Here’s a link to the abstract:
https://ascopubs.org/doi/abs/10.1200/JCO.2025.43.16_suppl.85...
apparently it was prospective and randomized. I’m a little shocked by the effect size.
Administering immunotherapy in the morning seems to matter. Why?
41–50 of 200 posts
Re: Administering immunotherapy in the morning seems to matter. Why?
#42This is bad science. Patients schedule when they go to immunotherapy appointments. People who go in the morning are still working/doing things, where once you get _really_ sick, you end up scheduling mid-day, because its such a hassle to do anything at all.
The appointment schedule was randomized, so your objection is incorrect.
Re: Administering immunotherapy in the morning seems to matter. Why?
#43Here’s a link to the abstract: https://ascopubs.org/doi/abs/10.1200/JCO.2025.43.16_suppl.85... apparently it was prospective and randomized. I’m a little shocked by the effect size.
This paper was not a retrospective analysis, it was a randomized clinical trial.
Re: Administering immunotherapy in the morning seems to matter. Why?
#44Here’s a link to the abstract: https://ascopubs.org/doi/abs/10.1200/JCO.2025.43.16_suppl.85... apparently it was prospective and randomized. I’m a little shocked by the effect size.
This paper was not a retrospective analysis, it was a randomized clinical trial.
Yeah I’m checking - I saw several other oncologists suggesting song a separate discussion.
Re: Administering immunotherapy in the morning seems to matter. Why?
#45This is bad science. Patients schedule when they go to immunotherapy appointments. People who go in the morning are still working/doing things, where once you get _really_ sick, you end up scheduling mid-day, because its such a hassle to do anything at all.
Writer of the article here: randomization fixes most of this, but the other commenters are correct in that doesnt fully account for the clinic performance (e.g. nurse performance, which does dip during the night according to the literature). I previously thought it wasn't a major issue for clinical trials, since a separate team independent from the main ward are giving the drugs, but there isn't super strong evidence to support that. I will update the article to admit this!
This said, I am inclined to believe that this isn't a major concern for chronotherapy studies, since I haven't yet seen it being raised in any paper yet as a concern and the results seem far too strong to blame entirely on 'night nurses make more mistakes'. Fully possible that that is the case! I just am on the other side of it
Re: Administering immunotherapy in the morning seems to matter. Why?
#46I'm doing CedarCure. You're required to not exercise or bath/shower for 2h after taking, which is fairly difficult in the morning, so I asked the doc if I could do it in the evening instead (despite explicit instructions to do it in the morning). The doc said it was fine, confirmed by the pharmacist. I should know better by now than to trust doctors to act based on research and not gut feeling, but I hope this doesn'…
Explicitly clear, but otherwise not overly specific, medication instructions would be best.
Say exactly what matters.
E.G. 'Take once a day at a similar time.' VS overly specific but not required 'take in the morning / evening / lunch / some other assumption that doesn't matter.' HOWEVER maybe "Take once a day with your first (full) meal." OR "Take once a day with your primary meal." might make more sense for medications that interact with food.
Re: Administering immunotherapy in the morning seems to matter. Why?
#47I'm doing CedarCure. You're required to not exercise or bath/shower for 2h after taking, which is fairly difficult in the morning, so I asked the doc if I could do it in the evening instead (despite explicit instructions to do it in the morning). The doc said it was fine, confirmed by the pharmacist. I should know better by now than to trust doctors to act based on research and not gut feeling, but I hope this doesn'…
> I could do it in the evening instead (despite explicit instructions to do it in the morning)
Have either you or your doctor identified the reason for the morning recommendation?
Maybe restart consideration of timing there?
Doctors are going to take your practical need to break one part of protocol, to maintain the rest of the protocol, seriously. They can't resolve the practicalities of patients' lives.
Re: Administering immunotherapy in the morning seems to matter. Why?
#48My 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 or the immune cells: lymphocyte and other progenitors, and found papers indicating that the cancer cells replicated continuously, but the progenitor cells replicated primarily during the day.
Based on this, we arranged for him to get the chemotherapy infusion in the evening, which took some doing, and the result was that his immune system was not suppressed in the subsequent rounds of chemo given using that schedule.
His doctor was very impressed, but said that since there was no clinical study, and it was inconvenient to do this, they would not be changing their protocol for other patients.
This was around 1995.
Re: Administering immunotherapy in the morning seems to matter. Why?
#49Earlier quoted context omitted.
I always have seen mid-day appointments as also a luxury for those doing well (at least professionally/financially). If you have to go first thing in the morning, it's often because your boss wants you in relatively early and won't let you take time mid-day. If you're in a position where you can go in at 2PM and not have to sacrifice sleep to do so, that feels healthier. Given the highly-evident strong circular natur…
Surely your boss legally has to let you attend a health appointment? Though they might not have to pay you. That seems like a very basic workers right, the sort of thing you'd have a general strike over if it didn't exist??
The most vulnerable, at least among those who have a job at least, often have the most draconian restrictions on when and what they can do.
Believe they are being treated like robots. Maybe even literally like gears rented by the hour, not even robots.
Re: Administering immunotherapy in the morning seems to matter. Why?
#50My 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…
Amazing. And shameful (for them.)