Administering immunotherapy in the morning seems to matter. Why?

Summary

Edit on 08/06/2024: At least one person has pointed out that, at one point, giving hypertensives at night were also thought to matter, a now disproven idea. Someone also mentioned how many times the clinical trial information was altered during the study. I added in a section at the end to discuss this. There’s a really interesting phenomenon in the immunotherapy field that has been going on for what seems to be several years now, but was raised to me — a non-oncologist — via a viral Twitter thread of some work at ASCO25:Translating the jargon: amongst the patients who received their immunotherapy infusion before 3pm (as opposed to after 3pm), their cancer stayed under control for longer (11.3 months vs. 5.7 months) and on median lived longer (at least 23.2 months versus 16.4 months). A near 2x~ improvement in the most important metrics doing something that is entirely risk-free and cost-free. These two images shown in the comments of the post also demonstrate genuine changes in levels of circulating T-cells between the two groups:Important context: the current standard of care for immunotherapy is not designed with timing in mind. You come in to get the injection when convenient for you or when there are free spots, there is no official recommendation to get it in the morning. But this study implies that we should potentially update our guidelines. Weird, right? And if you have my relatively naive instincts, obviously wrong. Something must have been off in the study. After all, wasn’t there that one paper about how time-a-lab-test-is-taken is more predictive of patient survival than the test results themselves? The punchline? Sicker patients have strangely-timed emergency lab orders at 2AM, healthy patients have routine morning blood draws. Timing is hard to rely on!But this paper was not a retrospective study of electronic health records, it was a randomized clinical trial, which is the gold standard. This means that we’ll be forced to immediately throw away our l...