# Chrono-immunotherapy’s current and future optimization strategies: immunotherapy timing in line with the circadian rhythm brings longer survival benefits

**Authors:** Daiwei Liu, Zhanlin Li, Huijuan Cui, Hua Zhang, Hai Li, Xiaoyuan Wu

PMC · DOI: 10.3389/fimmu.2026.1777437 · Frontiers in Immunology · 2026-02-16

## TL;DR

This paper explores how timing immunotherapy with the body's circadian rhythm can improve cancer treatment outcomes.

## Contribution

The paper introduces chrono-immunotherapy as a novel strategy to optimize immunotherapy efficacy by aligning treatment with circadian rhythms.

## Key findings

- Timing immunotherapy with circadian rhythms may enhance therapeutic effects in advanced lung cancer.
- Clinical evidence suggests that the time of day ICIs are administered impacts treatment outcomes.
- Chrono-immunotherapy presents practical challenges but holds significant therapeutic potential.

## Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment landscape for malignant tumors such as advanced lung cancer, but their efficacy is limited. In recent years, the circadian rhythm has provided a brand-new optimization strategy for immunotherapy. This perspective article aims to explore the potential mechanisms of the interaction between immunotherapy and circadian rhythms, reviews clinical evidence supporting that “time-of-day receipt of ICIs brings better therapeutic effects”, and conduct an in-depth analysis of the current practical challenges of chrono-immunotherapy. And emphasize the potential of “chrono-immunotherapy” as a valuable therapeutic approach.

## Full-text entities

- **Genes:** Cd274 (CD274 antigen) [NCBI Gene 60533] {aka A530045L16Rik, B7h1, Pdcd1l1, Pdcd1lg1, Pdl1}, IL6 (interleukin 6) [NCBI Gene 3569] {aka BSF-2, BSF2, CDF, HGF, HSF, IFN-beta-2}, Clock (clock circadian regulator) [NCBI Gene 12753] {aka 5330400M04Rik, KAT13D}, CD8A (CD8 subunit alpha) [NCBI Gene 925] {aka CD8, CD8alpha, IMD116, Leu2, p32}, CD28 (CD28 molecule) [NCBI Gene 940] {aka IMD123, Tp44}, PRL (prolactin) [NCBI Gene 5617] {aka GHA1, pPRL}, CD274 (CD274 molecule) [NCBI Gene 29126] {aka ADMIO5, B7-H, B7H1, PD-L1, PDCD1L1, PDCD1LG1}, GH1 (growth hormone 1) [NCBI Gene 2688] {aka GH, GH-N, GHB5, GHN, IGHD1A, IGHD1B}, Bmal1 (basic helix-loop-helix ARNT like 1) [NCBI Gene 11865] {aka Arnt3, Arntl, BMAL1b, MOP3, bHLHe5, bmal1b'}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, IL10 (interleukin 10) [NCBI Gene 3586] {aka CSIF, GVHDS, IL-10, IL10A, TGIF}, PDCD1 (programmed cell death 1) [NCBI Gene 5133] {aka ADMIO4, AIMTBS, CD279, PD-1, PD1, SLEB2}, Per2 (period circadian clock 2) [NCBI Gene 18627] {aka mKIAA0347, mPer2}, IL12B (interleukin 12B) [NCBI Gene 3593] {aka CLMF, CLMF2, IL-12B, IMD28, IMD29, NKSF}, TRBV20OR9-2 (T cell receptor beta variable 20/OR9-2 (non-functional)) [NCBI Gene 6962] {aka CDR3, TCRBV20S2, TCRBV2O, TCRBV2S2O}
- **Diseases:** urothelial cancer (MESH:D014523), irAEs (MESH:D002318), immune system dysfunction (MESH:D007154), toxicity (MESH:D064420), liver cancer (MESH:D006528), esophageal cancer (MESH:D004938), HL (MESH:C538324), Inflammation (MESH:D007249), melanoma (MESH:D008545), TOD (OMIM:300244), skin toxicity (MESH:D012871), lung cancer (MESH:D008175), cancer (MESH:D009369), Head and neck cancer (MESH:D006258), gastric cancer (MESH:D013274), fatigue (MESH:D005221), Sleep dysregulation (MESH:D021081), kidney cancer (MESH:D007680), NSCLC (MESH:D002289)
- **Chemicals:** melatonin (MESH:D008550), steroids (MESH:D013256), cortisol (MESH:D006854)
- **Species:** Homo sapiens (human, species) [taxon 9606], Mus musculus (house mouse, species) [taxon 10090]

## Full text

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## Figures

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## References

97 references — full list in the complete paper: https://tomesphere.com/paper/PMC12950682/full.md

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Source: https://tomesphere.com/paper/PMC12950682