Afternoon vs. morning chemotherapy extends survival among women with lymphoma subtype
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Women with diffuse large B-cell lymphoma experienced significantly longer PFS and OS when receiving chemotherapy in the afternoon compared with the morning, according to data published in JCI Insight.
Researchers reported no statistical difference in survival outcomes among men who received chemotherapy between the two time periods, researchers wrote.
Background and methodology
Interest among physicians and researchers has grown in the strategy of treating cancer according to biological rhythms. In this study, researchers explored chronotherapy — drug intervention delivered at specific times to optimize efficacy while minimizing adverse events — among adults with DLBCL undergoing chemotherapy.
Researchers performed chronotherapeutic analysis using two cohorts of patients with a dichotomized chemotherapy schedule, starting at either 8:30 a.m. or 2:30 p.m. Patients received treatment four to six times per session at intervals of approximately 3 weeks.
The investigators evaluated how the timing of the R-CHOP regimen (rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone) impacted survival and drug tolerability in a survival cohort (n = 210) and an adverse event cohort (n = 129).
Patients had a median age at diagnosis of 61 years (range 27-77), and about half had stage III or stage IV DLBCL.
Median follow-up was 40.7 months (interquartile range, 23.5-50.7).
Results
Researchers reported significantly shorter PFS and OS among women who received chemotherapy mostly in the morning vs. afternoon (HR for PFS = 0.35; 95% CI, 0.13-0.96; HR for OS = 0.14; 95% CI, 0.01-1.11).
Researchers reduced the dose intensity for women treated in the morning (cyclophosphamide 10%, P = 0.002; doxorubicin 8%, P = 0.002; rituximab 7%, P = 0.003), mostly due to infection and neutropenic fever. Women treated in the morning had a higher incidence of infections (16.7% vs. 2.4%) and febrile neutropenia (20.8% vs. 9.8%) than those treated in the afternoon.
Overall, women who received afternoon chemotherapy had a 12.5-times lower mortality rate (25% vs. 2%) and 2.8-times lower likelihood of cancer recurrence after 60 months (37% vs. 13%) than women who received morning treatment.
Next steps
Researchers said they are developing technology to estimate a patient’s circadian clock from their sleep pattern that could allow patients to be placed on individualized treatment schedules.
“We plan to verify the conclusions of this study again with a large-scale follow-up study that completely controls for the confounding variables, and to confirm whether chrono-chemotherapy has similar effects on other cancers,” Youngil Koh, PhD, MS, MD, oncologist at Seoul National University Hospital, said in a press release.
References:
- Afternoon chemotherapy proved to deliver more desirable results for female lymphoma patients (press release). Available at: www.newswise.com/articles/afternoon-chemotherapy-proved-to-deliver-more-desirable-results-for-female-lymphoma-patients. Published Jan. 27, 2023. Accessed Jan. 27, 2023.
- Kim DW, et al. JCI Insight. 2023;doi:10.1172/jci.insight.164767.
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Kim DW, et al. JCI Insight. 2023;doi:10.1172/jci.insight.164767.
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