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Administering immunotherapy in the morning seems to matter. Why?

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Re: Administering immunotherapy in the morning seems to matter. Why?

#171

Post by pinkmuffinere »

FollowingTheDao wrote: post #159
goda90 wrote: post #150

Earlier quoted context omitted.

Sleep, exercise, a balanced diet of mostly whole fruits and vegetables, and a moderate amount of whole grains, legumes and fresh meat/fish/eggs if you're not choosing a vegan lifestyle. Avoid ultra processed foods, cured meats, alcohol and other recreational drugs. Make sure you get enough vitamin D, which can be hard with certain diets if you're not supplementing, or getting the right amount of sunlight(latitude and…

Maybe your schema will work for someone who’s on the very top point of the bell curve of human population but human genetic and environmental variability will over rule your advice for the majority of people.

The states known for “hippie”/“granola” attitudes, which largely align with the advice given here, tend to live longer than the states that don’t (scroll through the list in [1] to see this). Usually I would insist on a study, but the effect is so striking, and the mechanism by which it would work is so obvious, that I think this simple list is enough. And I’m sure there are studies too, I’m just too lazy to find and link one.

[1] https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...

Re: Administering immunotherapy in the morning seems to matter. Why?

#172

Post by refurb »

echelon wrote: post #75
_qua wrote: post #65

Earlier quoted context omitted.

Even simple studies are expensive and difficult. You need IRB approval, data collection and organization, staff to do those things. It seems simple from the outside but making it happen takes time, effort, and money which then means also applying for grants which is a process in and of itself.

It's no wonder biology hasn't even entered into the punch-card phase. When I did my bio undergrad I was keenly aware our bodies are just scaled up molecular machines. I was hoping for a future where we'd grow MHC-neutral clonal bodies for organ harvesting. Nope. We're in the stone age.

It's almost as if your undergrad biology gave you just enough information to make assumptions that aren't true?

The medical journals are filled with studies that "should have worked" and didn't.

Heck, there are a ton of studies that "should have worked" that were harmful.

So much for "we're just scaled up molecular machines".

Re: Administering immunotherapy in the morning seems to matter. Why?

#174

Post by unnamed76ri »

cenamus wrote: post #131
HexPhantom wrote: post #105

Earlier quoted context omitted.

How many side effects people just accept because no one thought to tweak the schedule

And to think about how often such things are figured out individually, but go unnoticed, because there's basically 0 chance for the average person to get anyone to do a study on it.

I did make sure to bring it up to my doctor in case the idea could help anyone else.

Re: Administering immunotherapy in the morning seems to matter. Why?

#176

Post by s1artibartfast »

Aerroon wrote: post #167
NiloCK wrote: post #146

Earlier quoted context omitted.

1. The N=1 positive result isn't the sole basis for expanded effort. The basis the is the compelling, research backed, causal mechanism that predicted the scheduling adjustment's success. 2. Does it? Speaking directly out of my butt here (not in healthcare, not an academic), but the OP spoke of pretty acute symptoms specific to a treatment plan. If the treatment program is at all common, then a very straightforward A…

And if the A/B test says that your intervention made the situation worse? Now the doctor is held liable for that.

Not how it works. Doctors have wide latitude to treat patient based on their personal medical intuition. You already have doctors dosing patients at all times of day. If an A/B test shows evening is optimal, all the morning administrators will not suddenly become liable retroactively. Hell, they wont even be liable if they keep doing it in the morning because it fits their schedule better.

Re: Administering immunotherapy in the morning seems to matter. Why?

#177

Post by Gravityloss »

raylad wrote: post #48

My father was on chemotherapy with fludarabine, a dna base analog. The way it functions is that it is used in DNA replication, but then doesn’t work, and the daughter cells die. Typically, patients who get this drug experience a lot of adverse effects, including a highly suppressed immune system and risk of serious infections. I researched whether there was a circadian rhythm in replication of either the cancer cells…

I've heard similar things about fasting.

Re: Administering immunotherapy in the morning seems to matter. Why?

#178

Post by refulgentis »

jcims wrote: post #148
raylad wrote: post #48

My father was on chemotherapy with fludarabine, a dna base analog. The way it functions is that it is used in DNA replication, but then doesn’t work, and the daughter cells die. Typically, patients who get this drug experience a lot of adverse effects, including a highly suppressed immune system and risk of serious infections. I researched whether there was a circadian rhythm in replication of either the cancer cells…

You were obviously on to something and it's frustrating yet completely expected to see all replies with pat dismissals that anything like this gets when there is some real potential innovation in healthcare. Google 'chronotherapy' with some chemo/cancer/immunotherapy related terms and you'll find a ton of research being done. Given that most of it seems to have evolved in the last 8 years my guess is that the concept…

? The other replies don't dismiss it...

Re: Administering immunotherapy in the morning seems to matter. Why?

#179

Post by raylad »

teekert wrote: post #101
ch4s3 wrote: post #54

Earlier quoted context omitted.

It’s not shameful, it’s how evidence based medicine works. One case is interesting but not a basis for changing a protocol by itself. Tons of things could have influenced the outcome and you need a proper study to know that.

It is not shameful indeed. One never knows what the father had experienced if he had been given the therapy during the day. The oncologist could have written a paper (there are many single case papers), or started a trial by himself (requires a lot of organizing) if he was very intrigued. But of course one can’t do that for every above average case. I have to say, in this particular case there is a very plausible mec…

Previous rounds of chemo were done on the normal morning infusion schedule and he ended up with a completely depleted immune system and was put in strict quarantine. He also got multiple infections that were life threatening.

This is the reason I started looking into the alternate dosing schedule.

Re: Administering immunotherapy in the morning seems to matter. Why?

#180

Post by raylad »

Spooky23 wrote: post #83
tilne wrote: post #60

Earlier quoted context omitted.

Regarding 3: Shouldn’t the medical system be optimizing for patient outcomes rather than the business their in? Regarding the first two: I think the anecdote being from 1995 suggests there would have been time to put together said mountain of research. I’m not agreeing that this is shameful for the original doctor, but I do think it’s shameful if avenues for potential research are not taken because it’s inconvenient…

It is at cancer centers. Community oncologists don’t have the resources to do it. Example: https://www.medicalnewstoday.com/articles/cancer-time-of-day...

This was Sloan-Kettering.

They gave morning infusions because it was convenient. To get my father the evening infusion we had to hire private duty nurses to come to his apartment.

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