The evening intake of melatonin can extend the survival of patients with non-small cell lung cancer

reference

hrushesky WJM, LIS CG, Levin RD, et al. Daily evening melatonin extends survival in patients with advanced non-small cell lung cancer. Biol rhythm res. 2021: 1-15. DOI: 10.1080/09291016.2021.1899485.

Study goal

Assessment of the survival advantage of melatonin in patients with advanced non-small cell lung cancer (NSCLC) if there are

draft

A placebo-controlled, randomized, double-blind, 3-armed clinical study

participant

84 patients with advanced (stage IIIB or IV) NSCLC between the ages of 18 and 80 who received identical dosage of etoposide/cisplatin standard therapy.

The inclusion criteria included a performance status of the Eastern Cooperative Oncology Group (ECOG) of 0, 1 or 2.

Intervention

The patients were assigned 1 out of 3 poor according to the random principle:

• placebo at 8 a.m. and 8 p.m.
• 20 mg melatonin at 8 a.m. and placebo at 8 p.m.
• placebo at 8 a.m. and 20 mg melatonin at 8 p.m.

study parameters evaluated

The researchers used a Kaplan-Meier survival diagram to pursue the middle survival for each of the groups.

You assessed the quality of life based on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and the Ferrans and Powers Quality of Life Index (QLI).

The researchers collected and measured data on sleep quality using the Pittsburgh Sleep Quality Index (PSQI).

Primary result measurements

The most important result parameters were overall survival and the quality of sleep. Secondary endpoints were the objective tumor response and the quality of life.

important knowledge

In the nightly melatonin group there was a statistically significant ( p = 0.031) reduced the risk ratio for overall survival compared to the placebo group. The placebo group had a median survival time of 10.4 months, while the nightly melatonin group had a median survival of 17.6 months.

sleep quality and sleep efficiency had a statistically significant influence on survival, and an improvement in sleep quality compared to the initial value led to an even stronger decrease in the overall survival hazard ratio.

Remarkably, sleep efficiency had a negative impact on the Hazard Ratio, although this is probably due to the fact that the patients spend more time due to illness instead of sleeping openly.

There was no group with a remarkable response from the tumor, and unfortunately there were no patients who showed a complete response; However, the most common reaction was a stable disease, and this prevalence was higher in the evening melatonin group.

practice implications

sleep is a wonderful thing for our body and our brain. It has been proven that sufficient sleep is essential for general health. Sleep also has numerous advantages for risk reduction in a number of cancer and plays a crucial role in the tolerance of chemotherapy and radiation treatment for our oncology patients. At the beginning of my specialist training, I came across a study that describes how our body separates anti -inflammatory cytokines while sleeping. I have recognized that melatonin has a major influence on the core factor of Kappa B (NF-κB), which is considered the emperor of the inflammatory cascade. ^{1 This helps to explain why generalized symptoms of inflammation such as joint pain, 2 swelling, tiredness, headache/depression or a disturbed digestive system are often milder after waking up in the morning than before going to bed.}

This helps to explain why general inflammatory symptoms such as joint pain, swelling, tiredness, headache, anxiety/depression or a disturbed digestive system after waking up in the morning are often milder than before going to bed

A recently conducted study describes how shift workers can have increased inflammation values, which can lead to a dysregulation of the immune system and the many adverse consequences of shift work, with cancer is likely to be one of them. ^{3.4 melatonin is an inflammatory connection and a hormone modulating the immune system. It is surprising that melatonin can help normalize the circadian rhythm and to improve the results for cancer patients. 6}

In addition to improving the quality of life through better sleep, melatonin influences several intracellular signaling paths that lead to the regulation of growth and increased chemosensitivity in patients with non-small cell cancer who receive chemotherapy.

This special study focused on the importance of the timing of melatonin and found a significant survival advantage for patients with advanced lung cancer who took melatonin in the evening. This benefit was not found in those who took melatonin in the morning. This study suggests that the nightly dosage of melatonin is a critical part of the value of this hormone.

melatonin is inexpensive and is well tolerated by the majority of patients. In view of the accumulation of study data that suggest a benefit for sleep, the recovery of the bone marrow and overall survival during conventional treatment, I gradually ask myself the question of what melatonin does not do not do for our patients with non-small cell cancer?