If you have a cancer get immunotherapy infusion IN THE MORNING!!!!
03 June 2025
At the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, a China/French trial surprised the world, showing that starting Immunotherapy+Chemotherapy before 15 p.m nearly doubles patient survival in Lung cancer.
Bottom line
Timing, a free, non-pharmacologic variable, has become a lever for big clinical gains.
What happened
A stunning ASCO presentation shows timing injections doubles survival
A major international (China-France) study involving 713 patients with advanced lung cancer found something remarkable: simply scheduling the first four cancer treatments in the morning (before 15:00 PM) instead of later in the day dramatically improved outcomes. Patients who received morning treatments lived without their cancer progressing for nearly 12 months compared to just over 7 months for those treated later. Even more striking, patients lived an average of 33 months with morning treatments versus less than 20 months with later treatments—essentially doubling their survival time just by changing when they received the exact same medications.
The study was published in the Journal of Clinical Oncology ASCO Proceedings (abstract 8516) and highlighted in an oral session at ASCO 2025, giving it maximum visibility to oncologists and regulators.
Circadian rhythm is suspected to drive the response
The reason this works likely comes down to our body's internal clock. Our immune system naturally varies throughout the day. Certain immune cells that help fight cancer are more active and move around the body differently depending on the time. By timing treatments to match these natural rhythms, doctors can make the same cancer drugs work much more effectively.
Impact on our Investment Case
Cancer at a glance — still biotech’s darling
Cancer is now responsible for nearly 10 million deaths each year (≈ 1 in 6 global deaths) and is projected to reach 13 million deaths by 2030. That human toll underpins a booming oncology-drug market worth $196bn in 2023 and forecast to exceed $400bn by 2029 (12.7 % CAGR).
Oncology continues to attract the largest private financings, with median VC rounds hovering around $100mn in 2024-25. On the public market in 2025, 8 of the 18 M&A are cancer-focused.
Immunotherapy keeps compounding
Chemotherapy, a staple of cancer treatment, uses cytotoxic agents that indiscriminately attack fast-dividing cells—tumour and healthy—so hair loss, neutropenia, and nausea are common. Immunotherapy (‘IO’) instead primes or unleashes the immune system against tumour antigens, yielding deeper, longer-lasting responses but a different slate of immune-related side effects
IO is the growth engine of cancer treatment. The largest segment of IO is the PD-1/PD-L1 inhibitor market, which is projected to climb from $144bn (2024) to $247bn by 2029 (≈ 11 % CAGR). Any “free” tweak that adds double-digit efficacy should be highly accretive for incumbents and biosimilar entrants alike.
Low-cost life-extension = pricing power
Label updates that specify “administer in the morning when feasible” would refresh aging PD-1 franchises (Keytruda, Opdivo) at negligible cost, protecting them against upcoming biosimilars.
China’s innovation engine accelerates adoption
China approved 48 first-in-class drugs in 2024, more than any other regulator, after a decade of reforms reducing median review time to <12 months.
Domestic players like Innovent Biologics and Akeso already embed chrono-pharmacology endpoints in Phase 3 protocols, aiming for “best-in-class by timing” rather than molecule alone. Coupled with regulatory guidance prioritising circadian-informed trial design, we see China becoming the proving ground for chrono-IO standardisation.
Our Takeaway
Chronotherapy has just graduated from theory to ASCO-level evidence. Sometimes, the best new cancer “drug” is a better alarm clock, namely a Chinese one.
Companies mentioned in this article
Akeso (9926); Innovent Biologics (1801)
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