Investigators of a phase 3 randomized trial presented at the 2025 ASCO Annual Meeting examined whether time of day influences immunotherapy outcomes in stage IV non–small cell lung cancer. Authors enrolled 210 driver gene–negative patients (age ≥18) with no prior systemic therapy for metastatic disease and randomized them 1:1 to receive immunotherapy before 3 PM (early group) or after 3 PM (late group). Outcomes favored earlier dosing: median progression-free survival was 11.3 vs 5.7 months (HR 0.42; P<0.0001) and median overall survival was 16.4 vs 10.9 months (HR 0.45; P<0.0001), suggesting earlier infusions may be associated with better treatment effectiveness.

To explore a potential mechanism, investigators pointed to circadian rhythm effects on immune function. The late group had a decline in circulating CD8+ T cells, whereas the early group showed increases in activated CD8+ subsets (eg, HLA-DR+ and TIM-3+PD-1+ populations), which could reflect a more favorable immune state earlier in the day. Importantly, the safety profile appeared similar between groups, including grade 3 to 4 leukopenia and neutropenia rates and pneumonitis at 2.9% in both arms. With a median follow-up of 22.3 months, the findings raise a practical clinical question: whether simply scheduling immunotherapy earlier in the day could improve outcomes without changing the regimen—an approach that would benefit from confirmation in additional studies.

Reference: Timing of Immunotherapy NSCLC: Survival Gains at ASCO 2025. OncologyTube.com. Published June 3, 2025. Updated June 4, 2025. Accessed January 15, 2026. https://oncologytube.com/timing-of-immunotherapy-nsclc-asco-2025/

Updated American Society of Clinical Oncology and National Comprehensive Cancer Network antiemetic guidelines recommend olanzapine for prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC). However, Michigan Oncology Quality Consortium data showed substantial variation in how consistently it was prescribed appropriately. Because inadequately controlled CINV can compound physical symptoms and interfere with patients’ tolerance of, and recovery during, chemotherapy, this project set out to improve guideline-concordant olanzapine prescribing in an adult outpatient oncology clinic.

Over 6 months, the team implemented a Plan-Do-Study-Act (PDSA)–based intervention centered on a multidisciplinary, interactive education program for prescribers. Education was reinforced through monthly staff-meeting presentations on updated guideline recommendations and olanzapine pharmacodynamics, plus an “frequently asked questions” handout. Independent auditors collected pre- and post-intervention data. Appropriate prescribing increased from 82.05% to 94.74% (n=76), and the improvement was statistically significant (p=.02852). A sustainability audit one year later showed compliance remained high at 92.59% (n=27), a modest, non-significant decrease. Overall, the results support PDSA-driven education as a practical method to improve—and largely sustain—appropriate olanzapine use for CINV prevention with HEC.

Reference: Gennette RL, Dontje K, Rana J, et al. Improving the Appropriate Prescribing of Olanzapine for Chemotherapy-Induced Nausea and Vomiting: A Quality Improvement Initiative for the Outpatient Oncology Practice. J Adv Pract Oncol. 2025 Nov 10:1-10. doi: 10.6004/jadpro.2025.16.7.29.

Investigators of a large real-world retrospective study (463 patients across 9 centers, 2020–2023) in stage III non–small cell lung cancer (NSCLC) compared sequencing chemoimmunotherapy before definitive chemoradiotherapy (CRT; neoadjuvant/induction) vs immunotherapy after CRT (adjuvant; PACIFIC-like). The neoadjuvant approach was associated with significantly better outcomes: median progression-free survival was 25.0 vs 16.3 months (HR 0.57; P<.001) and overall survival was not reached vs 41.1 months (HR 0.54; P=.001). These benefits persisted after propensity-score matching and sensitivity analyses. Patterns of recurrence differed somewhat between cohorts, but both locoregional and distant failures were observed in each group.

Safety findings suggested no definitive increase in severe pneumonitis with the neoadjuvant strategy. Any-grade radiation pneumonitis occurred in 49.4% (neoadjuvant) vs 57.9% (adjuvant) (not significant), grade ≥2 rates were similar (~31% in both), and grade ≥3 pneumonitis was 14.0% vs 7.5% (P=.071). Any-grade checkpoint inhibitor pneumonitis was 9.3% vs 5.3% (not significant). The authors concluded that an induction immunotherapy approach followed by concurrent CRT and then consolidation may improve survival vs a PACIFIC-like regimen while maintaining an acceptable pneumonitis profile. They also called for further research to refine patient selection and optimize induction cycles and agents.

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Reference: Conroy R. Chemoimmunotherapy Before Radiation Improves Survival in Stage III NSCLC. Cancer Network. Published January 8, 2026. Accessed January 15, 2026. https://www.cancernetwork.com/view/chemoimmunotherapy-before-radiation-improves-survival-in-stage-iii-nsclc