ЧАС ІНФУЗІЇ ТА ЕФЕКТИВНІСТЬ ІМУНОТЕРАПІЇ ПРИ МЕТАСТАТИЧНОМУ НЕДРІБНОКЛІТИННОМУ РАКУ ЛЕГЕНЬ: МЕТААНАЛІЗ

Circadian rhythms are endogenous biological cycles with a period of approximately 24 hours that regulate the functions of many bodily systems, including the immune system. They influence gene expression, immune cell activity, and tumor cell proliferation, suggesting a potential role in shaping responses to immunotherapy for malignant neoplasms. One of the emerging areas of oncological research is the impact of the time of infusion on the efficacy of immune checkpoint inhibitors (ICIs) in the treatment of metastatic non-small cell lung cancer (NSCLC).Purpose – to assess the association between the time of infusion when ICI infusions are administered and overall survival (OS) in patients with metastatic NSCLC through a meta-analysis of published studies.Material and methods. Seven studies that met the inclusion criteria were analyzed. The sample comprised 1,491 patients, of whom 813 received ICIs primarily in the morning, and 678 in the afternoon. Sources were identified through PubMed and proceedings from ESMO and ASCO conferences. A random-effects meta-analysis model was used to calculate effect sizes and standard errors. Heterogeneity was assessed, and a Galbraith plot was generated.Results. All studies demonstrated an OS advantage for the "morning" group. The pooled effect size was 0.73 (95% CI: 0.521–0.938; p <0.001). Infusion time cut-off points ranged from 11:37 to 16:30. Six studies evaluated all treatment cycles, while one assessed only the first infusion. The I² statistic indicated high heterogeneity among studies (I² = 72.6%), suggesting substantial variability in effect sizes not attributable to chance (Q = 20.08; p = 0.0027). Effect sizes in individual studies ranged from 0.407 to 1.270, all favoring morning administration. No study contradicted the overall trend. The efficacy of immunotherapy in the morning group was approximately twice as high.Conclusions. The time of ICI infusion is a statistically significant predictor of survival in patients with metastatic NSCLC. Morning infusions was associated with improved therapeutic efficacy and should be considered in treatment protocols.