The cancer drugs that could improve survival rates if given to patients in the morning

Giving immunotherapy to cancer patients early in the morning instead of in the afternoon could improve survival rates.

A study found that people with terminal lung or skin cancer lived twice as long if they were given immunotherapy drugs – which help the immune system destroy cancer cells – at the start of the day rather than after lunch.

The best results were seen in those treated around 7:30 am. They lived an average of two and a half years.

The researchers who led the trial, published in the European Journal of Cancer, think this may be due to the immune system being more active very early in the day.

Previous research has shown that there are higher levels of immune cells circulating in the blood in the early morning.

Immunotherapy drugs prevent the proteins from binding to T cells, effectively turning the immune system back on so it can detect and destroy cancerous tumors. Pictured: An image of cancer cells

These can not only fight viruses and bacteria, but also attack cancer cells.

This is thought to be due to the circadian rhythm – our body clock – which prepares the immune system for any daytime threats from infectious agents, such as in food or transmitted through interaction with people around us.

Immunotherapy drugs such as ipilimumab, pembrolizumab and nivolumab have transformed cancer care in the UK over the past decade.

Since 2011, when the first immunotherapy drugs were approved in Britain to treat malignant melanoma (the most dangerous form of skin cancer), the average survival time has risen from six months to five years or more.

Most of these drugs – which can cost up to £100,000 per patient per year – work by attaching to a protein called PD-L1, which is produced in large quantities by cancer cells.

The protein disables T cells, defense cells released by the immune system, preventing them from attacking the cancer.

Immunotherapy drugs prevent the proteins from binding to T cells, effectively turning the immune system back on so it can detect and destroy cancerous tumors.

The theory is that giving immunotherapy at the start of the day would enhance this response because there are more T cells circulating.

This follows previous research showing that people who got the flu vaccine early in the day produced much higher levels of antibodies than those who got the jab later.

Again, the idea is that the immune system is then more active and therefore responds much more powerfully to vaccines.

The researchers from a number of agencies in France – including the PSL Research University in Paris – analyzed data from 361 patients with lung or skin cancer that had spread and were treated with immunotherapy drugs between 2015 and 2021.

Their survival rates were compared with the usual length of time each patient was treated; most had about the same time every week or two weeks.

The theory is that giving immunotherapy early in the day boosts a person’s immune response because there are more T cells. Image: Molecular model of an antibody

The results showed that those treated before noon survived an average of 30 months; thereafter, the average survival was 15.9 months.

Previous studies on the timing of cancer treatments came to similar conclusions.

Now two larger studies are underway in China and the US to see if more lives can be saved by administering the drugs in the morning. Results are expected in the next few years.

Dr. Pasquale Innominato, a cancer specialist at Ysbyty Gwynedd Hospital in Bangor, Wales, who also researches the effect of previous drug administration, said the findings have the potential to revolutionize NHS patient care.

‘We need to see results from the larger trials, but all the evidence to date shows that whatever type of immunotherapy drug is used and whatever type of cancer it is, there are benefits to treatment being given earlier in the day.’