Matthew Kurian: Does the Clock Matter in Cancer Care?

Matthew Kurian/youtube.com

Aug 5, 2025, 20:59

Matthew Kurian: Does the Clock Matter in Cancer Care?

Matthew Kurian, Assistant Professor of Medicine at the University of Kentucky College of Medicine, shared a post on LinkedIn:

“Does the Clock Matter in Cancer Care?

At ASCO 2025, one of the most intriguing and pragmatic findings wasn’t about what we give—but when.

In advanced non-small cell lung cancer, two studies presented this year raised eyebrows:

1. Large Bi-continental Retrospective Study (713 patients):
• Found that giving immunotherapy + chemo before ~11:30 AM was tied to significantly better outcomes:
• Improved overall survival, progression-free survival, and response rates

2. Phase III Randomized Trial (Zhang et al.):
• Confirmed the finding prospectively—early infusions (before 3 PM) led to:
• PFS: 11.3 vs 5.7 months
• OS Hazard Ratio: 0.45 (~55% reduction in risk of death)

Why does this matter?
• It’s a low-cost, pragmatic strategy to potentially improve outcomes—no new drugs required.
• But it raises real-world questions:
• Does this apply to other tumor types?
• How do we operationalize this when infusion chairs are already packed?

Sometimes improving outcomes isn’t about adding more—it’s about doing the same things smarter. Is your center thinking about timing of IO yet? How would you handle this logistically? And lastly, are you convinced”

H. Jack West, Vice President of Clinical Development at Summit Therapeutics, Inc, shared a post by Matthew Kurian, adding:

“I’ve been impressed by the range of groups and settings where we’ve seen about earlier administration of immunotherapy; while generally retrospective, they align to convey a clear message. In addition, the magnitude of the efficacy difference on the randomized phase 3 trial was…jaw-dropping.

For as much attention as this has received, I think it’s far less than it deserved. I have to wonder whether this would have been in the Plenary Session if it had come from a US-based cooperative group instead of China (I don’t actually wonder, because I’m nearly certain it would have been). I think other reasons that we’ve seen less shouting about this work from the rooftops is that we don’t truly understand it, so we tend to downplay it. Of course, there also isn’t an industry sponsor who stands as a “winner” when 9 AM administration is the big advance, so there won’t be glossy journal advertisements or campaigns in the exhibit hall booths about this.

While you’re absolutely right that this doesn’t add an expense (directly), it greatly challenges how immunotherapy is administered; needing to get all patients treated in the earlier part of the day (especially if we ultimately learn that a 3 PM cutoff is later than optimal) entails an upheaval in practice. Are we going to need to start clinics at 6 AM and front load the infusion center with patients getting ICIs in the earlier part of the day, relegating afternoon clinics only to patients not getting immunotherapy? I believe that this is part also contributes to an unspoken sense of this work as an ‘inconvenient truth’.”

More posts featuring Matthew Kurian.