1062P - Effect of the immunological circadian rhythm on the treatment of locally advanced non-small cell lung cancer treated with consolidation immunotherapy

Background

Some studies, including a recent meta-analysis, observed that the circadian rhythm of immune cell’s proliferation and destruction may influence progression-free and overall survival in metastatic cancer treated with immunotherapy (IO). This study aims to assess whether such differences persist in patients with locally advanced non-small-cell lung cancer (NSCLC) undergoing radical concurrent chemo/radiotherapy (CRT) and IO consolidation depending on the time of day of IO administration.

Methods

For this study, all the histologically confirmed patients with irresectable NSCLC PDL1 >1% treated with radical concurrent CRT and IO consolidation (PACIFIC protocol) from 2018 to 2023 in our hospital were included. These patients were categorized depending on the median time of IO administration in two groups: morning (before 3pm) or afternoon group (after 3 pm).

Results

A total of 41 patients were identified. The mean age was 65.4 years (range 45-78) of which 34 were males (82.9%) and 24 presented squamous cell carcinoma histology (58.5%). The morning group included 28 patients (68%), receiving 50% or more doses of IO before 3 pm, while the afternoon group included 13 patients (32%), receiving less than 50% of doses before 3pm. Patients received a mean of 7.78 months (range 1-13) of consolidation IO after radical concurrent CRT. Progression-free survival (PFS) was significantly better in the morning group compared to the afternoon group. Median PFS is not achieved vs 13 months (p=0.017; Hazard Ratio 3.04, 95% CI 1.17-7.91, p=0.023). The 1-year PFS rates were 68.5% vs. 51.9% and mean PFS was 33 vs. 16.4 months. Overall survival (OS) favoured the morning group but did not reach statistical significance. Median OS 44 vs. 31 months (p=0.21; HR 1.97, 95% CI 0.68-5.74). The 1-year OS rates were 91.8% vs. 84.6%, and 3year OS rates were 66.4% vs 32.6%.

Conclusions

This retrospective analysis indicates that patients treated preferentially before 3pm exhibit a better disease control than those treated onwards. Preferential treatment in the morning may enhance disease control and improve OS. This encourages the release of a prospective clinical trial.

Clinical trial identification

CEIM code 2023.217; Approved on 07/11/2023.

Editorial acknowledgement

Legal entity responsible for the study

Institut Català d'Oncologia - Girona and IDIBGI.

Funding

IDIBGI.

Disclosure

All authors have declared no conflicts of interest.