From chronotherapy to immunotherapy resistance, refining when and for whom treatments work is becoming central to making oncology sustainable.
Treatment optimisation (i.e. tailoring therapies to maximise efficacy while minimising harm) is no longer aspirational – it is essential for improving patients’ lives and alleviating the strain on healthcare systems.
Optimisation means integrating multidisciplinary approaches, leveraging genomic data, and refining regimens to reduce the toxicity and costs of antitumour treatments. For patients, this aims to translate to longer survival and better quality of life; for healthcare systems, it means efficient resource use, which results in fewer patient hospitalisations, lower drug waste and streamlined services delivered by knowledgeable oncology professionals. In an era where the population is ageing and healthcare budgets are increasingly constrained, ignoring optimisation could place additional burden on already stretched oncology networks, thus making the delivery of cancer care disorganised.
Today, actionable interventions are being explored to optimise treatments in oncology. One prime example is to root the timing of anticancer drug administration in chronotherapy. Evidence from preclinical and clinical studies suggests that the patient circadian rhythm seems to influence drug metabolism, immune responses and tumour growth (J Clin Invest. 2024;134:e175706). Also, retrospective pooled datasets suggest a potential benefit of this approach in diverse tumour types, including non-small cell lung cancer (NSCLC), melanoma and renal cell carcinoma (ESMO Open. 2024;9:102220). Administering immune checkpoint inhibitors (ICIs) earlier in the day – typically before midday or early afternoon – may therefore substantially enhance their efficacy. At the European Lung Cancer Congress (ELCC) 2026 (Copenhagen, 25–28 March), results from the ETOP-Roche i-TIMES study, retrospectively evaluating this question further in advanced NSCLC, demonstrated non-inferiority of administration of intravenous ICIs in the first half of the day Indeed, (LBA2). Prospective data have yet to clearly validate the relevance of time of day administration, with a recently published trial of chemoimmunotherapy in advanced NSCLC flagged for post-publication concerns (at time of press) (Nat Med. 2026;Feb 2).
Whilst considering if stronger evidence from research is necessary, we must reflect on some practical challenges that would abound for this approach. Reorganising services around patients’ individual biological clocks, in fact, demands huge efforts at a facility level, including flexible scheduling and staff retraining, which is logistically daunting for busy practices. Given the i-TIMES data, such efforts may not be needed.
Read full article: https://dailyreporter.esmo.org/european-lung-cancer-congress-2026/editorial/optimising-cancer-care-to-improve-clinical-outcomes-and-sustainability
