Nicholas Hornstein, Assistant Professor at Northwell Health, shared a post on X:

“Early bird gets the immunotherapy benefit? I literally told a young EOCRC patient with Lynch today to book his infusion first thing in the morning. If it ends up not mattering, fine. If it does… what’s the downside?

A phase 3 randomized trial finally tested something many of us have quietly wondered for years: does the time of day you give immunotherapy matter? In LungTIME-C01, treatment-naive stage IIIC–IV NSCLC patients received their first four cycles of anti-PD-1–based immunochemotherapy either before or after 3 pm. The difference was not subtle. Progression-free survival nearly doubled.

Overall survival was more than a year longer. Same drugs. Same patients. Same toxicity. The only variable was timing. This is lung cancer, not colorectal. It needs replication. It’s not changing guidelines tomorrow.

But circadian biology is real. The immune system doesn’t operate on a flat line. And if moving an infusion earlier is low risk, low cost, and potentially high upside, it’s hard not to at least think about it. With no added toxicity, this feels hard to ignore. Sometimes progress isn’t a new drug. Sometimes it’s just asking when.”

Title: Time-of-day immunochemotherapy in nonsmall cell lung cancer: a randomized phase 3 trial

Authors: Zhe Huang, Liang Zeng, Zhaohui Ruan, Qun Zeng, Huan Yan, Wenjuan Jiang, Yi Xiong, Chunhua Zhou, Haiyan Yang, Li Liu, Jiacheng Dai, Nachuan Zou, Shidong Xu, Ya Wang, Zhan Wang, Jun Deng, Xue Chen, Jing Wang, Hua Xiang, Xiaomei Li, Boris Duchemann, Guoqiang Chen, Yang Xia, Tony Mok, Yongchang Zhang