Impact of time-of-day and timing interval of neoadjuvant immunotherapy and chemotherapy infusions among patients with operable NSCLC using the inverse probability of treatment weighting method: a dual-center, retrospective study

Rákkutatás · NSCLC

Although early infusions of most neoIO drugs did not affect safety or efficacy, they showed a potential trend toward improving long‑term survival.

The study investigated whether the time-of-day (ToDA) of neoadjuvant immunotherapy (neoIO) and the timing interval (TI) between immunotherapy and chemotherapy infusions influence efficacy and survival outcomes in patients with operable non‑small cell lung cancer (NSCLC). Using inverse probability of treatment weighting (IPTW) and Cox regression, disease‑free survival (DFS) and overall survival (OS) were compared between patients receiving ≥75 % of neoIO infusions before 14:00 h and those receiving <75 %. Results: In 168 patients (median follow‑up 30.3 months), 123 (73.2 %) were in the ≥75 % group. The <75 % group had higher 3‑year OS (68.3 % vs. 89.1 %; P = 0.033) and DFS (77.1 % vs. 77.9 %; P = 0.065). Multivariate Cox analysis confirmed poorer OS in the <75 % group (HR = 7.625; 95 % CI = 1.112–52.272; P = 0.039) and identified a shorter mean TI (<23.5 h vs. ≥23.5 h) as an independent factor associated with better OS (HR = 0.143; 95 % CI = 0.024–0.875; P = 0.035). Conclusions: Although early infusions of most neoIO drugs did not affect safety or efficacy, they showed a potential trend toward improving long‑term survival, warranting further investigation into underlying immune microenvironment and molecular mechanisms to guide future prospective studies.

The finding suggests that timing of neoadjuvant immunotherapy relative to the circadian cycle may influence overall survival in operable NSCLC, highlighting the need to consider chronotherapy in clinical practice and future trials.

Bizonyítékszint: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.

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