Optimising cancer care to improve clinical outcomes and sustainability

Treatment optimisation (i.e. tailoring therapies to maximise efficacy while minimising harm) is no longer aspirational – it is essential for improving patients’ lives and alleviating the strain on healthcare systems.

Optimisation means integrating multidisciplinary approaches, leveraging genomic data, and refining regimens to reduce the toxicity and costs of antitumour treatments. For patients, this aims to translate to longer survival and better quality of life; for healthcare systems, it means efficient resource use, which results in fewer patient hospitalisations, lower drug waste and streamlined services delivered by knowledgeable oncology professionals. In an era where the population is ageing and healthcare budgets are increasingly constrained, ignoring optimisation could place additional burden on already stretched oncology networks, thus making the delivery of cancer care disorganised.

Today, actionable interventions are being explored to optimise treatments in oncology. One prime example is to root the timing of anticancer drug administration in chronotherapy. Evidence from preclinical and clinical studies suggests that the patient circadian rhythm seems to influence drug metabolism, immune responses and tumour growth (J Clin Invest. 2024;134:e175706). Also, retrospective pooled datasets suggest a potential benefit of this approach in diverse tumour types, including non-small cell lung cancer (NSCLC), melanoma and renal cell carcinoma (ESMO Open. 2024;9:102220). Administering immune checkpoint inhibitors (ICIs) earlier in the day – typically before midday or early afternoon – may therefore substantially enhance their efficacy. At the European Lung Cancer Congress (ELCC) 2026 (Copenhagen, 25–28 March), results from the ETOP-Roche i-TIMES study, retrospectively evaluating this question further in advanced NSCLC, demonstrated non-inferiority of administration of intravenous ICIs in the first half of the day Indeed, (LBA2). Prospective data have yet to clearly validate the relevance of time of day administration, with a recently published trial of chemoimmunotherapy in advanced NSCLC flagged for post-publication concerns (at time of press) (Nat Med. 2026;Feb 2).

Whilst considering if stronger evidence from research is necessary, we must reflect on some practical challenges that would abound for this approach. Reorganising services around patients’ individual biological clocks, in fact, demands huge efforts at a facility level, including flexible scheduling and staff retraining, which is logistically daunting for busy practices. Given the i-TIMES data, such efforts may not be needed.

Encouragingly, chemotherapy-free options are reshaping the landscapes for many cancers and ICIs have clearly transformed the landscape of cancer treatment towards optimisation. In NSCLC, acquired immunotherapy resistance remains problematic, with no drug to date having beaten docetaxel in head-to-head trial evaluation of overall survival. At the Congress, data from the much-awaited LATIFY trial, building on the very promising combination of ceralasertib with durvalumab on immunotherapy resistance from the previous HUDSON study (Nat Med. 2024;30:716–729), unexpectedly identified no overall survival nor progression-free survival benefit for the new combination over docetaxel (LBA1). Moreover, the response rate was inferior to docetaxel. Several questions arise from these findings: were the right patients selected for this study? And what was different about the patient group in the LATIFY study compared with that in the HUDSON trial? Is there a biological subset that should be prioritised for enrichment?

Also presented in Copenhagen, the PRESERVE-003 trial directly evaluated gotistobart – a novel anti-CTLA-4 monoclonal functioning through tumour microenvironment selective Treg depletion – versus docetaxel in relapsed squamous subtype NSCLC (Abstract 3O). A significant overall survival advantage was identified in the smaller part 1 of the study for squamous subtype NSCLC, and this seems to be driven by a higher response rate, leading to an improved duration of response, underpinning a significant progression-free survival advantage. The confirmatory part 2 trial is enrolling. Can combinations like a modified anti-CTLA4 or an ATR inhibitor with an anti-PD-(L)1 deliver in the future? And if so, for whom? How can patient selection be optimised to allow salvage from ICI failure?

Whereas answering these fundamental questions is key, it is also important that the promises from oncology research are put into a broader context. In fact, optimisation is not only a matter of improving clinical outcomes, but a driver to health equity as it may address disparities in access to high-quality cancer care. The integration of artificial intelligence-guided predictive modelling may further refine the dosing and timing of anticancer therapies, while giving greater attention to supportive care, including nutrition and physical activity, may bolster a patient’s resilience. Ultimately, optimised treatments not only have the potential to extend lives but also promote more sustainable oncology, reducing environmental footprints from drug production and waste.