{
  "abstract": "Background and Importance Immunotherapy has become a cornerstone in the treatment of several cancers, particularly solid tumours. Recent evidence suggests that the timing of administration may impact treatment effectiveness, with improved outcomes observed when immunotherapy is administered in the morning.Aim and Objectives To evaluate the effectiveness of immunotherapy according to time-of-day of administration using real-world data.Material and Methods A multicentre retrospective review was conducted, including all patients who received at least one dose of pembrolizumab, nivolumab, or atezolizumab as first-line treatment for metastatic disease between 01/01/2021 and 30/06/2025 in six hospitals, all of which use the same oncology information system to prescribe, prepare, and document administration of anticancer therapies.Each registered administration was classified as morning (before 3 pm) or afternoon (after 3 pm). For each patient, the proportion of afternoon doses was calculated and used for categorisation: <50% afternoon infusions vs ≥50% afternoon infusions.Variables collected: sex, age, diagnosis, treatment indication, date of diagnosis, date and time of infusion, and date of death.Outcome: overall survival (OS), defined as the time from immunotherapy first administration in metastatic setting to death from any cause. The cut-off date for the analysis was 01/10/2025. Survival was estimated using Kaplan–Meier curves, compared by log-rank test, and hazard ratios calculated with Cox regression (R software).Results A total of 8.896 administrations in 1.175 patients were analysed (66.4% male, n=780; mean age 66 years, range 25–92). The most frequent diagnoses were non-small-cell lung cancer (54%, n=635) and small-cell lung cancer (12.7%, n=149).Overall, 5.539 administrations (62.3%) were given in the morning. A total of 541 patients (46%) received ≥50% of doses in the afternoon.During follow-up, 428 deaths (36.4%) occurred. Median OS was not reached for patients receiving most infusions in the morning, compared with 28.6 months for those receiving most infusions in the afternoon (HR 0.64, 95% CI 0.53 to 0.78; log-rank p<0.0001).Conclusion and Relevance Consistent with previous reports, this review found improved overall survival in patients with predominantly morning administration of immunotherapy. Whenever feasible, scheduling immunotherapy in the morning should be considered to optimise treatment outcomes.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Son Espases University Hospital, Hospital Pharmacy, Palma, Spain"
      ],
      "name": "S Manso anda"
    },
    {
      "affiliations": [
        "Son Llàtzer University Hospital, Hospital Pharmacy, Palma, Spain"
      ],
      "name": "M Nigorra Caro"
    },
    {
      "affiliations": [
        "Mateu Orfila General Hospital, Hospital Pharmacy, Maó, Spain"
      ],
      "name": "R Romero Del Barco"
    },
    {
      "affiliations": [
        "Can Misses Hospital, Hospital Pharmacy, Ibiza, Spain"
      ],
      "name": "C Juez Santamaría"
    },
    {
      "affiliations": [
        "Inca District Hospital, Hospital Pharmacy, Inca, Spain"
      ],
      "name": "PJ Siquier Homar"
    },
    {
      "affiliations": [
        "Manacor Hospital, Hospital Pharmacy, Manacor, Spain"
      ],
      "name": "L Rodriguez Cajaraville"
    },
    {
      "affiliations": [
        "Son Espases University Hospital, Hospital Pharmacy, Palma, Spain"
      ],
      "name": "F Do Pazo Oubiña"
    },
    {
      "affiliations": [
        "Son Espases University Hospital, Hospital Pharmacy, Palma, Spain"
      ],
      "name": "C Martorell Puigserver"
    },
    {
      "affiliations": [
        "Son Espases University Hospital, Medical Oncology, Palma, Spain"
      ],
      "name": "A Azkarate Martínez"
    }
  ],
  "title": "4CPS-131 Effectiveness of immunotherapy according to time-of-day infusion",
  "uid": "20c611d3-3ab5-5988-902a-bd93a3618110"
}