Abstract 52P
Background
The immune circadian rhythm influences tumor behavior and treatment responses. Fluctuations in PD-1/PD-L1 expression throughout the day may affect Immunotherapy (IO) efficacy, depending on infusion timing. This study evaluates the impact of IO infusion timing on outcomes in patients (pts) with advanced/metastatic non-small cell lung cancer (NSCLC).
Methods
A retrospective analysis was performed on pts treated with nivolumab (nivo) or pembrolizumab (pembro) between January 2020 and July 2024, categorizing them into morning (before 2 p.m.) and afternoon (after 2 p.m.) infusion groups (MI and AI, respectively). Univariate and multivariate analyses assessed the correlation between infusion timing and pts outcomes.
Results
A total of 114 pts included, with median age of 67 years (41–86), 76.6% (n=99) male, and 56.1% (n=60) with ECOG PS of 1. Most had adenocarcinoma (n=90; 78.9%) and expressed PD-L1 (n=58; 50.9%). Sixty (52.6%) received nivo (83.3% in second-line), and 54 (47.4%) received pembro (87% in first-line). Eighty pts (75.4%) received MI, and 28 (24.6%) received AI. Median follow-up was 24.8 months ([mo], 5–185.3). Median progression-free survival (PFS) was 9.7 (5.6–13.76) vs. 10.2 mo (1–19.6) for MI and AI, respectively (p 0.99). For nivo, it was 7 mo (3.5–10.5) for MI vs. 4.7 mo (1–17.2) for AI (p 0.77). For pembro, it was 11.5 (7.7–15.3) vs. 13.5 mo (1–26.5) for MI and AI, respectively (p 0.83). Discontinuations due to toxicities occurred mostly in MI group (86.7%; 13/15). Median overall survival (OS) was 21.6 mo (16.1–27.1), with no significant difference between MI (28; 16.3–39.7) and AI (34.6; 1–71.9) groups (p 0.27). In the first-line setting, it was 59 (23.6–97.5) for MI vs. 22.5 mo (2–43) for AI (p 0.26). In the pembro subgroup, a non-significant trend toward better OS was observed in the MI group (36 vs. 14.3 m, p 0.28). For nivo, it was 34.6 vs. 32 mo for MI and AI, respectively (p 0.35). OS was longer for pts receiving pembro before 12 p.m. (40.4 vs. 16.6 mo), though not statistically significant (p 0.06). PD-L1 expression did not affect the results.
Conclusions
Our study found no statistically significant difference in IO timing infusion in PFS or OS in pts with advanced/metastatic NSCLC. Further studies may be needed for specific subgroups analysis.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.