Chronotherapy: timing treatment to the body clock
Giving the same drug at a different time of day, because the body clock changes how much damage it does and how well the immune system responds.
Retrospective series repeatedly report better outcomes when checkpoint inhibitors are infused earlier in the day, and chronomodulated chemotherapy has a long European history in colorectal cancer with mixed randomised results. The signal is confounded: patients infused late are often sicker or attend different clinics. Prospective randomised trials of infusion timing are small and ongoing, and nothing has changed practice.
How it works
Circadian variation in drug metabolism, DNA repair and immune-cell trafficking makes both toxicity and efficacy depend on time of day.
- Free: only scheduling changes
- Applies across drug classes
- Consistent direction across retrospective cohorts
- Retrospective data are heavily confounded
- Randomised chronomodulated chemotherapy gave mixed results with sex differences
- Clinic logistics make morning slots scarce
Latest papers
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