Should Immunotherapy Be Administered Earlier in the Day? Thoracic Oncologist Weighs in on New ASCO 2025 Data

Jorge Nieva, MD, of the University of Southern California Norris Comprehensive Cancer Center, joined Lung Cancers Today to share his insights on key developments in thoracic oncology from the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting.

“One of the studies that I found to be most exciting was a study presented out of China which looked at the impact of circadian rhythms on the efficacy of immunotherapy,” Dr. Nieva said.

“The central finding of the study was that patients who received immunotherapy in the early part of the day—when the infusion was completed before 3 p.m.—had better survival than patients who received immunotherapy later in the day, and this was statistically significant.”

Receiving immunotherapy earlier in the day was “highly impactful,” Dr. Nieva said, explaining that the study showed a median overall survival of 33 months in the patients who received immunotherapy earlier in the day, compared with 19.5 months for the patients who received immunotherapy later in the day.

It was “incredibly insightful that this study was done in the first place,” because “we don’t understand enough about circadian rhythms and cancer therapeutics in general,” he said.

However, there are many remaining questions, from the biological to the practical, Dr. Nieva said.

“Monoclonal antibodies have a very long half-life. I think people have a hard time understanding why the time of administration should matter, because if the drug is around for three weeks, it’s around for three weeks, day and night,” he said. “The specific time of administration theoretically wouldn’t matter if it was based on plasma levels.”

This data points to a fundamental question, Dr. Nieva said: Do plasma levels of the drug truly reflect the levels of the drug that are being seen in the tumor?

“This is a very difficult question to answer, but one that I think the scientific community needs to answer moving forward if we’re going to have the best care for our patients,” he explained.

Beyond the biological questions, there are also key logistical questions and considerations when it comes to putting these findings into practice.

“This is one of those factors that can impact patient survival at essentially no cost; it just means that we have to move our drug administration to earlier in the day,” he said.

However, moving drug administration to earlier in the day can “create a lot of logistical challenges for cancer centers all across the U.S.”

“It’s going to be important that advocacy organizations and patients make sure that if they are being treated with immunotherapy, for lung cancer in particular, that they try to get those early-in-the-day appointments,” Dr. Nieva said. “Here in Los Angeles, a lot of patients don’t like early-in-the-day appointments because it means they have to sit in traffic for a long time, so some patients do prefer their appointments to be later in the day for that reason. I think all these things need to be balanced with patient convenience and time toxicity.”

While the finding from this study requires confirmation in larger populations, the preliminary data on moving immunotherapy to earlier in the day “is so intriguing that people may want to take action on it right away,” Dr. Nieva explained.