Some forms of cancer immunotherapy are significantly more effective if administered in the morning, when lymphocytes are most active.
There is a right time for everything. Even in cancer therapies: according to research published in the scientific journal CancerPerforming immunotherapies in the morning, when immune cells are most active, could improve their effectiveness. The study may suggest a low-cost and easily implementable strategy to improve cancer treatment outcomes.
Keep an eye on the (biological) clock
Cells vary their activities, such as division and repair, over the course of 24 hours, following circadian rhythms. Many biological processes, such as inflammation or hormone release, are also synchronized to the biological clock. However, these cycles are altered in cancer cells: for example, it has been shown that the cells that originate breast cancer metastases are more active and aggressive at night.
A group of scientists from Central South University in Changsha, China, thought of exploiting these peculiarities of cells to enhance a type of immunotherapy used against lung cancer.
The drugs immune checkpoint inhibitorsantibodies that remove the brakes on the immune system, preventing tumor cells from slowing down the anti-tumor response of white blood cells, enhance the action of T lymphocytes, cells that are naturally more active in the morning. Administering these types of therapies early in the day could therefore increase their effectiveness against cancer.
The morning has gold in its mouth
Already a few months ago, the team of Chinese scientists had demonstrated that administering one of these immunotherapies, the pembrolizumabalong with chemotherapy to patients with advanced forms of non-small cell lung cancer (NSCLC), the most common form of lung cancer, before 11:30 a.m. was associated with a survival rate nearly double that of an afternoon treatment regimen.
Now the researchers tried to understand if the same was true for another form of lung cancer, which grows more aggressively: small cell cancer. Analysis of data on nearly 400 patients treated with immune checkpoint inhibitors atezolizumab or durvalumab along with chemo over 4 years showed that receiving infusions before 3pm was associated with a 52% lower risk of cancer progression, and a 63% lower risk of death over the period examined.
Morning therapies seem to make T lymphocytes work better, boost their number and regulate their entry into tumors. The same effect could also apply to other types of cancer (such as melanoma or renal carcinoma): for some time doctors and healthcare professionals have described, albeit anecdotally and not proven by controlled clinical trials, a greater effectiveness of immunotherapies administered in the early hours of the morning.
This intuition will be demonstrated in larger studies, also clarifying another aspect: does it apply to all patients regardless of their chronotype – “owls” included?
