Thread by @BrandonLuuMD

Circadian biology may be the next frontier in cancer care.

Patients with lung cancer who got chemo-immunotherapy before 11:30 AM had:
📉 53% lower risk of death
📆 Median overall survival: 33 vs. 19.5 months
📈 Improved treatment response

Let’s break it down 🧵1/7

Your body runs on a clock.
Cortisol, insulin, immune cells all peak at certain times.
Yet most cancer therapy is scheduled without considering circadian rhythms. That’s a problem, especially for immunotherapy, which depends on immune activation /2

Researchers analyzed patients from France & China with advanced NSCLC.
They grouped them by the median time of their first 4 infusions:
🕗 Before 11:30 AM
🕛 After 11:30 AM
Same treatment, different timing, very different outcomes /3

Key findings:
• OS: 33.0 vs 19.5 months
• PFS: 11.8 vs 7.2 months
• Death risk ↓53% (HR 0.47)
• Response: 62% vs 52%
Morning patients lived longer and responded better across both cohorts and most subgroups /4

Why might this happen?
✔️ T-cells are more active in the morning
✔️ Drug metabolism is circadian-regulated
✔️ Chemo (like platinum & taxanes) may be more effective earlier
Circadian biology shapes how the body responds to therapy /5

This was a retrospective study, causation isn’t proven so randomized trials are needed.
But the signal is strong, the biology checks out, and the fix is simple: treat earlier.
Chronotherapy could be a low-cost way to boost cancer outcomes /6

Chronotherapy, aligning treatment with the body’s clock, is a powerful and underrated frontier in personalized medicine.

This study shows it may even extend survival in cancer.

For the full breakdown, check out the newsletter linked in my bio /7