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Administering immunotherapy in the morning seems to matter. Why?


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Keep in mind, these results have not only been shown for short-lived small molecules, but also long-lived proteins with half-lives on order of weeks that shouldn’t be affected by 24-hour cycles: pembrolizumab (Keytruda), nivolumab (Opdivo), and ipilimumab (Yervoy). There was some mild mechanistic reason to suggest that circadian variation in sympathetic tone and cortisol levels could influence blood pressure regulation; going up when you sleep, potentially leading to more cardiac events. But I’m personally erring on the side of the connection between the immune system and the circadian rhythm being much stronger than it is for other physiological functions, just given how large the lymphocyte concentrations in the bloodstream can shift from night to day.

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