Timing matters. A study presented at the annual meeting of the American Society of Clinical Oncology in Chicago suggests that when patients receive pembrolizumab (Keytruda), an immune checkpoint inhibitor, correlates to their overall survival. It places circadian rhythms at the forefront of cancer therapy.

Although the study was not conducted in patients with melanoma, it may be applicable to them because pembrolizumab is commonly used to treat melanoma.

The study demonstrated that patients who received pembrolizumab with chemotherapy before 11:30 am (n=345) had a median overall survival of 33.0 months, with a range of 27.5 to 41.0 months. In comparison, patients who received pembrolizumab with chemotherapy after 11:30 am (n=368) had a median overall survival of 19.5 months, with a range of 18.0 to 22.5 months. The results were highly significant when analyzed by statistical tests.

The data came from two retrospective studies that assessed 713 patients with Stage III and IV non-small cell lung cancer in France and China. The patients were treated with pembrolizumab, and with pemetrexed-carboplatin, pemetrexed-cisplatin, or paclitaxel-carboplatin, over 2-4 courses of therapy.

Due to the retrospective analysis, a randomized clinical trial will be needed to confirm these findings. If the data is repeated, it could represent a paradigm-changing discovery that is incorporated into clinical practice.

The results were included in abstract 2510, “Overall survival according to time-of-day of combined immuno-chemotherapy for advanced non-small cell lung cancer: A bicentric bicontinental study,” by Francis A. Lévi, Zhe Huang, Abdoulaye Karaboue, et al. presented at the American Society of Clinical Oncology meeting in Chicago.